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Nsobundu C, Nmadu YW, Wagle NS, Foster MJ, McKyer ELJ, Sherman L, Ory MG, Burdine J(JN. Process Evaluations of Diabetes Self-Management Programs: A Systematic Review of the Literature. Am J Health Promot 2024; 38:1048-1067. [PMID: 38648265 PMCID: PMC11348640 DOI: 10.1177/08901171241238554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To conduct a systematic review of process evaluations (PEs) of diabetes self-management programs (DSMPs). DATA SOURCE An electronic search using Medline (Ovid), Embase (Ovid), CINAHL (Ensco), Academic Search (Ebsco), and APA PsycInfo (Ebsco). STUDY INCLUSION AND EXCLUSION CRITERIA Peer-reviewed, empirical quantitative, qualitative, or mixed-method studies were included if they (1) were a traditional, group-based DSMP, (2) involved adults at least 18 years with T1DM or T2DM, (3) were a stand-alone or embedded PE, and (4) published in English. DATA EXTRACTION The following process evaluation outcomes were extracted: fidelity, dose delivered, dose received, reach, recruitment, retention, and context. Additional items were extracted, (eg, process evaluation type, data collection methods; theories; frameworks or conceptual models used to guide the process evaluation, and etc). DATA SYNTHESIS Due to heterogeneity across studies, studies were synthesized qualitatively (narratively). RESULTS Sixty-eight studies (k) in 78 articles (n) (k = 68; n = 78) were included. Most were mixed methods of low quality. Studies were typically integrated into outcome evaluations vs being stand-alone, lacked theoretical approaches to guide them, and incorporated limited outcomes such as dose received, reach, and retention. CONCLUSION Future research should 1) implement stand-alone theoretically grounded PE studies and 2) provide a shared understanding of standardized guidelines to conduct PEs. This will allow public health practitioners and researchers to assess and compare the quality of different programs to be implemented.
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Affiliation(s)
- Chinelo Nsobundu
- Center for Community Health & Aging, School of Public Health, Texas A&M University, College Station, TX, USA
- School of Medicine, St George’s University, St George’s, Grenada
| | - Yeka W. Nmadu
- Department of Pediatrics, University of Florida College of Medicine- Jacksonville, Jacksonville, FL, USA
| | - Nikita Sandeep Wagle
- Population Informatics Lab, Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Margaret J. Foster
- Department of Medical Education, Texas A&M College of Medicine, College Station, TX, USA
| | - Ellisa Lisako Jones McKyer
- Vice Dean Faculty Affairs & Diversity, Equity, and Inclusion, Alice L. Walton School of Medicine, Bentonville, AR, USA
| | - Ledric Sherman
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Marcia G. Ory
- Department of Environmental & Occupational Health, School of Public Health, Texas A&M University, College Station, TX, USA
| | - James (Jim) N. Burdine
- Department of Health Behavior, Director of the Center for Community Health & Aging, School of Public Health, Texas A&M University, College Station, TX, USA
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San Diego ERN, West NT, Pichon LC, Jiang Y, Powell TW, Rugless F, Lewis J, Campbell B, McCann L, McNeals S, Harmon BE. Associations Between Sociodemographic Variables, Social Determinants of Health, and Diabetes: Findings From a Congregational Health Needs Assessment. Am J Health Promot 2024; 38:809-819. [PMID: 38395415 PMCID: PMC11376194 DOI: 10.1177/08901171241234662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
PURPOSE To examine associations between sociodemographic variables, social determinants of health (SDOHs) and diabetes using health needs assessment data. DESIGN Cross-sectional study. SETTING Faith-based communities in the Mid-South U.S. SAMPLE Of the 378 churches, 92 participated in the study (24% response rate); N = 828 church leaders and members completed the survey. MEASURE The Mid-South Congregational Health Survey assessed perceived health-related needs of congregations and the communities they serve. ANALYSIS Generalized linear mixed modeling examined the associations between sociodemographic variables (age, sex, race/ethnicity, educational level), SDOHs (affordable healthcare, healthy food, employment), and diabetes. RESULTS Individuals with less education had lower odds of reporting all SDOHs as health needs compared to individuals with more education (ORrange = .59-.63). Men had lower odds of reporting diabetes as a health need or concern compared to women (OR = .70; 95% CI = .50, .97). African Americans had greater odds of reporting diabetes as a health need compared to individuals in the 'Other' race/ethnicity category (OR = 3.91; 95% CI = 2.20, 6.94). Individuals who reported affordable healthcare (OR = 2.54; 95% CI = 1.73, 3.72), healthy food (OR = 2.24; 95% CI = 1.55, 3.24), and employment (OR = 3.33; 95% CI = 2.29, 4.84) as health needs had greater odds of reporting diabetes as a health need compared to those who did not report these SDOHs as needs. CONCLUSIONS Future studies should evaluate strategies to merge healthcare and faith-based organizations' efforts to address SDOHs impacting diabetes.
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Affiliation(s)
- Emily Rose N San Diego
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, CA, USA
- Scripps Research Translational Institute, Scripps Research, La Jolla, CA, USA
| | - Nathan T West
- Institute of Social and Economic Research, University of Alaska, Anchorage, AK, USA
| | - Latrice C Pichon
- Division of Social and Behavioral Sciences, University of Memphis School of Public Health, Memphis, TN, USA
| | - Yu Jiang
- Division of Epidemiology, Biostatistics, and Environmental Health, University of Memphis School of Public Health, Memphis, TN, USA
| | - Terrinieka W Powell
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Fedoria Rugless
- Population Health Department, Amerigroup, Nashville, TN, USA
| | - Jonathan Lewis
- Community Partnerships, Methodist Le Bonheur Healthcare, Memphis, TN, USA
| | - Bettina Campbell
- Oak Hill Regional Community Development Center, Hernando, MS, USA
| | - Lauren McCann
- Le Bonheur Pediatrics, Le Bonheur Children's Hospital, Memphis, TN, USA
| | | | - Brook E Harmon
- Department of Nutrition and Healthcare Management, Appalachian State University, Boone, NC, USA
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Singh H, Fulton J, Mirzazada S, Saragosa M, Uleryk EM, Nelson MLA. Community-Based Culturally Tailored Education Programs for Black Communities with Cardiovascular Disease, Diabetes, Hypertension, and Stroke: Systematic Review Findings. J Racial Ethn Health Disparities 2023; 10:2986-3006. [PMID: 36508135 PMCID: PMC10645635 DOI: 10.1007/s40615-022-01474-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/17/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Community-based culturally tailored education (CBCTE) programs for chronic diseases may reduce health disparities; however, a synthesis across chronic diseases is lacking. We explored (1) the characteristics and outcomes of CBCTE programs and (2) which strategies for culturally appropriate interventions have been used in CBCTE programs, and how they have been implemented. METHODS A systematic review was conducted by searching three databases to identify empirical full-text literature on CBCTE programs for Black communities with cardiovascular disease, hypertension, diabetes, or stroke. Studies were screened in duplicate, then data regarding study characteristics, participants, intervention, and outcomes were extracted and analyzed. Cultural tailoring strategies within programs were categorized using Kreuter and colleagues' framework. RESULTS Of the 74 studies, most were conducted in the USA (97%) and delivered in one site (53%; e.g., church/home). CBCTE programs targeted diabetes (65%), hypertension (30%), diabetes and hypertension (1%), cardiovascular disease (3%), and stroke (1%). Reported program benefits included physiological, medication-related, physical activity, and literacy. Cultural tailoring strategies included peripheral (targeted Black communities), constituent-involving (e.g., community informed), evidential (e.g., integrated community resources), linguistic (e.g., delivered in community's dialect/accent), and sociocultural (e.g., integrated community members' religious practices). CONCLUSIONS CBCTE programs may have beneficial outcomes, but a small sample size limited several. The strategies identified can be adopted by programs seeking to culturally tailor. Future interventions should clearly describe community members' roles/involvement and deliver programs in multiple locations to broaden reach. TRIAL REGISTRATION PROSPERO CRD42021245772.
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Affiliation(s)
- Hardeep Singh
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue Toronto, Toronto, ON, M5G 1V7, Canada.
- KITE, Toronto Rehabilitation Institute, University Health Network, 520 Sutherland Drive, Toronto, ON, Canada.
- Temerty Faculty of Medicine, Rehabilitation Science Institute, University of Toronto, 500 University Avenue Toronto, Toronto, ON, M5G 1V7, Canada.
| | - Joseph Fulton
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- March of Dimes Canada, 10 Overlea Blvd, Toronto, ON, Canada
| | - Sofia Mirzazada
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue Toronto, Toronto, ON, M5G 1V7, Canada
| | - Marianne Saragosa
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 1 Bridgepoint Drive, Toronto, ON, Canada
| | | | - Michelle L A Nelson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- March of Dimes Canada, 10 Overlea Blvd, Toronto, ON, Canada
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 1 Bridgepoint Drive, Toronto, ON, Canada
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Weber JM, Doolittle BR. Religion, spirituality and improved glycemic control among people with type 2 diabetes: A systematic review. Int J Psychiatry Med 2023; 58:617-636. [PMID: 37164905 DOI: 10.1177/00912174231176171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE This systematic review investigates the association between measures of religiosity or spirituality (R/S) and glycemic control in patients with type 2 diabetes. METHODS A systematic literature review was conducted for all English language articles published between 1966 and August 2022 in six relevant databases: PubMed, PSYCHinfo, CINAHL, ATLA, Scopus, Sociological Abstracts, and the Cochrane Central Register of Controlled Clinical Trials. Search terms for religious variables included, "religion", "religiosity", "spirituality", "religious attendance". Search terms for diabetes outcomes included, "diabetes", "hemoglobin A1c", "blood glucose", "glycemic control." The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO). RESULTS A total of 758 studies examining correlations between R/S and glycemic control were screened from relevant databases. Forty studies were evaluated for eligibility and inclusion. Eight studies were selected and analyzed. Three studies showed positive associations, two studies showed positive and neutral associations, two studies showed positive and negative associations, and one study showed a neutral association. Limitations included small sample sizes and heterogeneity of study designs. CONCLUSION Involvement in religious and spiritual practices may be associated with improved glycemic control in patients with type 2 diabetes. Specific mechanisms for associations may be partially explained by more effective self-management practices, increased positive social contacts, and regular community support. Further research is needed to clarify these associations.
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Affiliation(s)
- Jonathan M Weber
- Department of Medicine, Section of General Internal Medicine Yale School of Medicine Physician Associate Program, New Haven, CT, USA
| | - Benjamin R Doolittle
- Internal Medicine and Pediatrics, Yale School of Medicine, Religion and Health, Yale University Divinity School, New Haven, CT, USA
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Chan KY, Srivastava N, Wang Z, Xia X, Huang Z, Poon AN, Reidpath DD. A systematic review and meta-analysis of the effectiveness of hypertension interventions in faith-based organisation settings. J Glob Health 2023; 13:04075. [PMID: 37830137 PMCID: PMC10570758 DOI: 10.7189/jogh.13.04075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023] Open
Abstract
Background Hypertension is the global, leading cause of mortality and is the main risk factor for cardiovascular disease. Community-based partnerships can provide cost-saving ways of delivering effective blood pressure (BP) interventions to people in resource-poor settings. Faith-based organisations (FBOs) prove important potential health partners, given their reach and community standing. This potential is especially strong in hard-to-reach, socio-economically marginalised communities. This systematic review explores the state of the evidence of FBO-based interventions on BP management, with a focus on randomised controlled trials (RCTs) and cluster RCTs (C-RCTs). Methods Seven academic databases (English = 5, Chinese = 2) and grey literature were searched for C-/RCTs of community-based interventions in FBO settings. Only studies with pre- and post-intervention BP measures were kept for analysis. Random effects models were developed using restricted maximum likelihood estimation (REML) to estimate the population average mean change and 95% confidence interval (CI) of both systolic and diastolic blood pressure (SBP and DBP). The overall heterogeneity was assessed by successively adding studies and recording changes in heterogeneity. Prediction intervals were generated to capture the spread of the pooled effect across study settings. Results Of the 19 055 titles identified, only 11 studies of fair to good quality were kept for meta-analysis. Non-significant, average mean differences between baseline and follow-up for the intervention and control groups were found for both SBP (0.78 mm of mercury (mmHg) (95% CI = 2.11-0.55)) and DBP (-0.20 mm Hg (95% CI = -1.16 to 0.75)). Subgroup analysis revealed a significant reduction in SBP of -6.23 mm Hg (95% CI = -11.21 to -1.25) for populations with mean baseline SBP of ≥140 mm Hg. Conclusions The results support the potential of FBO-based interventions in lowering SBP in clinically hypertensive populations. However, the limited evidence was concentrated primarily in Christian communities in the US More research is needed to understand the implications of such interventions in producing clinically meaningful long-term effects in a variety of settings. Further research can illuminate factors that affect success and potential expansion to sites outside the US as well as non-Christian FBOs. Current evidence is inadequate to evaluate the potential of FBO-based interventions in preventing hypertension in non-hypertensive populations. Intervention effects in non-hypertensive population might be better reflected through intermediate outcomes.
