1
|
Dhir P, Evans TS, Drew KJ, Maynard M, Nobles J, Homer C, Ells L. Views, perceptions, and experiences of type 2 diabetes or weight management programs among minoritized ethnic groups living in high-income countries: A systematic review of qualitative evidence. Obes Rev 2024; 25:e13708. [PMID: 38343087 DOI: 10.1111/obr.13708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 12/06/2023] [Accepted: 01/16/2024] [Indexed: 04/18/2024]
Abstract
BACKGROUND Prevalence of both obesity and type 2 diabetes can be higher in patients from certain ethnic groups, yet uptake and adherence to current support within these groups is lower, leading to widening health inequalities in high-income countries. OBJECTIVES The main objective of this study is to understand the views, perceptions, and experiences of and barriers and facilitators in relation to the uptake and adherence to weight management and type 2 diabetes programs in minoritized ethnic groups in high-income countries. METHODS CINAHL, MEDLINE, PsycINFO, Scopus, Academic Search Complete, and PubMed were searched for English language studies undertaken in community-dwelling adults residing in high-income countries, who are from a minoritized ethnic group within the country of study. RESULTS Seventeen studies were synthesized using the JBI System for the Unified Management of the Assessment and Review of Information. From these studies, 115 findings were retrieved, and seven key themes were identified: (1) family health status and program education, (2) social support, (3) challenges, (4) cultural beliefs, (5) increased awareness and dietary changes, (6) impact of psychological evaluations, and (7) considerations for future. CONCLUSIONS Nutritional considerations for type 2 diabetes mellitus and weight management programs in high-income countries should include social, habitual, economic, and conceptual components, which should include consideration of local ethnic and cultural norms and building community relationships while creating culturally tailored programs.
Collapse
Affiliation(s)
- Pooja Dhir
- School of Health, Obesity Institute, Leeds Beckett University, Leeds, UK
| | - Tamla S Evans
- School of Health, Obesity Institute, Leeds Beckett University, Leeds, UK
| | - Kevin J Drew
- School of Health, Obesity Institute, Leeds Beckett University, Leeds, UK
| | - Maria Maynard
- School of Health, Obesity Institute, Leeds Beckett University, Leeds, UK
| | - James Nobles
- School of Health, Obesity Institute, Leeds Beckett University, Leeds, UK
| | - Catherine Homer
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Louisa Ells
- School of Health, Obesity Institute, Leeds Beckett University, Leeds, UK
| |
Collapse
|
2
|
Villalona S, Ortiz V, Castillo WJ, Garcia Laumbach S. Cultural Relevancy of Culinary and Nutritional Medicine Interventions: A Scoping Review. Am J Lifestyle Med 2022; 16:663-671. [PMID: 36389044 PMCID: PMC9644144 DOI: 10.1177/15598276211006342] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 02/14/2021] [Accepted: 03/11/2021] [Indexed: 10/15/2023] Open
Abstract
Background. Taking into account the disproportionate impacts of disease burden from chronic conditions by racial and ethnic group, this scoping review sought to examine the extent to which nutritional interventions incorporated culturally relevant topics into their design and analyses. Methods. A literature search of 5 databases was conducted for any peer-reviewed studies on nutritional and culinary medicine interventions published between 2000 and 2019. Results. Studies were divided into 2 categories, medical education interventions (n = 12) and clinical/community interventions (n = 20). The majority of medical education interventions were not culturally tailored and focused on obesity/weight management within the Northeast and Southeast United States. In contrast, clinical/community interventions were primarily culturally tailored for Latinos/Hispanics and African American/Black populations residing in the Northeast and diagnosed with prediabetes/diabetes mellitus or hypertension/cardiovascular disease. Conclusions. This review identified an existent gap and need for inclusive studies that consider the culturally relevant topics into the design and implementation of nutritional intervention studies. Studies within medical education appeared to be the area where these changes can be most beneficial. There may be some value among clinic and communal-based studies in stratifying heterogeneous subgroups because of the missed cultural nuances missed when grouping larger racial cohorts.