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Affiliation(s)
- Kit Yee Chan
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
- School of Social Sciences, Monash University, Clayton, Victoria, Australia
| | - Noori Srivastava
- Department of Medicine, School of Medicine & Health Sciences, George Washington University, Washington DC, USA
| | - Zhicheng Wang
- China Development Research Foundation, Beijing, China
| | - Xiaoqian Xia
- London School of Hygiene & Tropical Medicine, London, UK
| | - Zhangziyue Huang
- Milken Institute School of Public Health, George Washington University, Washington DC, USA
| | - Adrienne N Poon
- Department of Medicine, School of Medicine & Health Sciences, George Washington University, Washington DC, USA
| | - Daniel D Reidpath
- School of Social Sciences, Monash University, Clayton, Victoria, Australia
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
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Roddy MK, Spieker AJ, Nelson LA, Greevy RA, LeStourgeon LM, Bergner EM, El-Rifai M, Elasy TA, Aikens JE, Wolever RQ, Mayberry LS. Well-being outcomes of a family-focused intervention for persons with type 2 diabetes and support persons: Main, mediated, and subgroup effects from the FAMS 2.0 RCT. Diabetes Res Clin Pract 2023; 204:110921. [PMID: 37742801 PMCID: PMC10617415 DOI: 10.1016/j.diabres.2023.110921] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/12/2023] [Accepted: 09/20/2023] [Indexed: 09/26/2023]
Abstract
AIMS Type 2 diabetes self-management occurs within social contexts. We sought to test the effects of Family/friend Activation to Motivate Self-care (FAMS), a self-care support intervention delivered via mobile phones, on psychosocial outcomes for persons with diabetes (PWDs) and their support persons. METHODS PWDs had the option to enroll with a friend/family member as a support person in a 15-month RCT to evaluate FAMS versus enhanced usual care. FAMS included 9 months of monthly phone coaching and text message support for PWDs, and text message support for enrolled support persons. RESULTS PWDs (N = 329) were 52% male and 39% reported minoritized race or ethnicity ; 50% enrolled with elevated diabetes distress. Support persons (N = 294) were 26% male and 33% reported minoritized race or ethnicity. FAMS improved PWDs' diabetes distress (d = -0.19) and global well-being (d = 0.21) during the intervention, with patterns of larger effects among minoritized groups. Post-intervention (9-month) and sustained (15-month) improvements were driven by changes in PWDs' self-efficacy, self-care behaviors, and autonomy support. Among support persons, FAMS improved helpful involvement without increasing burden or harmful involvement. CONCLUSIONS FAMS improved PWDs' psychosocial well-being, with post-intervention and sustained improvements driven by improved self-efficacy, self-care, and autonomy support. Support persons increased helpful involvement without adverse effects.
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Affiliation(s)
- McKenzie K Roddy
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Andrew J Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Lyndsay A Nelson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Robert A Greevy
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Lauren M LeStourgeon
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Erin M Bergner
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Merna El-Rifai
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Tom A Elasy
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, United States
| | - James E Aikens
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Ruth Q Wolever
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, United States; Osher Center for Integrative Health at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Lindsay S Mayberry
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, United States; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States.
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Roddy MK, Spieker AJ, Nelson LA, Greevy RA, LeStourgeon LM, Bergner EM, El-Rifai M, Elasy TA, Aikens JE, Wolever RQ, Mayberry LS. Well-being outcomes of a family-focused intervention for persons with type 2 diabetes and support persons: Main, mediated, and subgroup effects from the FAMS 2.0 RCT. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.11.23295375. [PMID: 37745314 PMCID: PMC10516078 DOI: 10.1101/2023.09.11.23295375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Aims Type 2 diabetes self-management occurs within social contexts. We sought to test the effects of Family/friends Activation to Motivate Self-care (FAMS), a self-care support intervention delivered via mobile phones, on psychosocial outcomes for persons with diabetes (PWDs) and their support persons. Methods PWDs had the option to enroll with a friend/family member as a support person in a 15-month RCT to evaluate FAMS versus enhanced usual care. FAMS included 9-months of monthly phone coaching and text message support for PWDs, and text message support for enrolled support persons. Results PWDs (N=329) were 52% male and 39% from minoritized racial or ethnic groups; 50% enrolled with elevated diabetes distress. Support persons (N=294) were 26% male and 33% minoritized racial or ethnic groups. FAMS improved PWDs' diabetes distress ( d =-0.19) and global well-being ( d =0.21) during the intervention, with patterns of larger effects among minoritized groups. Post-intervention and sustained (15-month) improvements were driven by changes in PWDs' self-efficacy, self-care behaviors, and autonomy support. Among support persons, FAMS improved helpful involvement without increasing burden or harmful involvement. Conclusions FAMS improved PWDs' psychosocial well-being, with post-intervention and sustained improvements driven by improved self-efficacy, self-care, and autonomy support. Support persons increased helpful involvement without adverse effects.
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Affiliation(s)
- McKenzie K. Roddy
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN
| | - Andrew J. Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Lyndsay A Nelson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN
| | - Robert A. Greevy
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Lauren M. LeStourgeon
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN
| | - Erin M. Bergner
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN
| | - Merna El-Rifai
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN
| | - Tom A. Elasy
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - James E. Aikens
- Department of Family Medicine, University of Michigan, Ann Arbor, MI
| | - Ruth Q. Wolever
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN
- Osher Center for Integrative Health at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN
| | - Lindsay S. Mayberry
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
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Maroney K, Laurent J, Alvarado F, Gabor A, Bell C, Ferdinand K, He J, Mills KT. Systematic review and meta-analysis of church-based interventions to improve cardiovascular disease risk factors. Am J Med Sci 2023; 366:199-208. [PMID: 37244637 DOI: 10.1016/j.amjms.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 04/18/2023] [Accepted: 05/22/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Church-based interventions have been shown to reduce cardiovascular disease (CVD) risk factors and could reduce health disparities in groups with a high burden of CVD. We aim to conduct a systematic review and meta-analysis to determine the effectiveness of church-based interventions for CVD risk factor improvement and to examine the types of interventions that are effective. METHODS Systematic searches of MEDLINE, Embase, and manual reference searches were conducted through November 2021. Study inclusion criteria were church-based interventions delivered in the United States to address CVD risk factors. Interventions targeted barriers to improving blood pressure, weight, diabetes, physical activity, cholesterol, diet, or smoking. Two investigators independently extracted study data. Random effects meta-analyses were conducted. RESULTS A total of 81 studies with 17,275 participants were included. The most common interventions included increasing physical activity (n = 69), improving diet (n = 67), stress management (n = 20), medication adherence (n = 9), and smoking cessation (n = 7). Commonly used approaches for implementation included cultural tailoring of the intervention, health coaching, group education sessions, inclusion of spiritual components in the intervention, and home health monitoring. Church-based interventions were associated with significant reductions in body weight (-3.1 lb, [95% CI, -5.8, -1.2], N = 15), waist circumference (-0.8 in, [CI, -1.4, -0.1], N = 6), and systolic blood pressure (-2.3 mm Hg, [CI, -4.3, -0.3], N = 13). CONCLUSIONS Church-based interventions targeting CVD risk factors are effective for reducing CVD risk factors, particularly in populations with health disparities. These findings can be used to design future church-based studies and programs to improve cardiovascular health.
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Affiliation(s)
- Kieran Maroney
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
| | - Jodie Laurent
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Flor Alvarado
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Alexandra Gabor
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Caryn Bell
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | | | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA; Tulane University Translational Sciences Institute, New Orleans, LA, USA
| | - Katherine T Mills
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA; Tulane University Translational Sciences Institute, New Orleans, LA, USA
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Tang TS, Afshar R, Elliott T, Kong J, Gill S. From clinic to community: A randomized controlled trial of a peer support model for adults with type 2 diabetes from specialty care settings in British Columbia. Diabet Med 2022; 39:e14931. [PMID: 36052812 DOI: 10.1111/dme.14931] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/12/2022] [Accepted: 07/31/2022] [Indexed: 11/30/2022]
Abstract
AIMS To examine the impact of a 12-month peer-led diabetes self-management support intervention delivered via telephone amongst adults with type 2 diabetes (T2D) from specialty care settings in British Columbia (BC). METHODS One-hundred ninety-six adults with T2D were randomly assigned to either a 12-month Peer-Led, Empowerment-based, Approach, to Self-management Efforts in Diabetes (PLEASED) intervention or a usual care condition. PLEASED involved weekly telephone contacts from a peer leader (PL) in the first 3 months followed by bi-weekly telephone contacts in the last 9 months. Assessments were conducted at baseline, 3 and 12 months. The primary outcome was HbA1c ; secondary outcomes included diabetes distress (DD), ApoB, systolic and diastolic blood pressure (BP), body mass index, waist circumference and depressive symptoms. RESULTS No within or between group changes were observed for HbA1c at 3 or 12 months. However, amongst participants with HbA1c ≥ 69 mmol/mol (8.5%), the PLEASED group significantly lowered their HbA1c at 12 months [-11.7 mmol/mol (-1.07%); 95% CI: -20.7, -2.5 (-1.89, -0.23); p = 0.016] compared to usual care. Amongst secondary outcomes, within-group improvements in overall DD were found at 3 months (-0.21; 95% CI: -0.35, -0.08; p = 0.002) for the PLEASED group and at 12 months for both groups (PLEASED: -0.35; 95% CI: -0.49, -0.21; p < 0.001 and control: -0.33; 95% CI: -0.47, -0.19; p < 0.001), however, no between-group differences were observed. The PLEASED group improved systolic BP at 12 months (-5.4 mm Hg; 95% CI: -10.0, -0.8; p = 0.023) compared to usual care. CONCLUSIONS Participation in a peer support intervention in diabetes delivered via telephone leads to long-term improvements in HbA1c amongst high-risk adults with T2D living in BC. TRIAL REGISTRATION The study was registered on clinicaltrials.gov (NT02804620).
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Affiliation(s)
- Tricia S Tang
- Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rowshanak Afshar
- Department of Family Medicine, University of British Columbia, West Vancouver, British Columbia, Canada
| | - Thomas Elliott
- Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason Kong
- Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sabrina Gill
- Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Pano O, Rincón MG, Bullón-Vela V, Aguilera-Buenosvinos I, Diaz ZR, Minder B, Kopp-Heim D, Laine-Carmeli J, Martínez González M, Martinez J, Sayón-Orea C. Eating behaviors and health-related quality of life: A scoping review. Maturitas 2022; 165:58-71. [DOI: 10.1016/j.maturitas.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/06/2022] [Accepted: 07/13/2022] [Indexed: 10/31/2022]
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11
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Hangaard S, Laursen SH, Andersen JD, Kronborg T, Vestergaard P, Hejlesen O, Udsen FW. The Effectiveness of Telemedicine Solutions for the Management of Type 2 Diabetes: A Systematic Review, Meta-Analysis, and Meta-Regression. J Diabetes Sci Technol 2021; 17:794-825. [PMID: 34957864 DOI: 10.1177/19322968211064633] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous systematic reviews have aimed to clarify the effect of telemedicine on diabetes. However, such reviews often have a narrow focus, which calls for a more comprehensive systematic review within the field. Hence, the objective of the present systematic review, meta-analysis, and meta-regression is to evaluate the effectiveness of telemedicine solutions versus any comparator without the use of telemedicine on diabetes-related outcomes among adult patients with type 2 diabetes (T2D). METHODS This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We considered telemedicine randomized controlled trials (RCT) including adults (≥18 years) diagnosed with T2D. Change in glycated hemoglobin (HbA1c, %) was the primary outcome. PubMed, EMBASE, and the Cochrane Library Central Register of Controlled Trials (CENTRAL) were searched on October 14, 2020. An overall treatment effect was estimated using a meta-analysis performed on the pool of included studies based on the mean difference (MD). The revised Cochrane risk-of-bias tool was applied and the certainty of evidence was graded using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. RESULTS The final sample of papers included a total of 246, of which 168 had sufficient information to calculate the effect of HbA1c%. The results favored telemedicine, with an MD of -0.415% (95% confidence interval [CI] = -0.482% to -0.348%). The heterogeneity was great (I2 = 93.05%). A monitoring component gave rise to the higher effects of telemedicine. CONCLUSIONS In conclusion, telemedicine may serve as a valuable supplement to usual care for patients with T2D. The inclusion of a telemonitoring component seems to increase the effect of telemedicine.