Collapse
Affiliation(s)
| | - Vanessa Ortiz
- Rutgers Robert Wood Johnson Medical School,
Piscataway, New Jersey
| | | | | |
Collapse
|
3
|
Jimenez EY, Kelley K, Schofield M, Brommage D, Steiber A, Abram JK, Kramer H. Medical Nutrition Therapy Access in CKD: A Cross-sectional Survey of Patients and Providers. Kidney Med 2021; 3:31-41.e1. [PMID: 33604538 PMCID: PMC7873758 DOI: 10.1016/j.xkme.2020.09.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
RATIONALE & OBJECTIVE Nutrition management can slow the progression of chronic kidney disease (CKD) and help manage complications of CKD, but few individuals with CKD receive medical nutrition therapy before initiating dialysis. This study aimed to identify knowledge, attitudes, experiences, and practices regarding medical nutrition therapy and barriers and facilitators to medical nutrition therapy access for individuals with CKD stages G1-G5 from the perspective of patients and providers. STUDY DESIGN Cross-sectional study composed of anonymous surveys. SETTING & POPULATION Adults with CKD stages G1-G5 and medical providers and registered dietitian nutritionists who regularly see patients with CKD stages G1-G5 were recruited by email using National Kidney Foundation and Academy of Nutrition and Dietetics databases and through the National Kidney Foundation 2019 Spring Clinical Meetings mobile app. ANALYTICAL APPROACH Descriptive analyses and Fisher exact tests were conducted with Stata SE 16. RESULTS Respondents included 348 patients, 66 registered dietitian nutritionists, and 30 medical providers. In general, patients and providers had positive perceptions of medical nutrition therapy and its potential to slow CKD progression and manage complications, and most patients reported interest in a medical nutrition therapy referral. However, there were feasibility concerns related to cost to the patient, lack of insurance coverage, and lack of renal registered dietitian nutritionists. There was low awareness of Medicare no-cost share coverage for medical nutrition therapy across patients and providers. About half the practices did not bill for medical nutrition therapy and those that did reported issues with being paid and low reimbursement rates. LIMITATIONS Results may not be generalizable due to the small number of respondents and the potential for self-selection, nonresponse, and social desirability bias. CONCLUSIONS Many patients with CKD stages G1-G5 are interested in medical nutrition therapy and confident that it can help with disease management, but there are feasibility concerns related to cost to the patient, insurance coverage, and reimbursement. There are significant opportunities to design and test interventions to facilitate medical nutrition therapy access for patients with CKD stages G1-G5.
Collapse
Affiliation(s)
- Elizabeth Yakes Jimenez
- Nutrition Research Network, Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM
- College of Population Health, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Kathryn Kelley
- Nutrition Research Network, Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL
| | - Marsha Schofield
- Governance and Nutrition Services Coverage, Academy of Nutrition and Dietetics, Chicago, IL
| | | | - Alison Steiber
- Nutrition Research Network, Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL
| | - Jenica K. Abram
- Nutrition Research Network, Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL
| | - Holly Kramer
- Division of Nephrology and Hypertension, Department of Public Health Sciences and Medicine, Loyola University Medical Center, Maywood, IL
| |
Collapse
|
4
|
Position of the Academy of Nutrition and Dietetics: The Role of Medical Nutrition Therapy and Registered Dietitian Nutritionists in the Prevention and Treatment of Prediabetes and Type 2 Diabetes. J Acad Nutr Diet 2019; 118:343-353. [PMID: 29389511 DOI: 10.1016/j.jand.2017.11.021] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Indexed: 01/03/2023]
Abstract
It is the position of the Academy of Nutrition and Dietetics that for adults with prediabetes or type 2 diabetes, medical nutrition therapy (MNT) provided by registered dietitian nutritionists (RDNs) is effective in improving medical outcomes and quality of life, and is cost-effective. MNT provided by RDNs is also successful and essential to preventing progression of prediabetes and obesity to type 2 diabetes. It is essential that MNT provided by RDNs be integrated into health care systems and public health programs and be adequately reimbursed. The Academy's evidence-based nutrition practice guidelines for the prevention of diabetes and the management of diabetes document strong evidence supporting the clinical effectiveness of MNT provided by RDNs. Cost-effectiveness has also been documented. The nutrition practice guidelines recommend that as part of evidence-based health care, providers caring for individuals with prediabetes or type 2 diabetes should be referred to an RDN for individualized MNT upon diagnosis and at regular intervals throughout the lifespan as part of their treatment regimen. Standards of care for three levels of diabetes practice have been published by the Diabetes Care and Education Practice Group. RDNs are also qualified to provide additional services beyond MNT in diabetes care and management. Unfortunately, barriers to accessing RDN services exist. Reimbursement for services is essential. Major medical and health organizations have provided support for the essential role of MNT and RDNs for the prevention and treatment of type 2 diabetes.