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Affiliation(s)
- Stine Hangaard
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg, Denmark
| | - Sisse H Laursen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Department of Nursing, University College of Northern Denmark, Aalborg, Denmark
| | - Jonas D Andersen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Thomas Kronborg
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg, Denmark
| | - Peter Vestergaard
- Steno Diabetes Center North Denmark, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ole Hejlesen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Flemming W Udsen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Othman MM, Khudadad H, Dughmosh R, Syed A, Clark J, Furuya-Kanamori L, Abou-Samra AB, Doi SAR. Towards a better understanding of self-management interventions in type 2 diabetes: A meta-regression analysis. Prim Care Diabetes 2021; 15:985-994. [PMID: 34217643 DOI: 10.1016/j.pcd.2021.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 05/31/2021] [Accepted: 06/17/2021] [Indexed: 01/15/2023]
Abstract
AIMS Attributes that operationally conceptualize diabetes self-management education (DSME) interventions have never been studied previously to assess their impact on relevant outcomes of interest in people with type 2 diabetes (T2D). The aim of this study was to determine the impact of existing interventions classified by their delivery of skills or information related attributes on immediate (knowledge), intermediate (physical activity), post-intermediate (HbA1c), and long-term (quality of life) outcomes in people with T2D. METHODS PubMed, Embase, PsycINFO, and Cochrane Library/Cochrane CENTRAL as well as the grey literature were searched to identify interventional studies that examined the impact of DSME interventions on the four different outcomes. Eligible studies were selected and appraised independently by two reviewers. A meta-regression analysis was performed to determine the impact of delivery of the skills- and information-related attributes on the chosen outcomes. RESULTS 142 studies (n = 25,511 participants) provided data, of which 39 studies (n = 5278) reported on knowledge, 39 studies (n = 8323) on physical activity, 99 studies (n = 17,178) on HbA1c and 24 studies (n = 5147) on quality of life outcomes. Meta-regression analyses demonstrated that skills-related attributes had an estimated effect suggesting improvement in knowledge (SMD [standardized mean difference] increase of 0.80; P = 0.025) and that information-related attributes had an estimated effect suggesting improvement in quality of life (SMD increase of 0.96; P = 0.405). Skill- and information-related attributes did not have an estimated effect suggesting improvement in physical activity or in HbA1c. CONCLUSIONS The study findings demonstrate that the skills and information related attributes contribute to different outcomes for people with T2D. This study provides, for the first time, preliminary evidence for differential association of the individual DSME attributes with different levels of outcome.
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Affiliation(s)
- Manal M Othman
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar; Medicine Department, Hamad Medical Corporation, Doha, Qatar.
| | - Hanan Khudadad
- Department of Clinical Research, Primary Health Care Corporation, Doha, Qatar.
| | - Ragae Dughmosh
- Medicine Department, Hamad Medical Corporation, Doha, Qatar.
| | - Asma Syed
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar.
| | - Justin Clark
- The Centre for Research into Evidence Based Practice, Bond University, Gold Coast, Queensland, Australia.
| | - Luis Furuya-Kanamori
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia.
| | - Abdul-Badi Abou-Samra
- Qatar Metabolic Institute and Medicine Department, Hamad Medical Corporation, Doha, Qatar.
| | - Suhail A R Doi
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar.
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Resilience as a Mediator of the Association between Spirituality and Self-Management among Older People with Chronic Obstructive Pulmonary Disease. Healthcare (Basel) 2021; 9:healthcare9121631. [PMID: 34946360 PMCID: PMC8700824 DOI: 10.3390/healthcare9121631] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 02/05/2023] Open
Abstract
This study examined the mediating effect of resilience in the relationship between spirituality and self-management among older people with chronic obstructive pulmonary disease (COPD). The participants were 151 older people with COPD in four general hospitals in Jiangsu Province, China. Data were collected from September 2020 to May 2021 using a questionnaire developed by the investigator, the Function Assessment of Chronic Illness Therapy-Spiritual Scale (FACIT-SP-12), 10-item Connor-Davidson Resilience Scale (CD-RISC-10), and COPD Self-Management Scale (CSMS). One-way ANOVA and t-test were used to compare the level of self-management in patients with different sociodemographic and clinical characteristics. Partial correlation analysis was used to explore the correlation between spirituality, resilience, and self-management. Hierarchical multiple regression analyses were performed to examine the contribution of spirituality and resilience to the prediction of self-management. A bootstrapping test was implemented using the SPSS PROCESS macro to test the statistical significance of the mediating effect. There was a pairwise positive correlation between spirituality, resilience, and self-management. Resilience mediated the relationship between spirituality and self-management. These findings suggested that resilience interventions could be incorporated into future COPD self-management interventions to better improve self-management and health outcomes. Moreover, resilience should be an important component of healthy aging initiatives.
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Walker RJ, Walker RE, Mosley-Johnson E, Egede LE. Insights about interventions to address food insecurity in adults with type 2 diabetes: Valuable lessons from the stories of African Americans living in the inner city. PATIENT EDUCATION AND COUNSELING 2021; 104:2785-2790. [PMID: 33838940 PMCID: PMC8481339 DOI: 10.1016/j.pec.2021.03.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES This qualitative study aimed to gain insight from the perspectives of food insecure African Americans living in an inner city regarding important diabetes intervention strategies and components. METHODS Using a grounded theory approach, two focus groups (totaling 16 individuals) were conducted in Milwaukee, Wisconsin. Purposive, convenience sampling was used to identify food insecure adults with diabetes. Questions were asked using a moderator guide to explore challenges and barriers to managing diabetes within the context of food insecurity, and facilitators or resources that helped participants improve diabetes management. Questions were open ended and followed by probes asking for additional perspectives and personal experiences related to the overarching topic, and questions asking to clarify statements. RESULTS Overarching concepts and themes specific to possible interventions discussed during the focus groups included group education, peer support, access to community resources and programs, stress management, and faith-based programs as desired intervention outcomes. CONCLUSIONS Key findings from the current study show that inner-city African Americans with diabetes desire interventions that foster social and community support systems. PRACTICE IMPLICATIONS Given this insight, more robust and comprehensive interventions are needed to account for the multifaceted experience of food insecurity and diabetes within the inner-city environment.
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Affiliation(s)
- Rebekah J Walker
- Division of General Internal Medicine, Department of Medicine, Froedtert & The Medical College of Wisconsin, Milwaukee, WI, United States; Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Renee E Walker
- Zilber School of Public Health, University of Wisconsin at Milwaukee, Milwaukee, WI, United States
| | - Elise Mosley-Johnson
- Division of General Internal Medicine, Department of Medicine, Froedtert & The Medical College of Wisconsin, Milwaukee, WI, United States; Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Froedtert & The Medical College of Wisconsin, Milwaukee, WI, United States; Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, United States.
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Azmiardi A, Murti B, Febrinasari RP, Tamtomo DG. The Effect of Peer Support in Diabetes Self-Management Education on Glycemic Control in Patients with Type 2 Diabetes: A Meta-Analysis. Epidemiol Health 2021; 43:e2021090. [PMID: 34696569 PMCID: PMC8920738 DOI: 10.4178/epih.e2021090] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/22/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Diabetes self-management education (DSME) programs are a strategy to maintain healthy behaviors. Nevertheless, limited evidence has been reported from systematic evaluations of the effects of DSME integrated with peer support on glycemic control. This study aimed to review the effectiveness of DSME interventions integrated with peer support on glycemic control in patients with type 2 diabetes. METHODS A systematic search was carried out in electronic databases, including PubMed, Cochrane Library, ProQuest, SpringerLink, ScienceDirect, Scopus, and Google Scholar, for English-language articles published from 2005 until 2020. The effect size was estimated as the standard mean difference (SMD). The Cochrane Collaboration’s Risk of Bias tool was employed to assess the risk of bias. RESULTS Twelve studies were included in this study. DSME integrated with peer support effectively reduced glycated hemoglobin A1c (HbA1c) levels, with a statistically significant effect (SMD, -0.41; 95% confidence interval [CI], -0.69 to -0.13; p<0.001). Programs with a sample size <100 (SMD, -0.45; 95% CI, -0.79 to -0.11; p=0.009), duration of intervention ≤6 months (SMD, -0.52; 95% CI, -0.96 to -0.07; p=0.020), baseline HbA1c <8.5% (SMD, -0.42; 95% CI, -0.77 to -0.07; p=0.020), delivery by group (SMD, -0.28; 95% CI, -0.51 to -0.06; p=0.010), and high frequency of contact (SMD, -0.29; 95% CI, -0.48 to -0.10; p=0.003) had statistically significant effects on reducing HbA1c levels in patients with type 2 diabetes. CONCLUSIONS DSME integrated with peer support effectively enhances glycemic control in patients with type 2 diabetes. Programs with smaller participants groups, shorter interventions, weekly meetings, and closer group sessions improved glycemic control in patients with type 2 diabetes.
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Affiliation(s)
- Akhmad Azmiardi
- Doctoral Program on Public Health, Universitas Sebelas Maret, Surakarta, Indonesia, Surakarta, Indonesia
| | - Bhisma Murti
- Doctor of Public Health Program, Universitas Sebelas Maret, Surakarta, Indonesia, Surakarta, Indonesia
| | - Ratih Puspita Febrinasari
- Department of Pharmacology, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia, Surakarta, Indonesia
| | - Didik Gunawan Tamtomo
- Doctor of Public Health Program, Universitas Sebelas Maret, Surakarta, Indonesia, Surakarta, Indonesia
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Culturally tailored lifestyle interventions for the prevention and management of type 2 diabetes in adults of Black African ancestry: a systematic review of tailoring methods and their effectiveness. Public Health Nutr 2021; 25:422-436. [PMID: 34435943 PMCID: PMC8883766 DOI: 10.1017/s1368980021003682] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective: To evaluate the cultural tailoring methods used in type 2 diabetes (T2D), prevention and management interventions for populations of Black African ancestry and to examine their effectiveness on measures of glycaemia. Design: Three databases were searched in October 2020; eligible studies used a randomised controlled trial (RCT) design to evaluate the effectiveness of culturally tailored lifestyle interventions compared with usual care for the prevention or management of T2D in adults of Black African ancestry. Cultural tailoring methods were evaluated using the Facilitator-Location-Language-Messaging (FiLLM) framework, whereby facilitator refers to delivery by individuals from the target community, language focuses on using native language or language appropriate to literacy levels, location refers to delivery in meaningful settings, and messaging is tailoring with relevant content and modes of delivery. Results: Sixteen RCT were identified, all from USA. The mean age of participants was 55 years, majority female. Six of fifteen RCT reported significant improvements in glycated haemoglobin (HbA1c) at 6 and 8 months; one, in prediabetes, reported significantly improved fasting plasma glucose. Diabetes knowledge improvement (5/7 studies) was associated with HbA1c improvement. The majority tailored to location (12/16), facilitators (11/16), messaging (9/16) and language (6/16) domains of FiLLM. Those with ethnically matched facilitators and those which tailored to more than one domain showed the greatest HbA1C benefits. Conclusion: This evidence supports the effectiveness of culturally tailored lifestyle interventions for T2D management in populations of Black African ancestry, with further RCT needed to evaluate interventions for T2D prevention and for communities outside of the USA.
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Kim J, Hur MH. The Effects of Dietary Education Interventions on Individuals with Type 2 Diabetes: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168439. [PMID: 34444187 PMCID: PMC8393495 DOI: 10.3390/ijerph18168439] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 12/14/2022]
Abstract
As the incidence and prevalence of diabetes increases, intervention through dietary education is becoming more important for diabetes control. This systematic review examines the evidence for the efficacy of dietary education interventions on diabetes control. The study subjects were patients with type 2 diabetes, and the main outcome variable was glycosylated hemoglobin level (HbA1c). The target studies were randomized controlled trials. Thirty-six studies were included in the analysis, of which 33 were included in the meta-analysis. The effect size between dietary education and general interventions was -0.42 (n = 5639, MD = -0.42; 95% CI -0.53 to -0.31) and was significantly different (Z = 7.73, p < 0.001). When subgroup analyses were performed following the application periods, intervention methods, and intervention contents, the mean differences in 4-6-month application, individual education, and diet-exercise-psychosocial intervention were -0.51, (n = 2742, 95% CI -0.71 to -0.32), -0.63 (n = 627, 95% CI -1.00 to -0.26), and -0.51 (n = 3244, 95% CI -0.71 to -0.32), respectively. Dietary education interventions provided for at least 3 months were highly effective in controlling HbA1c levels. Regarding the education method, individualized education was more effective, and contact or non-contact education may be applied for this. Combining diet, exercise, and psychosocial intervention is more effective than diet education alone.
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Affiliation(s)
- Juri Kim
- Department of Nursing, University of Kyungmin, 545 Seobu-ro, Uijeongbu-si 11618, Korea;
| | - Myung-Haeng Hur
- College of Nursing, Eulji University, 712 Dongil-ro, Uijeongbu-si 11759, Korea
- Correspondence: ; Tel.: +82-31-951-3868
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Xia Z, Jiang YY, Shang WJ, Guo HJ, Mao F, Dong WL, Dong JQ. Long-term effectiveness of group-based diabetes self-management on glycosylated haemoglobin for people with type 2 diabetes in community: a protocol of systematic review and meta-analysis. BMJ Open 2021; 11:e046692. [PMID: 34193493 PMCID: PMC8246354 DOI: 10.1136/bmjopen-2020-046692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The rapid rise in the prevalence of diabetes has a negative impact on patients' quality of life. Diabetes self-management group education is cost-effective and efficient for patients to control blood glucose. However, there are no consistent standards for self-management group education, and its long-term effects (≥12 months) are unclear. Although a few systematic reviews evaluated the long-term effects, they did not make clear provisions on the content of self-management, and the number and sample size of included studies were small, which may lead to misclassification bias and reporting bias. Therefore, we plan to conduct this systematic review to evaluate the long-term effects of self-management group education and determine the effects of different self-management characteristics on glycosylated haemoglobin (HbA1c). METHODS AND ANALYSIS We will retrieve Chinese databases (Wanfang, Chinese Hospital Knowledge Warehouse) and English databases (PubMed, ScienceDirect, EMBASE, Web of Science, Bailian Platform, Cochrane Central Register of Controlled Trials, Google Scholar) for randomly controlled trials and cluster randomly controlled trials of which participants are adults with type 2 diabetes mellitus. We will manually search citation lists and trial registries, and consult authors to obtain relevant articles. The retrieval time range will be from the establishment of the database to July 2020 to avoid omitting relevant studies. The primary outcome will be HbA1c. The secondary outcomes will be fasting plasma glucose, postprandial blood glucose, total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, systolic blood pressure, diastolic blood pressure, body mass index, waist circumference and death event. Two reviewers will independently conduct article screening and assessment of risk of bias, with a third reviewer arbitrating if necessary. We will give priority to the use of meta-analysis to evaluate the pooled effects of all outcomes. For the outcomes of unrecognised sources of heterogeneity, missing data and less than three related studies, narrative synthesis approach will be used. ETHICS AND DISSEMINATION Ethical approval is not required for this systematic review. We plan to present the findings in a peer-reviewed scientific journal, relevant and responsible organisations, and training meetings. PROSPERO REGISTRATION NUMBER CRD42020209011.
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Affiliation(s)
- Zhang Xia
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ying-Ying Jiang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wei-Jing Shang
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hai-Jun Guo
- Center for Environment and Population Health, Griffith University, Nathan, Queensland, Australia
| | - Fan Mao
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wen-Lan Dong
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jian-Qun Dong
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Stormacq C, Wosinski J, Boillat E, Van den Broucke S. Effects of health literacy interventions on health-related outcomes in socioeconomically disadvantaged adults living in the community: a systematic review. JBI Evid Synth 2021; 18:1389-1469. [PMID: 32813388 DOI: 10.11124/jbisrir-d-18-00023] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES The objectives of this review were: i) to identify and synthesize the best available evidence on the effectiveness on health-related outcomes of health literacy interventions for enabling socioeconomically disadvantaged people living in the community to access, understand, appraise and apply health information; and ii) to identify components of health literacy interventions associated with improved health-related outcomes. INTRODUCTION Health literacy is defined as a person's competence in accessing, understanding, appraising and applying health information in order to make sound health decisions. A high level of health literacy is positively related to better health outcomes. However, nearly half of the American and European populations have low health literacy levels. Socioeconomically disadvantaged groups in particular present with the weakest health literacy levels, suggesting that differences in health literacy levels contribute to health disparities. Therefore, there is a need to understand the conditions under which health literacy interventions aiming at improving health-related outcomes among socioeconomically disadvantaged people can be implemented. INCLUSION CRITERIA This review considered studies on socioeconomically disadvantaged adults living in the community identified using the socially stratifying PROGRESS factors (Place of residence, Race/ethnicity, Occupation, Gender, Religion, Education, Socioeconomic status, Social capital).This review considered studies evaluating the following interventions: i) targeting health literacy based on either a clinical and/or a public health approach, ii) delivered at the individual, interpersonal, community or societal level, iii) delivered by any healthcare/social work professional, and iv) using a single or multicomponent strategy. The comparator was no treatment, standard care or a variation of the intervention. All randomized and non-randomized controlled trials as well as quasi-experimental designs were included. Outcomes considered were: i) health-related quality of life and health-related outcomes, ii) health behavior outcomes, and iii) outcomes related to the access and use of healthcare services. METHODS A three-step strategy was conducted for primary research published up to May 2018 across seven databases without any language restriction. A search for gray literature was also conducted. Titles and abstracts were screened for assessment against the inclusion criteria. Studies that met the inclusion criteria were retrieved in full and then assessed in detail against the inclusion criteria. Critical appraisal was undertaken using the standardized critical appraisal instruments from JBI. Data were extracted from included studies using standardized data extraction tools from JBI. A meta-analysis was not possible; findings have been presented in a narrative form. RESULTS Twenty-one studies were included in the review. Three studies addressed the health literacy competency of understanding health information, and 18 addressed the competency of applying health information. Thirteen studies were found as effective based on a variety of health-related outcomes (mainly clinical outcomes), preventive health practices and behaviors, and health-promoting behaviors. Results enabled identification of some effective intervention operational components, including cultural appropriateness, tailoring, skills building, goal setting and active discussions. Multi-faceted interventions, combining both an information transfer medium and contact with an interventionist, appear to be more effective than single modality interventions. The use of an appropriate theoretical foundation is also an important factor for successful interventions. CONCLUSION To improve health-related outcomes among socioeconomically disadvantaged people, health literacy interventions are more likely to be successful if they are theory-based, are multi-faceted and use person-centered operational components such as cultural appropriateness, tailoring, skills building, goal setting and active discussions.
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Affiliation(s)
- Coraline Stormacq
- 1Université Catholique de Louvain, Faculté de Santé Publique, Woluwé-Saint-Lambert, Belgium 2La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland 3Bureau d'Echanges des Savoirs pour des praTiques exemplaires de soins (BEST): a Joanna Briggs Centre of Excellence 4Ngoma School of Nursing, Adventist University of Central Africa, Kigali, Rwanda 5Université Catholique de Louvain, Faculté de Psychologie et des Sciences de l'Éducation, Louvain-la-Neuve, Belgium
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Frerichs L, Bess K, Young TL, Hoover SM, Calancie L, Wynn M, McFarlin S, Cené CW, Dave G, Corbie-Smith G. A Cluster Randomized Trial of a Community-Based Intervention Among African-American Adults: Effects on Dietary and Physical Activity Outcomes. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 21:344-354. [PMID: 31925605 DOI: 10.1007/s11121-019-01067-5] [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] [Indexed: 10/25/2022]
Abstract
Evidence of the effectiveness of community-based lifestyle behavior change interventions among African-American adults is mixed. We implemented a behavioral lifestyle change intervention, Heart Matters, in two rural counties in North Carolina with African-American adults. Our aim was to evaluate the effect of Heart Matters on dietary and physical activity behaviors, self-efficacy, and social support. We used a cluster randomized controlled trial to compare Heart Matters to a delayed intervention control group after 6 months. A total of 143 African-American participants were recruited and 108 completed 6-month follow-up assessments (75.5%). We used mixed regression models to evaluate changes in outcomes from baseline to 6-month follow-up. The intervention had a significant positive effect on self-reported scores of encouragement of healthy eating, resulting in an increase in social support from family of 6.11 units (95% CI [1.99, 10.22]) (p < .01). However, intervention participants also had an increase in discouragement of healthy eating compared to controls of 5.59 units (95% CI [1.46, 9.73]) among family (p < .01). There were no significant differences in changes in dietary behaviors. Intervention participants had increased odds (OR = 2.86, 95% CI [1.18, 6.93]) of increased frequency of vigorous activity for at least 20 min per week compared to control participants (p < .05). Individual and group lifestyle behavior counseling can have a role in promoting physical activity levels among rural African-American adults, but more research is needed to identify the best strategies to bolster effectiveness and influence dietary change. Trial Registration: Clinical Trials, NCT02707432. Registered 13 March 2016.
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Affiliation(s)
- Leah Frerichs
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1102C McGavran-Greenberg Hall, Campus Box 7411, Chapel Hill, NC, 27599-7411, USA.
| | - Kiana Bess
- Center for Health Equity Research, Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Tiffany L Young
- The North Carolina Translational Research and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Lenell & Lillie Consulting, LLC, New Bern, NC, USA
| | - Stephanie M Hoover
- Center for Health Equity Research, Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Larissa Calancie
- Center for Health Equity Research, Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Mysha Wynn
- Project Momentum, Inc., Rocky Mount, USA
| | | | - Crystal W Cené
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Gaurav Dave
- Center for Health Equity Research, Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA.,Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Giselle Corbie-Smith
- Center for Health Equity Research, Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA.,Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA.,Department of Social Medicine and Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
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Abstract
Latinos face healthcare access barriers and are highly religious. Church-based health interventions could help address these disparities. We conducted a systematic review of church-based health interventions among Latinos using multiple search terms and databases. The 21 articles reviewed represented 19 interventions. Only six were tested through full-scale randomized controlled trials and five had statistically significant improvements in health-related outcomes. Most (16) utilized groups classes, eight promoted screening or preventive services, and three provided these on-site. Few intervened at multiple levels (e.g., individual, group, and community) and only three utilized pastors' sermons to deliver health-related messages. Church-based health interventions among Latinos are nascent, with only a handful of full-scale trials. Various pilot studies demonstrating feasibility across diverse health conditions suggest model adaptability. Larger studies with objectively measured outcomes and interventions that address multiple levels and structural issues are needed to ensure improvements in Latinos' access and health.
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Kumah E, Abuosi AA, Ankomah SE, Anaba C. Self-management Education Program: The Case of Glycemic Control of Type 2 Diabetes. Oman Med J 2021; 36:e225. [PMID: 33585046 PMCID: PMC7868594 DOI: 10.5001/omj.2021.01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 05/28/2019] [Indexed: 01/05/2023] Open
Abstract
Objectives Self-management education (SME) is recognized globally as a tool that enables patients to achieve optimal glucose control. While factors influencing the effectiveness of self-management interventions have been studied extensively, the impact of program length on clinical endpoints of patients diagnosed with diabetes is underdeveloped. This paper synthesized information from the existing literature to understand the effect of program length on glycated hemoglobin (HbA1C) in adults with type 2 diabetes mellitus. Methods We searched Web of Science, PubMed, Scopus, MEDLINE, EMBASE, PsychINFO, and the Cochrane Central Register of Controlled Trials to identify relevant English language publications on diabetes self-management education published between January 2000 and April 2019. Results The review included 25 randomized controlled trials, with 64.0% reporting significant changes in HbA1C. The studies classified as long-term (lasting one year and above) were associated with the greatest number of interventions achieving statistically significant (87.5% significant vs. 12.5% non-significant) differences in changes in HbA1C between the intervention and the control subjects, recording an overall between-group HbA1C mean difference of 0.6±0.3% (range = 0.2–1.2). Conclusions Our findings suggest that program length may change the effectiveness of educational interventions. Achieving sustained improvements in patients’ HbA1C levels will require long-term, ongoing SME, and support.