Collapse
|
5
|
Barriers to adherence to a nutritional plan and strategies to overcome them in patients with type 2 diabetes mellitus; results after two years of follow-up. ACTA ACUST UNITED AC 2019; 67:4-12. [PMID: 31387846 DOI: 10.1016/j.endinu.2019.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/29/2019] [Accepted: 05/01/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Lifestyle changes in medical nutrition therapy (MNT) are associated to HbA1c decreases ranging from 0.3 to 2%. Evidence shows that people with barriers are less likely to adhere to a long-term nutritional plan. Little information is available on the barriers that prevent the implementation of a healthy nutritional plan, and the strategies used to overcome them. OBJECTIVE To report the longitudinal changes in perceptions of barriers to adherence to a nutritional plan in T2DM. METHODS A prospective cohort study with intervention. Follow-up was assessed at two years, and all patients received comprehensive care according to the CAIPaDi model. A questionnaire was used to detect the most common barriers to adherence to a nutritional plan at baseline and at 3 months and 1 and 2 years of follow-up. The analysis included data from 320 patients with complete evaluations from baseline to 2 years. Patients with T2DM aged 53.8±9.1 years (55.9% women), BMI 29.2±4.4kg/m2, and time since the diagnosis 1 (0-5) years were included in the study. RESULTS At baseline, 78.4% of patients reported any barrier that limited adherence to a nutritional plan. The most common were "Lack of information on an adequate diet" (24.7%), "I eat away from home most of the time" (19.7%), and "Denial or refusal to make changes in my diet" (14.4%). After a structured nutritional intervention including strategies to eliminate each barrier, a 37% reduction (p<0.001) was seen in barriers at 2 years of follow-up. Patients with persistent barriers at two years had a greater proportion of HbA1c values >7% (24.7%) and triglyceride levels >150mg/dL (27.5%) out of the control range as compared to those with no barriers (11.6% and 14.4% respectively, p<0.05). CONCLUSIONS Identification of barriers to adherence to a nutritional plan may allow healthcare professionals design interventions with the specific behavioral components needed to overcome such barrier, thus improving adherence to the nutritional plan with the resultant long-term changes.