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Affiliation(s)
- Emmanuel Kumah
- Policy, Planning, Monitoring, and Evaluation Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Aaron Asibi Abuosi
- Department of Public Administration and Health Services Management, University of Ghana Business School, Accra, Ghana
| | | | - Cynthia Anaba
- Department of Administration, St. Dominic Hospital, Akwatia, Eastern Region, Ghana
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Siopis G, Colagiuri S, Allman-Farinelli M. Effectiveness of dietetic intervention for people with type 2 diabetes: A meta-analysis. Clin Nutr 2021; 40:3114-3122. [PMID: 33413914 DOI: 10.1016/j.clnu.2020.12.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/20/2020] [Accepted: 12/05/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Diet is central to treatment of type 2 diabetes. This review aimed to compare the effectiveness of nutrition therapy delivered by dietitians to nutrition advice delivered by other healthcare professionals in adults with type 2 diabetes on metabolic parameters. METHODS Cochrane CENTRAL, CINAHL, EMBASE, MEDLINE and PsychINFO were searched for randomised controlled trials of three months duration or longer, published from 1st January 2008 to 18th June 2019. Relevant data were extracted from studies with additional author information. Random-effects meta-analysis assessed mean changes in HbA1c and other clinical parameters. PROSPERO registration number: CRD42019130528. RESULTS Of 2477 records identified, fourteen studies, involving 3338 participants, were eligible for qualitative synthesis and meta-analysis. The mean changes [95% CI] at follow-up in HbA1c, BMI, weight, LDL cholesterol, systolic and diastolic blood pressure were -0·47 [-0·92, -0·02] %, -0·38 [-0·63, -0·13] kg/m2, -1·49 [-2·14, -0·84] kg, -0·15 [-0·33, 0·04] mmol/L, -0·75 [-2·45, 0·96] mm Hg and -1·17 [-4·52, 2·17] mm Hg respectively in favour of the intervention group. The quality of evidence was limited due to heterogeneity, risk of bias, publication bias and indirectness. CONCLUSIONS Nutrition therapy provided by dietitians was associated with better clinical parameters of type 2 diabetes, including clinically significant improved glycaemic control, across diverse multiethnic patient groups from all six inhabited continents. This conclusion should be reflected in clinical guidelines.
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Affiliation(s)
- George Siopis
- Charles Perkins Centre, School of Life and Environmental Sciences, The University of Sydney, Sydney, NSW, Australia.
| | - Stephen Colagiuri
- WHO Collaborating Centre for Physical Activity, Nutrition and Obesity, The Boden Collaboration for Obesity, Nutrition, Exercise & Eating Disorders, Faculty of Medicine and Health; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Margaret Allman-Farinelli
- Charles Perkins Centre, School of Life and Environmental Sciences, The University of Sydney, Sydney, NSW, Australia
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Kumah E, Afriyie EK, Abuosi AA, Ankomah SE, Fusheini A, Otchere G. Influence of the Model of Care on the Outcomes of Diabetes Self-Management Education Program: A Scoping Review. J Diabetes Res 2021; 2021:2969243. [PMID: 33688505 PMCID: PMC7914106 DOI: 10.1155/2021/2969243] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 01/14/2021] [Accepted: 02/11/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) accounts for approximately 95% of all diabetes cases, making the disease a global public health concern. The increasing prevalence of T2DM has highlighted the importance of evidence-based guidelines for effective prevention, management, and treatment. Diabetes self-management education (DSME) can produce positive effects on patient behaviors and health status. Study objective. We synthesized findings from the existing studies to find out whether or not the impact of DSME on patient health behaviors and outcomes differ by the different models of diabetes care. That is, we determined whether there are differences in DSME outcomes when patient's care provider is a general practitioner, a specialist, a nurse, or a combination of these health professionals. METHODS Searches were made of six electronic databases to identify relevant English language publications on DSME from 2000 through 2019. Titles and abstracts of the search results were screened to select eligible papers for full-text screening. All eligible papers were retrieved, and full-text screening was done by three independent reviewers to select studies for inclusion in the final analysis. Twenty-one studies were included in the final analysis. The main outcome measures assessed were glycated hemoglobin (HbA1c), body mass index (BMI), diet, and physical activity. RESULTS The majority of the patients with diabetes were seen by primary care physicians. In general, the studies reported significant improvements in patient health behaviors and outcomes. Some differences in outcomes between the different models of care were observed. CONCLUSION Our findings suggest that the effects of DSME on patients' health behaviors and outcomes could differ by the different models of diabetes care. However, considering the limited sample of publications reviewed, and because none of the reviewed studies directly measured the impact of the DSME program on patient behaviors and outcomes, significant conclusions could not be reached.
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Affiliation(s)
- Emmanuel Kumah
- Policy, Planning, Monitoring, & Evaluation Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Emmanuel K. Afriyie
- Laboratory Services Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Aaron A. Abuosi
- Department of Public Administration and Health Services Management, University of Ghana Business School, Ghana
| | - Samuel E. Ankomah
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Adam Fusheini
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Center for Health Literacy and Rural Health Promotion, P.O. Box GP1563, Accra, Ghana
| | - Godfred Otchere
- Policy, Planning, Monitoring, & Evaluation Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
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25
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Castillo-Hernandez KG, Laviada-Molina H, Hernandez-Escalante VM, Molina-Segui F, Mena-Macossay L, Caballero AE. Peer Support Added to Diabetes Education Improves Metabolic Control and Quality of Life in Mayan Adults Living With Type 2 Diabetes: A Randomized Controlled Trial. Can J Diabetes 2020; 45:206-213. [PMID: 33129754 DOI: 10.1016/j.jcjd.2020.08.107] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 06/29/2020] [Accepted: 08/26/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Yucatán, located in the southern region of Mexico, is the state with the country's highest prevalence of uncontrolled diabetes. Because of its particular cultural and socioeconomic characteristics, the residents of Yucatán face unique health-care challenges. The objective of our study was to evaluate the effect of peer support added to a diabetes education program on glycemic control and diabetes-related quality of life when compared with a conventional diabetes education program in patients with type 2 diabetes in a Mayan community in Mexico. METHODS In March 2015, a total of 58 participants with a previous diagnosis of type 2 diabetes who were recruited from community health centres in Komchén were randomly assigned in equal numbers to 1 of 2 groups: 1) a peer support and diabetes self-management education group (PSEG) or 2) a conventional diabetes self-management education-only group. The primary outcomes of interest were glycated hemoglobin (A1C) values and diabetes-related quality of life. The majority of subjects were bilingual (Mayan and Spanish speakers), female and middle aged, and had a low level of formal education and high baseline A1C (mean, 8.7%). RESULTS Whereas both groups showed significant improvements from baseline to study end in absolute levels of A1C, the PSEG group had a more pronounced clinical improvement, but no statistical improvement, in A1C compared with the conventional diabetes self-management education-only group. PSEG participants exhibited statistically significant improvement in diabetes-related quality of life at 8 months. CONCLUSIONS Our study demonstrates the benefits of peer-support education above and beyond the impact of diabetes self-management education on diabetes-related quality of life in an underserved Mayan community in Mexico.
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Affiliation(s)
- Karen G Castillo-Hernandez
- Marist University of Mérida, Mérida, Mexico; Faculty of Medicine, Autonomous University of Yucatán, Mérida, Mexico
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A systematic review of nudge theories and strategies used to influence adult health behaviour and outcome in diabetes management. DIABETES & METABOLISM 2020; 46:450-460. [PMID: 32387700 DOI: 10.1016/j.diabet.2020.04.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/07/2020] [Accepted: 04/22/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Diabetes is a chronic disease associated with a variety of complications, and nudging may be a potential solution to improve diabetes control. Since nudging is a new concept, no review of literature on nudging diabetic patients into improving their health behaviour has been done. Therefore, we aim to collate a list of nudge intervention and determine the context in which nudging is successful. METHODS We adopted a two-arm search strategy comprising the search of literature databases and snowballing using relevant search terms. We summarized patient characteristics, the nudge intervention, according to nudging strategies, delivery mode and their outcomes. The conditions present in effective nudge interventions were assessed and reported. RESULTS We retrieved 11,494 studies from our searches and included 33. An additional five studies were added through snowballing. Studies included utilized framing (n=5), reminders (n=10), gamification (n=2), social modelling (n=5) and social influence (n=16). Studies on reminders and gamification were more likely to have a statistically significant outcome. The targeted health behaviours identified were medication adherence, physical activity, diet, blood glucose monitoring, foot care, self-efficacy, HbA1c and quality of life. Of these, studies with adherence to medication, foot care practice and quality of life as targeted health behaviours were more likely to show a statistically significant outcome. CONCLUSION Nudging has shown potential in changing health behaviour of patients with diabetes in specific context. We identified two possible factors (delivery mode and patient characteristics) that may affect the effectiveness of nudge intervention.
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Gittelsohn J, Anderson Steeves ET, Ho JJ, Shin A, Farner H, Summers A. A Church-Based Diabetes Risk Factor Prevention Program Improves Psychosocial Factors and Food-Related Behaviors. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2020. [DOI: 10.1080/19320248.2018.1564720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Joel Gittelsohn
- Center for Human Nutrition, Johns Hopkins School of Public Health, Baltimore, USA
| | | | - Jessica J Ho
- Center for Human Nutrition, Johns Hopkins School of Public Health, Baltimore, USA
| | - Ahyoung Shin
- Center for Human Nutrition, Johns Hopkins School of Public Health, Baltimore, USA
| | - Harmony Farner
- Center for Human Nutrition, Johns Hopkins School of Public Health, Baltimore, USA
| | - Amber Summers
- Center for Communication Programs, Johns Hopkins School of Public Health, USA
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Flórez KR, Payán DD, Palar K, Williams MV, Katic B, Derose KP. Church-based interventions to address obesity among African Americans and Latinos in the United States: a systematic review. Nutr Rev 2020; 78:304-322. [PMID: 31539069 PMCID: PMC8453621 DOI: 10.1093/nutrit/nuz046] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
CONTEXT Multilevel church-based interventions may help address racial/ethnic disparities in obesity in the United States since churches are often trusted institutions in vulnerable communities. These types of interventions affect at least two levels of socio-ecological influence which could mean an intervention that targets individual congregants as well as the congregation as a whole. However, the extent to which such interventions are developed using a collaborative partnership approach and are effective with diverse racial/ethnic populations is unclear, and these crucial features of well-designed community-based interventions. OBJECTIVE The present systematic literature review of church-based interventions was conducted to assess their efficacy for addressing obesity across different racial/ethnic groups (eg, African Americans, Latinos). DATA SOURCES AND EXTRACTION In total, 43 relevant articles were identified using systematic review methods developed by the Center for Disease Control and Prevention (CDC)'s Task Force on Community Preventive Services. The extent to which each intervention was developed using community-based participatory research principles, was tailored to the particular community in question, and involved the church in the study development and implementation were also assessed. DATA ANALYSIS Although 81% of the studies reported significant results for between- or within-group differences according to the study design, effect sizes were reported or could only be calculated in 56% of cases, and most were small. There was also a lack of diversity among samples (eg, few studies involved Latinos, men, young adults, or children), which limits knowledge about the ability of church-based interventions to reduce the burden of obesity more broadly among vulnerable communities of color. Further, few interventions were multilevel in nature, or incorporated strategies at the church or community level. CONCLUSIONS Church-based interventions to address obesity will have greater impact if they consider the diversity among populations burdened by this condition and develop programs that are tailored to these different populations (eg, men of color, Latinos). Programs could also benefit from employing multilevel approaches to move the field away from behavioral modifications at the individual level and into a more systems-based framework. However, effect sizes will likely remain small, especially since individuals only spend a limited amount of time in this particular setting.
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Affiliation(s)
- Karen R Flórez
- CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Denise D Payán
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, Merced, California, USA
- RAND Corporation, Santa Monica, California, USA
| | - Kartika Palar
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | | | - Bozena Katic
- CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
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Yun Q, Ji Y, Liu S, Shen Y, Jiang X, Fan X, Liu J, Chang C. Can autonomy support have an effect on type 2 diabetes glycemic control? Results of a cluster randomized controlled trial. BMJ Open Diabetes Res Care 2020; 8:8/1/e001018. [PMID: 32299898 PMCID: PMC7199146 DOI: 10.1136/bmjdrc-2019-001018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/05/2020] [Accepted: 03/24/2020] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES To assess whether social support or autonomy support intervention for patients with type 2 diabetes can achieve glycemic control at the end of intervention, and to test whether the glycemic control effect can be maintained for a long time. RESEARCH DESIGN AND METHODS In this cluster randomized controlled trial, 18 community healthcare stations (CHSs) were randomized to the following: (1) usual care group (UCG) offering regular public health management services, (2) social support group (SSG) providing 3-month social support intervention based on problem solving principles, and (3) autonomy support group (ASG) offering 3-month autonomy support intervention based on self-determination theory. A total of 364 patients registered in the CHSs were enrolled into either of the three groups. The primary outcome was hemoglobin A1c (HbA1c), and secondary outcomes were diabetes self-management (DSM) behaviors. Assessment was conducted at baseline and at 3 and 6 months. RESULTS Patients in ASG achieved better HbA1c reduction at the end of intervention (0.53% or 7.23 mmol/mol, p<0.001) than those in the UCG and successfully maintained it up to 6 months (0.42% or 5.41 mmol/mol, p<0.001). However, patients in SSG did not experience significant change in HbA1c at 3 or 6 months when compared with patients in UCG. Besides, patients in both the SSG (0.12, p<0.05) and ASG (0.22, p<0.001) experienced improvement in exercise at 3 months. Patients in ASG sustained improvement in exercise up to 6 months (0.21, p<0.001), but those in the SSG did not. CONCLUSIONS Autonomy support for patients with type 2 diabetes could help achieve glycemic control at the end of intervention and successfully maintain it up to 6 months. These findings indicate that autonomy support has positive long-term effects on DSM behaviors and glycemic control and can be recommended in future diabetes intervention programs. TRIAL REGISTRATION NUMBER ChiCTR1900024354.
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Affiliation(s)
- Qingping Yun
- School of Public Health, Peking University, Beijing, China
| | - Ying Ji
- School of Public Health, Peking University, Beijing, China
| | - Shenglan Liu
- School of Public Health, Peking University, Beijing, China
| | - Yang Shen
- School of Public Health, Peking University, Beijing, China
| | - Xuewen Jiang
- School of Public Health, Peking University, Beijing, China
| | - Xinyi Fan
- School of Public Health, Peking University, Beijing, China
| | - Jingnan Liu
- School of Public Health, Peking University, Beijing, China
| | - Chun Chang
- School of Public Health, Peking University, Beijing, China
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Glenn LE, Nichols M, Enriquez M, Jenkins C. Impact of a community-based approach to patient engagement in rural, low-income adults with type 2 diabetes. Public Health Nurs 2019; 37:178-187. [PMID: 31833102 DOI: 10.1111/phn.12693] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/20/2019] [Accepted: 11/23/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE This secondary analysis examined the relationships between Patient Activation Measure (PAM) scores, use of health services, and HgA1C. DESIGN A feasibility study was conducted for a community-based intervention for high-risk adults with uncontrolled diabetes. Data were collected at baseline and monthly, including PAM and modified Diabetes Self-Management Assessment Report Tool. INTERVENTION Participants (n = 58) were randomized to a 3-month nurse (RN) telephone management or community health worker (CHW) in-home intervention, focusing on medication adherence, timely follow-up, diabetes self-management coaching, and linkage to resources. RESULTS Sample was mostly female (73%), African-American (90%), low income (75%), high school education or less (80%), and mean age of 59 years. A positive association between PAM score and self-reported diabetes care recommendations was found (r = .356, p = .014) and significant correlation between baseline PAM score and HgA1C levels (r = -.306, p = .029). A paired samples t test showed statistically significant increases in PAM scores in the CHW intervention group (mean increase +8.5, CI [+2.49 to +14.65]); baseline (M = 60.31, SD = 13.3) to end of study ([M = 68.89, SD = 16.39], t(22) = 2.924, p = .008 [two-tailed]). CONCLUSION A community-based approach to diabetes management demonstrated a positive effect on patient activation. Although disparities in health care access among rural, low-income populations exist, community-based interventions show potential for improving patient engagement in diabetes management and recommended health services.
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Affiliation(s)
- Lynn E Glenn
- University of Missouri Sinclair School of Nursing, Columbia, MO, USA
| | - Michelle Nichols
- Medical University of South Carolina College of Nursing, South Carolina Clinical and Translational Research Institute, Charleston, SC, USA
| | - Maithe Enriquez
- University of Missouri Sinclair School of Nursing, Columbia, MO, USA
| | - Carolyn Jenkins
- Medical University of South Carolina College of Nursing, South Carolina Clinical and Translational Research Institute, Charleston, SC, USA
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Azzi JL, Azzi S, Lavigne-Robichaud M, Vermeer A, Barresi T, Blaine S, Giroux I. Participant Evaluation of a Prediabetes Intervention Program Designed for Rural Adults. CAN J DIET PRACT RES 2019; 81:80-85. [PMID: 31736334 DOI: 10.3148/cjdpr-2019-033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The type 2 diabetes epidemic is a global crisis threatening the health and economies of many nations. This study aimed to evaluate a prediabetes intervention program designed for rural adults in southwestern Ontario based on the feedback of participants. Rural adults with prediabetes were referred by physicians to an intervention program developed to assist with unique barriers rural adults face related to the built environment and socioeconomic status when adopting a healthy lifestyle. After 6 monthly education sessions offered by a dietitian and a nurse, participants completed a questionnaire to share their program experience. In addition, 6 focus groups consisting of 5-9 participants were conducted to assess program acceptability, feasibility, and practicality. Of 49 enrolled, 35 participants aged 60.8 ± 7.1 (mean ± SD) evaluated the program. Participants reported finding the program to be acceptable, feasible, and practical due to the interactive nature of the sessions, the group setting and the availability of health professionals. This prediabetes lifestyle intervention program was perceived as successfully addressing rural adults' needs in terms of adopting a healthy lifestyle. Feedback received through program evaluation, which included a participant experience survey and focus groups has helped improve this program and may benefit other prediabetes education intervention programs.
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Affiliation(s)
- Jayson L Azzi
- Faculty of Medicine, University of Ottawa, Ottawa, ON
| | - Sarita Azzi
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON
| | | | | | | | | | - Isabelle Giroux
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON
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32
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Moore AP, Rivas CA, Stanton-Fay S, Harding S, Goff LM. Designing the Healthy Eating and Active Lifestyles for Diabetes (HEAL-D) self-management and support programme for UK African and Caribbean communities: a culturally tailored, complex intervention under-pinned by behaviour change theory. BMC Public Health 2019; 19:1146. [PMID: 31429735 PMCID: PMC6702734 DOI: 10.1186/s12889-019-7411-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 07/31/2019] [Indexed: 01/02/2023] Open
Abstract
Background UK African and Caribbean (AfC) communities are disproportionately burdened by type 2 diabetes (T2D). Promoting healthy eating and physical activity through structured education is the cornerstone of T2D care, however cultural barriers may limit engagement in these communities. In addition, changes in lifestyle behaviour are shaped by normative influences within social groups and contextual factors need to be understood to facilitate healthful behaviour change. The Behaviour Change Wheel (BCW) and associated COM-B framework offer intervention designers a systematic approach to developing interventions. The aim of this study was to apply the BCW in the design of a culturally sensitive self-management support programme for T2D in UK AfC communities. Methods An intervention development study was conducted. Focus groups were held with 41 AfC patients with T2D to understand healthful weight-management, diet and physical activity behaviours. The COM-B framework and BCW were used to evaluate the qualitative data, identify appropriate behaviour change techniques and specify the intervention components. Results Participants were motivated to avoid diabetes-related consequences although did not always understand the negative impact of their current health behaviours on long-term diabetes outcomes. Barriers to healthful behaviour included gaps in knowledge related to diet, physical activity and weight management guidance. In addition, motivation and social opportunity barriers included an acceptance of larger body sizes, rejection of body mass index for weight guidance and cultural identity being strongly linked to consumption of traditional starches. There was a lack of social opportunity to perform moderate to vigorous physical activity, although walking and dance were culturally acceptable. The resulting Healthy Eating & Active Lifestyles for Diabetes (HEAL-D) intervention uses social support, social comparison, credible sources and demonstration as key behaviour change techniques. Conclusion Use of COM-B and the BCW highlighted the need for an intervention to address motivational and social opportunity barriers to engaging in healthful behaviours, as well as addressing key gaps in knowledge. This framework facilitated the linkage of theoretical behaviour constructs with evidence-based behaviour change techniques, which will enable us to evaluate operationalisation of our chosen BCTs and their impact on behaviour change in a future feasibility study. Electronic supplementary material The online version of this article (10.1186/s12889-019-7411-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amanda P Moore
- King's College London, Departments of Diabetes & Nutritional Sciences, School of Life Course Sciences, Faculty of Life Sciences & Medicine, Room 3.87 Franklin-Wilkins Building, Stamford Street, London, SE1 9NH, England
| | - Carol A Rivas
- Institute of Education, University College London, 18 Woburn Square, London, WC1H ONR, England
| | - Stephanie Stanton-Fay
- Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, Alexandra House, 17-19 Queens Square, WC1N 3AZ, London, England
| | - Seeromanie Harding
- King's College London, Departments of Diabetes & Nutritional Sciences, School of Life Course Sciences, Faculty of Life Sciences & Medicine, Room 3.87 Franklin-Wilkins Building, Stamford Street, London, SE1 9NH, England
| | - Louise M Goff
- King's College London, Departments of Diabetes & Nutritional Sciences, School of Life Course Sciences, Faculty of Life Sciences & Medicine, Room 3.87 Franklin-Wilkins Building, Stamford Street, London, SE1 9NH, England.
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33
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Han HR, Nkimbeng M, Ajomagberin O, Grunstra K, Sharps P, Renda S, Maruthur N. Health literacy enhanced intervention for inner-city African Americans with uncontrolled diabetes: a pilot study. Pilot Feasibility Stud 2019; 5:99. [PMID: 31410294 PMCID: PMC6686457 DOI: 10.1186/s40814-019-0484-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 07/30/2019] [Indexed: 01/14/2023] Open
Abstract
Background Disparities in diagnosis and control of type 2 diabetes mellitus are most evident in African Americans (AAs) with lower socioeconomic status. Health literacy is an important predictor of adequate self-management and control of diabetes. The purpose of this pilot study was to test the feasibility and preliminary efficacy of a health literacy-enhanced diabetes intervention, PLAN 4 Success (Prevention through Lifestyle intervention And Numeracy)-Diabetes, in inner-city, low-income AAs with uncontrolled type 2 diabetes. Methods Nineteen of 30 participants who completed the baseline survey received the study intervention which consisted of 4-week health literacy training and disease knowledge education followed by two home visits and monthly phone counseling for over 24 weeks. Results A retention rate of 58% was achieved at 24 weeks. All participants who completed the follow-up assessment at 24 weeks reported high satisfaction with the intervention. Participation in the PLAN 4 Success-Diabetes was associated with improved glucose control and psychological outcomes at 12 weeks but the positive trend was attenuated at 24 weeks. Conclusions The current intervention protocols were in general feasible and highly acceptable. The results support health literacy training as a promising component of interventions to promote glucose control among inner-city AAs. Some changes are suggested to optimize the protocols, before conducting a randomized controlled trial. Future interventions should consider addressing social determinants of health such as transportation as part of designing an intervention targeting low-income AAs with uncontrolled type 2 diabetes. Trial registration ClinicalTrials.gov, NCT03925948. Registered on 24 April 2019—retrospectively registered.