Collapse
|
6
|
Kramer H, Jimenez EY, Brommage D, Vassalotti J, Montgomery E, Steiber A, Schofield M. Medical Nutrition Therapy for Patients with Non-Dialysis-Dependent Chronic Kidney Disease: Barriers and Solutions. J Acad Nutr Diet 2018; 118:1958-1965. [PMID: 30076072 DOI: 10.1016/j.jand.2018.05.023] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 05/25/2018] [Indexed: 01/11/2023]
|
7
|
Chourdakis M, Kontogiannis V, Malachas K, Pliakas T, Kritis A. Self-care behaviors of adults with type 2 diabetes mellitus in Greece. J Community Health 2015; 39:972-9. [PMID: 24519180 DOI: 10.1007/s10900-014-9841-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to examine self-care behaviors of adults with type 2 diabetes mellitus living in the Metropolitan Area of Thessaloniki in Northern Greece. The Summary of Diabetes Self-Care behaviors measurement was administered to 215 patients, out of which 177 were eligible to participate (87 males). Patients, aged 30 years or more, were recruited through a university hospital day-clinic. Older patients (>65 years), as well as those with "higher educational level" did not distribute their daily carbohydrate intake equally. Nevertheless, they were more likely to adapt to their physician's recommendations regarding medication and to regularly perform suggested blood glucose checking. Exercise patterns were more often found for higher educated, earlier diagnosed males. Younger patients were less likely to follow their healthcare professional's recommendations, regarding diet, medication intake, blood glucose checking, foot care and exercise compared to older patients. These results pose a higher risk for complications and morbidity in younger patients with type 2 diabetes mellitus, who most possibly will require intensive treatment in the future.
Collapse
Affiliation(s)
- Michael Chourdakis
- Department of Pharmacology, School of Medicine, Aristotle University of Thessaloniki, 54006, Thessaloniki, Greece,
| | | | | | | | | |
Collapse
|
8
|
Soria-Contreras DC, Bell RC, McCargar LJ, Chan CB. Feasibility and efficacy of menu planning combined with individual counselling to improve health outcomes and dietary adherence in people with type 2 diabetes: a pilot study. Can J Diabetes 2014; 38:320-5. [PMID: 25175312 DOI: 10.1016/j.jcjd.2014.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 01/21/2014] [Accepted: 03/26/2014] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The purpose of this study was to test the feasibility and efficacy of implementing a 4-week menu plan combined with individual counselling among people with type 2 diabetes. METHODS A 12-week pilot study with a pretest and post-test design was conducted among 15 participants with type 2 diabetes. The menu plan incorporated the overall recommendations of the Canadian Diabetes Association nutrition therapy guidelines and considered factors such as the accessibility, availability and acceptability of foods. Change in glycated hemoglobin (A1C) was the primary outcome, and secondary outcomes were changes in serum lipid, anthropometric and dietary measures. RESULTS Mean (±SD) age of the participants was 59.3±9.9 years, and duration of diabetes was 8.1±8.3 years. After the program, A1C decreased by 1.0%±0.86% (p<0.05). There were significant reductions (p<0.05) in weight, body mass index, waist circumference and fat mass and increased high-density lipoprotein cholesterol. No significant changes were observed in dietary measures except for perceived dietary adherence score, which increased significantly (p<0.05). Participants reported using the menu plan an average of 5.0±1.9 days a week and attended, on average, 4 of 6 counselling sessions. CONCLUSIONS Menu planning and individual counselling were demonstrated to be feasible and effective for diabetes management, and they represent a simple and practical approach to implement the nutritional recommendations for diabetes in Canada.
Collapse
Affiliation(s)
- Diana C Soria-Contreras
- Department of Agricultural, Food and Nutritional Science, Alberta Diabetes Institute, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, Canada
| | - Rhonda C Bell
- Department of Agricultural, Food and Nutritional Science, Alberta Diabetes Institute, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, Canada
| | - Linda J McCargar
- Department of Agricultural, Food and Nutritional Science, Alberta Diabetes Institute, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, Canada
| | - Catherine B Chan
- Department of Agricultural, Food and Nutritional Science, Alberta Diabetes Institute, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, Canada; Department of Physiology, Medical Sciences Building, University of Alberta, Edmonton, Alberta, Canada.
| |
Collapse
|
9
|
Grant SM, Wolever TMS. Perceived barriers to application of glycaemic index: valid concerns or lost in translation? Nutrients 2011; 3:330-340. [PMID: 22254100 PMCID: PMC3257746 DOI: 10.3390/nu3030330] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 02/17/2011] [Accepted: 02/23/2011] [Indexed: 12/12/2022] Open
Abstract
The term glycaemic-index (GI) originally appeared in the literature in the early 1980s. GI categorizes carbohydrate according to glycaemic effect postprandially. Since its inception, GI has obtained and maintained interest of academics and clinicians globally. Upon review of GI literature, it becomes clear that the clinical utility of GI is a source of controversy. Can and should GI be applied clinically? There are academics and clinicians on both sides of the argument. Certainly, this controversy has been a stimulus for the evolution of GI methodology and application research, but may also negatively impact clinicians' perception of GI if misunderstood. This article reviews two assessments of GI that are often listed as barriers to application; the GI concept is (1) too complex and (2) too difficult for clients to apply. The literature reviewed does not support the majority of purported barriers, but does indicate that there is a call from clinicians for more and improved GI education tools and clinician GI education. The literature indicates that the Registered Dietitian (RD) can play a key role in GI knowledge translation; from research to application. Research is warranted to assess GI education tool and knowledge needs of clinicians and the clients they serve.
Collapse
Affiliation(s)
- Shannan M. Grant
- Department of Nutritional Sciences, University of Toronto, 150 College Street, Toronto, Ontario, M5S 3E2, Canada
| | - Thomas M. S. Wolever
- Department of Nutritional Sciences, University of Toronto, 150 College Street, Toronto, Ontario, M5S 3E2, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael’s Hospital, 61 Queen Street East, Toronto, Ontario, M5C 2T2, Canada;
| |
Collapse
|
10
|
Russell BE, Gurrola E, Ndumele CD, Landon BE, O'Malley JA, Keegan T, Ayanian JZ, Hicks LS. Perspectives of non-Hispanic Black and Latino patients in Boston's urban community health centers on their experiences with diabetes and hypertension. J Gen Intern Med 2010; 25:504-9. [PMID: 20180156 PMCID: PMC2869432 DOI: 10.1007/s11606-010-1278-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Revised: 08/28/2009] [Accepted: 01/20/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Racial/ethnic disparities exist in the prevalence and outcomes of diabetes and hypertension in the U.S. A better understanding of the health beliefs and experiences of non-Hispanic Blacks and Latinos with these diseases could help to improve their care outcomes. METHODS We conducted eight focus groups stratified by participants' race/ethnicity, with 34 non-Hispanic Blacks and Latinos receiving care for diabetes and/or hypertension in one of 7 community health centers in Boston. Focus groups were designed to determine participants' levels of understanding about their chronic illness, assess their barriers to the management of their illness, and inquire about interventions they considered may help achieve better health outcomes. RESULTS Among both groups of participants, nutrition (traditional diets), genetics and environmental stress (e.g. neighborhood crime and poor conditions) were described as primary contributors to diabetes and hypertension. Unhealthy diets were reported as being a major barrier to disease management. Participants also believed that they would benefit from attending groups on management and education for their conditions that include creative ways to adopt healthy foods that complement their ethnic diets, exercise opportunities, and advice on how to prevent disease manifestation among family members. CONCLUSIONS Interactive discussion groups focused on lifestyle modification and disease management should be created for patients to learn more about their diseases. Future research evaluating the effectiveness of interactive diabetes and hypertension groups that apply patient racial/ethnic traditions should be considered.
Collapse
Affiliation(s)
- Beverley E Russell
- The Center for Community Health Education Research and Service CCHERS, 716 Columbus Ave, Suite 398, Boston, MA 02120, USA.