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Affiliation(s)
- Hae-Ra Han
- 1School of Nursing, The Johns Hopkins University, 525 N. Wolfe St., Room 526, Baltimore, MD 21205 USA.,2Center for Community Innovation and Scholarship, The Johns Hopkins University, Baltimore, MD 21205 USA
| | - Manka Nkimbeng
- 1School of Nursing, The Johns Hopkins University, 525 N. Wolfe St., Room 526, Baltimore, MD 21205 USA
| | - Olayinka Ajomagberin
- 1School of Nursing, The Johns Hopkins University, 525 N. Wolfe St., Room 526, Baltimore, MD 21205 USA.,2Center for Community Innovation and Scholarship, The Johns Hopkins University, Baltimore, MD 21205 USA
| | - Kelli Grunstra
- 1School of Nursing, The Johns Hopkins University, 525 N. Wolfe St., Room 526, Baltimore, MD 21205 USA
| | - Phyllis Sharps
- 1School of Nursing, The Johns Hopkins University, 525 N. Wolfe St., Room 526, Baltimore, MD 21205 USA.,2Center for Community Innovation and Scholarship, The Johns Hopkins University, Baltimore, MD 21205 USA
| | - Susan Renda
- 1School of Nursing, The Johns Hopkins University, 525 N. Wolfe St., Room 526, Baltimore, MD 21205 USA
| | - Nisa Maruthur
- 3School of Medicine, The Johns Hopkins University, Baltimore, MD USA
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Han P, Nicholson W, Norton A, Graffeo K, Singerman R, King S, Sundaresan A, Bennett W. DiabetesSistersVoices: Virtual Patient Community to Identify Research Priorities for Women Living With Diabetes. J Med Internet Res 2019; 21:e13312. [PMID: 31094360 PMCID: PMC6533875 DOI: 10.2196/13312] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/29/2019] [Accepted: 03/30/2019] [Indexed: 01/16/2023] Open
Abstract
Background Women with or at high risk of diabetes have unique health concerns across their life course. Effective methods are needed to engage women living with diabetes to develop and carry out a patient-centered research agenda. Objective This study aimed to (1) describe the creation of DiabetesSistersVoices, a virtual patient community for women living with and at risk for diabetes and (2) assess the feasibility and acceptability of DiabetesSistersVoices for engaging women in talking about their experiences, health care, and research priorities. Methods We partnered with a national advocacy organization to create DiabetesSistersVoices and to develop recruitment strategies, which included use of social media, Web-based newsletters, and weblinks through partnering organizations. Study inclusion criteria were as follows: Being a woman aged ≥18 years, residing in the United States, and self-reporting a diagnosis of diabetes or risk of diabetes. Eligible participants were given access to DiabetesSistersVoices and completed online surveys at enrollment and 6 months. We assessed trends in participants’ activities, including posting questions, sharing experiences about living with diabetes, and searching for posted resources. Results We enrolled 332 women (white: 86.5%; type 1 diabetes: 76.2%; median age: 51 years [interquartile range: 31 to 59 years]) over 8 months. Most (41.6%, 138/332) were classified as being active users (ie, posting) of the virtual community, 36.1% (120/332) as observers (ie, logged in but no posts), and 22.3% (74/332) as never users (ie, completed baseline surveys but then never logged in). Online activities were constant during the study, although participants had the highest website usage during the first 10 weeks after their enrollment. Conclusions We demonstrated the feasibility and acceptability of an online patient community for women living with diabetes by showing durability of recruitment and online usage over 6 months of testing. Next steps are to address barriers to joining a virtual patient community for women of color and women with type 2 diabetes to enhance inclusiveness and gain diverse perspectives to inform diabetes research.
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Affiliation(s)
- Peijin Han
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Wanda Nicholson
- Center for Women's Health Research, Department of Obstetrics and Gynecology, Chapel Hill, NC, United States.,Public Health Leadership Program, The University of North Carolina School of Medicine and, Gillings Global School of Public Health, Chapel Hill, NC, United States
| | - Anna Norton
- DiabetesSisters, #180, 1112 W Boughton Road, Bolingbrook, IL, United States
| | - Karen Graffeo
- DiabetesSisters, #180, 1112 W Boughton Road, Bolingbrook, IL, United States
| | | | | | - Aditi Sundaresan
- Center for Women's Health Research, Department of Obstetrics and Gynecology, Chapel Hill, NC, United States
| | - Wendy Bennett
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.,Johns Hopkins University School of Medicin, Division of General Internal Medicine, Baltimore, MD, United States
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Nonpharmacologic Interventions for the Self-Management of Anxiety in Parkinson's Disease: A Comprehensive Review. Behav Neurol 2019; 2019:8459579. [PMID: 31191740 PMCID: PMC6525888 DOI: 10.1155/2019/8459579] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 02/13/2019] [Accepted: 03/17/2019] [Indexed: 12/21/2022] Open
Abstract
Anxiety in Parkinson's disease (aPD) is underdiagnosed, undertreated, and understudied. As many as 50% of persons diagnosed with Parkinson's disease (PD) are reported to suffer from anxiety. Current treatment is largely pharmacologic, which can result in a myriad of undesirable and unsafe side effects. The aim of this paper is to examine intervention studies of self-managed nonpharmacological strategies for the treatment of anxiety. A comprehensive review was conducted on experimental or quasi-experimental trials that included self-management approaches for the nonpharmacologic treatment of anxiety as a primary or secondary aim or outcome measure. Thirteen studies were identified from four databases. Study quality demonstrated variability in design and delivery of self-managed interventions; sample sizes were small; anxiety was most commonly a secondary aim; and the use of anxiety measures varied widely. Statistical significance was evident in slightly more than 50% of the anxiety intervention studies. A common element in the interventions in all studies was the focused use of breath. Further research is needed to determine the feasibility of using focused breathing, alone, as an intervention for the self-management of anxiety in Parkinson's disease.
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McElfish PA, Long CR, Kohler PO, Yeary KHK, Bursac Z, Narcisse MR, Felix HC, Rowland B, Hudson JS, Goulden PA. Comparative Effectiveness and Maintenance of Diabetes Self-Management Education Interventions for Marshallese Patients With Type 2 Diabetes: A Randomized Controlled Trial. Diabetes Care 2019; 42:849-858. [PMID: 30862659 PMCID: PMC6489107 DOI: 10.2337/dc18-1985] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 02/07/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Marshallese adults experience high rates of type 2 diabetes. Previous diabetes self-management education (DSME) interventions among Marshallese were unsuccessful. This study compared the extent to which two DSME interventions improved glycemic control, measured on the basis of change in glycated hemoglobin (HbA1c). RESEARCH DESIGN AND METHODS A two-arm randomized controlled trial compared a standard-model DSME (standard DSME) with a culturally adapted family-model DSME (adapted DSME). Marshallese adults with type 2 diabetes (n = 221) received either standard DSME in a community setting (n = 111) or adapted DSME in a home setting (n = 110). Outcome measures were assessed at baseline, immediately after the intervention, and at 6 and 12 months after the intervention and were examined with adjusted linear mixed-effects regression models. RESULTS Participants in the adapted DSME arm showed significantly greater declines in mean HbA1c immediately (-0.61% [95% CI -1.19, -0.03]; P = 0.038) and 12 months (-0.77% [95% CI -1.38, -0.17]; P = 0.013) after the intervention than those in the standard DSME arm. Within the adapted DSME arm, participants had significant reductions in mean HbA1c from baseline to immediately after the intervention (-1.18% [95% CI -1.55, -0.81]), to 6 months (-0.67% [95% CI -1.06, -0.28]), and to 12 months (-0.87% [95% CI -1.28, -0.46]) (P < 0.001 for all). Participants in the standard DSME arm had significant reductions in mean HbA1c from baseline to immediately after the intervention (-0.55% [95% CI -0.93, -0.17]; P = 0.005). CONCLUSIONS Participants receiving the adapted DSME showed significantly greater reductions in mean HbA1c immediately after and 12 months after the intervention than the reductions among those receiving standard DSME. This study adds to the body of research that shows the potential effectiveness of culturally adapted DSME that includes participants' family members.
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Affiliation(s)
- Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR
| | - Christopher R Long
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR
| | - Peter O Kohler
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR
| | - Karen H K Yeary
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Zoran Bursac
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL
| | - Marie-Rachelle Narcisse
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR
| | - Holly C Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR
| | - Jonell S Hudson
- College of Pharmacy, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR
| | - Peter A Goulden
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
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Derose KP, Williams MV, Branch CA, Flórez KR, Hawes-Dawson J, Mata MA, Oden CW, Wong EC. A Community-Partnered Approach to Developing Church-Based Interventions to Reduce Health Disparities Among African-Americans and Latinos. J Racial Ethn Health Disparities 2019; 6:254-264. [PMID: 30120736 PMCID: PMC6378139 DOI: 10.1007/s40615-018-0520-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/01/2018] [Accepted: 08/07/2018] [Indexed: 10/28/2022]
Abstract
Faith and public health partnerships offer promise to addressing health disparities, but examples that incorporate African-Americans and Latino congregations are lacking. Here we present results from developing a multi-ethnic, multi-denominational faith and public health partnership to address health disparities through community-based participatory research (CBPR), focusing on several key issues: (1) the multi-layered governance structure and activities to establish the partnership and identify initial health priority (obesity), (2) characteristics of the congregations recruited to partnership (n = 66), and (3) the lessons learned from participating congregations' past work on obesity that informed the development of a multi-level, multi-component, church-based intervention. Having diverse staff with deep ties in the faith community, both among researchers and the primary community partner agency, was key to recruiting African-American and Latino churches. Involvement by local health department and community health clinic personnel provided technical expertise and support regarding health data and clinical resources. Selecting a health issue-obesity-that affected all subgroups (e.g., African-Americans and Latinos, women and men, children and adults) garnered high enthusiasm among partners, as did including some innovative aspects such as a text/e-mail messaging component and a community mapping exercise to identify issues for advocacy. Funding that allowed for an extensive community engagement and planning process was key to successfully implementing a CBPR approach. Building partnerships through which multiple CBPR initiatives can be done offers efficiencies and sustainability in terms of programmatic activities, though long-term infrastructure grants, institutional support, and non-research funding from local foundations and health systems are likely needed.
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Affiliation(s)
| | | | - Cheryl A Branch
- Los Angeles Metropolitan Churches, Los Angeles, CA, 90011, USA
| | - Karen R Flórez
- CUNY Graduate School of Public Health and Health Policy, New York, NY, 10027, USA
| | | | | | | | - Eunice C Wong
- RAND Corporation, 1776 Main St., Santa Monica, CA, 90401, USA
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Grady PA, Gough LL. El automanejo de las enfermedades crónicas: un método integral de atención. Am J Public Health 2018. [DOI: 10.2105/ajph.2014.302041s] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Patricia A. Grady
- Instituto Nacional de Investigación en Enfermería, Institutos Nacionales de Salud, Bethesda, Maryland, Estados Unidos de América
| | - Lisa Lucio Gough
- Instituto Nacional de Investigación en Enfermería, Institutos Nacionales de Salud, Bethesda, Maryland, Estados Unidos de América
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Self-Management: A Comprehensive Approach to Management of Chronic Conditions. Am J Public Health 2018; 108:S430-S436. [PMCID: PMC6291774 DOI: 10.2105/ajph.2014.302041r] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2014] [Indexed: 08/05/2023]
Abstract
For both clinical and economic reasons, the increasing number of persons living with chronic conditions represents a public health issue of growing importance. Emphasizing patient responsibility, and acting in concert with the provider community, self-management represents a promising strategy for treating chronic conditions—moving beyond education to teaching individuals to actively identify challenges and solve problems associated with their illness. Self-management also shows potential as an effective paradigm across the prevention spectrum (primary, secondary, and tertiary) by establishing a pattern for health early in life and providing strategies for mitigating illness and managing it in later life. We suggest ways to advance research methods and practical applications of self-management as steps in its future development and implementation.
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40
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Yorke E, Atiase Y. Impact of structured education on glucose control and hypoglycaemia in Type-2 diabetes: a systematic review of randomized controlled trials. Ghana Med J 2018; 52:41-60. [PMID: 30013260 DOI: 10.4314/gmj.v52i1.8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Evidence for the use of structured education in diabetes management is accumulating and has shown positive influence in the management of Type-2 diabetes. Objective To assess the impact of structured education on glucose control and hypoglycaemia in the management of Type-2 diabetes. Methods A systematic review was done using Medline via Ovid and EMBASE databases of published English literature between 1980 and 2014. Included studies were randomized control trials that assessed the impact of structured education on glucose control and hypoglycaemia. Results Out of the 12,086 full text articles were identified, 36 full text articles were finally considered for this review after applying both inclusion and exclusion criteria, of which 34 were exclusively on the effect of structured diabetes education on glucose control whilst 2 were studies on the effects of structured diabetes education on glucose control and hypoglycaemia. Majority of the studies included a predominant Caucasian population. There was heterogeneity in the included studies such as intervention methods and intensity as well as follow up periods. Group based education was preferred over individual education by most studies. Overall, most of the studies showed a significant positive effect on glycaemic control compared with control groups. One study showed a significant impact of structured education on hypoglycaemia. Conclusion Structured education has positive impact on glucose control and hypoglycaemia in Type-2 diabetes and must be incorporated in routine care. Funding The study was funded by the authors.