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Nguyen GC, Munsell M, Brant SR, LaVeist TA. Racial and geographic disparities in the use of parenteral nutrition among inflammatory bowel disease inpatients diagnosed with malnutrition in the United States. JPEN J Parenter Enteral Nutr 2009; 33:563-8. [PMID: 19564625 PMCID: PMC2962862 DOI: 10.1177/0148607109332907] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Racial disparities have been described in the use of a diverse spectrum of surgical procedures. The objectives of this study are to determine whether disparities also exist for the use of parenteral nutrition (PN) in inflammatory bowel disease (IBD). METHODS The U.S. Nationwide Inpatient Sample between 1998 and 2003 is analyzed to determine PN use among IBD inpatients diagnosed with protein-calorie malnutrition and assess whether use patterns differ by race and geographical region. RESULTS The proportion of African American IBD admissions with protein-calorie malnutrition who receive PN is significantly lower than that in whites (19.9% vs 28.1%, P = .001), whereas there is no difference between Hispanics and non-Hispanic whites. After adjustment for gender, comorbidity, health insurance status, geographic region, and median neighborhood income, African Americans remain less likely than whites to receive PN (odds ratio [OR] 0.67; 95% confidence interval [CI], 0.50-0.89), whereas the difference between Hispanics and non-Hispanic whites is marginally significant (OR 0.65; 95% CI, 0.41-1.04). PN use varies geographically, with highest rates in the Northeast (44.3%) and lowest in the Midwest (17.3%). Uninsured patients are less than half as likely to receive PN as those with insurance (OR 0.46; 95% CI, 0.31-0.69). Compared with whites, Hispanics experience a longer time interval between admission and initiation of PN (3.5 vs 4.8 days, P = .02) and have higher rates of catheter-related complications (5.1% vs 12.2%, P = .04). CONCLUSIONS Among IBD inpatients with clinically diagnosable malnutrition, PN use is lower among African Americans compared with whites. The underlying mechanisms of these racial variations merit further investigation.
Collapse
Affiliation(s)
- Geoffrey C Nguyen
- Mount Sinai Hospital IBD Centre, University of Toronto, Toronto, Ontario, Canada.
| | | | | | | |
Collapse
|
12
|
Melkus GD, Whittemore R, Mitchell J. Type 2 diabetes in urban black and rural white women. DIABETES EDUCATOR 2009; 35:293-301. [PMID: 19204103 DOI: 10.1177/0145721708327532] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this secondary analysis was to describe and compare physiological, psychosocial, and self-management characteristics of urban black and rural white women with type 2 diabetes (T2D) in the northeast United States. METHODS A descriptive, cross-sectional secondary analysis was conducted with baseline data from 2 independent study samples: rural white women and urban black women. RESULTS Results revealed the sample were on average educated, working, low-income, mid-life women with poor glycemic and blood pressure control, despite having a usual source of primary care. When compared, black women were younger, had lower income levels, worked more, and were often single and/or divorced. They had worse glycemic control, significantly higher levels of diabetes-related emotional distress, and less support than white women. CONCLUSION Despite differences in geography and study findings, both groups had suboptimal physiological and psychosocial levels that impede self-management. These findings serve to aid in the understanding of health disparities, emphasizing the importance of developing and evaluating effective interventions of diabetes care for women with T2D.
Collapse
|
13
|
Tan MY, Magarey J. Self-care practices of Malaysian adults with diabetes and sub-optimal glycaemic control. PATIENT EDUCATION AND COUNSELING 2008; 72:252-267. [PMID: 18467068 DOI: 10.1016/j.pec.2008.03.017] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Revised: 01/24/2008] [Accepted: 03/15/2008] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To investigate the self-care practices of Malaysian adults with diabetes and sub-optimal glycaemic control. METHODS Using a one-to-one interviewing approach, data were collected from 126 diabetic adults from four settings. A 75-item questionnaire was used to assess diabetes-related knowledge and self-care practices regarding, diet, medication, physical activity and self-monitoring of blood glucose (SMBG). RESULTS Most subjects had received advice on the importance of self-care in the management of their diabetes and recognised its importance. Sixty-seven subjects (53%) scored below 50% in their diabetes-related knowledge. Subjects who consumed more meals per day (80%), or who did not include their regular sweetened food intakes in their daily meal plan (80%), or who were inactive in daily life (54%), had higher mean fasting blood glucose levels (p=0.04). Subjects with medication non-adherence (46%) also tended to have higher fasting blood glucose levels. Only 15% of the subjects practiced SMBG. Predictors of knowledge deficit and poor self-care were low level of education (p = <0.01), older subjects (p=0.04) and Type 2 diabetes subjects on oral anti-hyperglycaemic medication (p = <0.01). CONCLUSION There were diabetes-related knowledge deficits and inadequate self-care practices among the majority of diabetic patients with sub-optimal glycaemic control. PRACTICE IMPLICATIONS This study should contribute to the development of effective education strategies to promote health for adults with sub-optimal diabetes control.
Collapse
MESH Headings
- Adult
- Blood Glucose/metabolism
- Blood Glucose Self-Monitoring
- Diabetes Mellitus, Type 1/metabolism
- Diabetes Mellitus, Type 1/prevention & control
- Diabetes Mellitus, Type 1/psychology
- Diabetes Mellitus, Type 2/metabolism
- Diabetes Mellitus, Type 2/prevention & control
- Diabetes Mellitus, Type 2/psychology
- Diet, Diabetic
- Educational Status
- Energy Intake
- Exercise
- Female
- Health Behavior
- Health Knowledge, Attitudes, Practice
- Humans
- Hypoglycemic Agents/therapeutic use
- Life Style
- Malaysia
- Male
- Middle Aged
- Patient Compliance/psychology
- Patient Compliance/statistics & numerical data
- Patient Education as Topic
- Self Care/methods
- Self Care/psychology
- Statistics, Nonparametric
- Surveys and Questionnaires
- Treatment Outcome
Collapse
Affiliation(s)
- Ming Yeong Tan
- Discipline of Nursing, The University of Adelaide, Adelaide, Australia.
| | | |
Collapse
|
14
|
Munoz-Plaza CE, Filomena S, Morland KB. Disparities in Food Access: Inner-City Residents Describe their Local Food Environment. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2008. [DOI: 10.1080/19320240801891453] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
15
|
Knobf MT, Juarez G, Lee SYK, Sun V, Sun Y, Haozous E. Challenges and strategies in recruitment of ethnically diverse populations for cancer nursing research. Oncol Nurs Forum 2008; 34:1187-94. [PMID: 18024345 DOI: 10.1188/07.onf.1187-1194] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To describe common barriers, identify challenges for researchers, and provide strategies for recruitment and retention of ethnic minority groups for cancer nursing research. DATA SOURCES Computerized search of databases, published articles, abstracts, master's theses, and doctoral dissertations. DATA SYNTHESIS Social, economic, and cultural factors present challenges to recruitment of minorities into research. Knowing the culture of the target population, developing trust, engaging the community, and using tailored materials are strategies for recruitment and retention of minorities. CONCLUSIONS Knowledge of potential barriers and challenges to research with diverse populations provides the foundation for the development of strategies for successful recruitment of minorities in cancer nursing research. IMPLICATIONS FOR NURSING Increasing ethnic minorities in research will generate knowledge that will contribute to culturally competent cancer care.
Collapse
Affiliation(s)
- M Tish Knobf
- The School of Nursing, Yale University, New Haven, CT, USA.
| | | | | | | | | | | |
Collapse
|
16
|
Abstract
This review of the literature on vulnerable populations with diabetes identifies trends, summarizes major findings, and recommends strategies to fill gaps in the state of the science. For the purposes of this article "vulnerable populations" refers to members of diverse racial and ethnic groups, people of low-income, and those who live in rural and medically underserved areas.
Collapse
Affiliation(s)
- Alexandra A García
- School of Nursing, The University of Texas at Austin, TX 78701-1499, USA.
| | | |
Collapse
|