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Affiliation(s)
- Ernest Yorke
- Department of Medicine & Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Yacoba Atiase
- Department of Medicine & Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
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Sherifali D, Berard LD, Gucciardi E, MacDonald B, MacNeill G. Self-Management Education and Support. Can J Diabetes 2018; 42 Suppl 1:S36-S41. [PMID: 29650109 DOI: 10.1016/j.jcjd.2017.10.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Indexed: 12/16/2022]
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42
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Kumah E, Sciolli G, Toraldo ML, Murante AM. The diabetes self-management educational programs and their integration in the usual care: A systematic literature review. Health Policy 2018; 122:866-877. [PMID: 30007520 DOI: 10.1016/j.healthpol.2018.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/02/2018] [Accepted: 06/06/2018] [Indexed: 12/14/2022]
Abstract
The increasing prevalence of type 2 diabetes has highlighted the importance of evidence-based guidelines for effective prevention, management and treatment. Diabetes self-management education (SME) produces positive effects on patient behaviours and health status. We analyzed the literature to identify (i) the level of integration between usual care and SME programs and (ii) any possible differences across them in terms of outcomes. Searches were made on three databases - PubMed, Scopus and Web of Science - to identify relevant publications on diabetes SME to 2015, which also describe the provider of usual care. In total, 49 studies met the inclusion criteria. We identified three levels of integration (high, medium and low) between usual care and SME programs based on the level of involvement of usual care professionals within the SME programs. In most cases, the primary care physician was responsible for the diabetes patients. Patient health behaviors and/or outcomes improve in most of the studies, independently from the level of integration. However, findings suggest that when patients/participants could perceive that usual care provider is highly involved in SME delivery, educational programs produced results that appear to be more positive.
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Affiliation(s)
- Emmanuel Kumah
- Laboratorio Management e Sanità, Institute of Management, Scuola Superiore Sant'Anna, Italy
| | - Giulia Sciolli
- Laboratorio Management e Sanità, Institute of Management, Scuola Superiore Sant'Anna, Italy
| | - Maria Laura Toraldo
- Laboratorio Management e Sanità, Institute of Management, Scuola Superiore Sant'Anna, Italy
| | - Anna Maria Murante
- Laboratorio Management e Sanità, Institute of Management, Scuola Superiore Sant'Anna, Italy.
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Cunningham AT, Crittendon DR, White N, Mills GD, Diaz V, LaNoue MD. The effect of diabetes self-management education on HbA1c and quality of life in African-Americans: a systematic review and meta-analysis. BMC Health Serv Res 2018; 18:367. [PMID: 29769078 PMCID: PMC5956958 DOI: 10.1186/s12913-018-3186-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/04/2018] [Indexed: 12/20/2022] Open
Abstract
Background Type 2 diabetes presents a major morbidity and mortality burden in the United States. Diabetes self-management education (DSME) is an intervention associated with improved hemoglobin A1c(HbA1c) and quality of life(QOL), and is recommended for all individuals with type 2 diabetes. African-Americans have disproportionate type 2 diabetes morbidity and mortality, yet no prior meta-analyses have examined DSME outcomes exclusively in this population. This systematic review and meta-analysis examined the impact of DSME on HbA1c and QOL in African-Americans compared to usual care. Methods Randomized controlled trials, cluster-randomized trials, and quasi-experimental interventions were included. 352 citations were retrieved; 279 abstracts were reviewed, and 44 full-text articles were reviewed. Fourteen studies were eligible for systematic review and 8 for HbA1c meta-analysis; QOL measures were too heterogeneous to pool. Heterogeneity of HbA1c findings was assessed with Cochran’s Q and I2. Results HbA1c weighted mean difference between intervention and usual care participants was not significant: − 0.08%[− 0.40–0.23];χ2 = 84.79 (p < .001), I2 = 92%, (n = 1630). Four of five studies measuring QOL reported significant improvements for intervention participants. Conclusions Meta-analysis results showed non-significant effect of DSME on HbA1c in African-Americans. QOL did show improvement and is an important DSME outcome to measure in future trials. Further research is needed to understand effectiveness of DSME on HbA1c in this population. Trial registration PROSPERO registration: CRD42017057282. Electronic supplementary material The online version of this article (10.1186/s12913-018-3186-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amy T Cunningham
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, 1015 Walnut Street, Suite 401, Philadelphia, PA, 19107, USA.
| | - Denine R Crittendon
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - Neva White
- Center for Urban Health, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Geoffrey D Mills
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, 1015 Walnut Street, Suite 401, Philadelphia, PA, 19107, USA
| | - Victor Diaz
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, 1015 Walnut Street, Suite 401, Philadelphia, PA, 19107, USA
| | - Marianna D LaNoue
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, 1015 Walnut Street, Suite 401, Philadelphia, PA, 19107, USA
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Owolabi MO, Yaria JO, Daivadanam M, Makanjuola AI, Parker G, Oldenburg B, Vedanthan R, Norris S, Oguntoye AR, Osundina MA, Herasme O, Lakoh S, Ogunjimi LO, Abraham SE, Olowoyo P, Jenkins C, Feng W, Bayona H, Mohan S, Joshi R, Webster R, Kengne AP, Trofor A, Lotrean LM, Praveen D, Zafra-Tanaka JH, Lazo-Porras M, Bobrow K, Riddell MA, Makrilakis K, Manios Y, Ovbiagele B. Gaps in Guidelines for the Management of Diabetes in Low- and Middle-Income Versus High-Income Countries-A Systematic Review. Diabetes Care 2018; 41:1097-1105. [PMID: 29678866 PMCID: PMC5911785 DOI: 10.2337/dc17-1795] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 01/17/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The extent to which diabetes (DM) practice guidelines, often based on evidence from high-income countries (HIC), can be implemented to improve outcomes in low- and middle-income countries (LMIC) is a critical challenge. We carried out a systematic review to compare type 2 DM guidelines in individual LMIC versus HIC over the past decade to identify aspects that could be improved to facilitate implementation. RESEARCH DESIGN AND METHODS Eligible guidelines were sought from online databases and websites of diabetes associations and ministries of health. Type 2 DM guidelines published between 2006 and 2016 with accessible full publications were included. Each of the 54 eligible guidelines was assessed for compliance with the Institute of Medicine (IOM) standards, coverage of the cardiovascular quadrangle (epidemiologic surveillance, prevention, acute care, and rehabilitation), translatability, and its target audiences. RESULTS Most LMIC guidelines were inadequate in terms of applicability, clarity, and dissemination plan as well as socioeconomic and ethical-legal contextualization. LMIC guidelines targeted mainly health care providers, with only a few including patients (7%), payers (11%), and policy makers (18%) as their target audiences. Compared with HIC guidelines, the spectrum of DM clinical care addressed by LMIC guidelines was narrow. Most guidelines from the LMIC complied with less than half of the IOM standards, with 12% of the LMIC guidelines satisfying at least four IOM criteria as opposed to 60% of the HIC guidelines (P < 0.001). CONCLUSIONS A new approach to the contextualization, content development, and delivery of LMIC guidelines is needed to improve outcomes.
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Affiliation(s)
| | | | - Meena Daivadanam
- Department of Food, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden.,Department of Public Health Sciences, Karolinska Institutet, Solna, Sweden
| | | | | | | | | | - Shane Norris
- University of the Witwatersrand, Johannesburg, South Africa
| | | | | | | | | | | | | | | | | | - Wuwei Feng
- Medical University of South Carolina, Charleston, SC
| | - Hernán Bayona
- Fundación Santa Fe de Bogotá Hospital, University of the Andes, Bogota, Colombia
| | | | - Rohina Joshi
- The George Institute for Global Health, The University of New South Wales, Sydney, Australia
| | - Ruth Webster
- The George Institute for Global Health, The University of New South Wales, Sydney, Australia
| | - Andre P Kengne
- South African Medical Research Council, Cape Town, South Africa
| | - Antigona Trofor
- Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
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Leppin AL, Schaepe K, Egginton J, Dick S, Branda M, Christiansen L, Burow NM, Gaw C, Montori VM. Integrating community-based health promotion programs and primary care: a mixed methods analysis of feasibility. BMC Health Serv Res 2018; 18:72. [PMID: 29386034 PMCID: PMC5793407 DOI: 10.1186/s12913-018-2866-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 01/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Implementation of evidence-based programs (EBPs) for disease self-management and prevention is a policy priority. It is challenging to implement EBPs offered in community settings and to integrate them with healthcare. We sought to understand, categorize, and richly describe key challenges and opportunities related to integrating EBPs into routine primary care practice in the United States. METHODS As part of a parent, participatory action research project, we conducted a mixed methods evaluation guided by the PRECEDE implementation planning model in an 11-county region of Southeast Minnesota. Our community-partnered research team interviewed and surveyed 15 and 190 primary care clinicians and 15 and 88 non-clinician stakeholders, respectively. We coded interviews according to pre-defined PRECEDE factors and by participant type and searched for emerging themes. We then categorized survey items-before looking at participant responses-according to their ability to generate further evidence supporting the PRECEDE factors and emerging themes. We statistically summarized data within and across responder groups. When consistent, we merged these with qualitative insight. RESULTS The themes we found, "Two Systems, Two Worlds," "Not My Job," and "Seeing is Believing," highlighted the disparate nature of prescribed activities that different stakeholders do to contribute to health. For instance, primary care clinicians felt pressured to focus on activities of diagnosis and treatment and did not imagine ways in which EBPs could contribute to either. Quantitative analyses supported aspects of all three themes, highlighting clinicians' limited trust in community-placed activities, and the need for tailored education and system and policy-level changes to support their integration with primary care. CONCLUSIONS Primary care and community-based programs exist in disconnected worlds. Without urgent and intentional efforts to bridge well-care and sick-care, interventions that support people's efforts to be and stay well in their communities will remain outside of-if not at odds with-healthcare.
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Affiliation(s)
- Aaron L Leppin
- Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Karen Schaepe
- Division of Health Care and Policy Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jason Egginton
- Division of Health Care and Policy Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Sara Dick
- Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Megan Branda
- Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Lori Christiansen
- Southeastern Minnesota Area Agency on Aging, 2720 Superior Drive NW, Suite 102, Rochester, MN, 55901, USA
| | - Nicole M Burow
- Dan Abraham Healthy Living Center, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Charlene Gaw
- Mayo Clinic School of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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Utumatwishima JN, Chung ST, Bentley AR, Udahogora M, Sumner AE. Reversing the tide - diagnosis and prevention of T2DM in populations of African descent. Nat Rev Endocrinol 2018; 14:45-56. [PMID: 29052590 DOI: 10.1038/nrendo.2017.127] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Populations of African descent are at the forefront of the worldwide epidemic of type 2 diabetes mellitus (T2DM). The burden of T2DM is amplified by diagnosis after preventable complications of the disease have occurred. Earlier detection would result in a reduction in undiagnosed T2DM, more accurate statistics, more informed resource allocation and better health. An underappreciated factor contributing to undiagnosed T2DM in populations of African descent is that screening tests for hyperglycaemia, specifically, fasting plasma glucose and HbA1c, perform sub-optimally in these populations. To offset this problem, combining tests or adding glycated albumin (a nonfasting marker of glycaemia), might be the way forward. However, differences in diet, exercise, BMI, environment, gene-environment interactions and the prevalence of sickle cell trait mean that neither diagnostic tests nor interventions will be uniformly effective in individuals of African, Caribbean or African-American descent. Among these three populations of African descent, intensive lifestyle interventions have been reported in only the African-American population, in which they have been found to provide effective primary prevention of T2DM but not secondary prevention. Owing to a lack of health literacy and poor glycaemic control in Africa and the Caribbean, customized lifestyle interventions might achieve both secondary and primary prevention. Overall, diagnosis and prevention of T2DM requires innovative strategies that are sensitive to the diversity that exists within populations of African descent.
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Affiliation(s)
- Jean N Utumatwishima
- Section on Ethnicity and Health, Diabetes, Endocrinology and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health (NIH), 9000 Rockville Pike, Bethesda, Maryland 20892, USA
| | - Stephanie T Chung
- Section on Ethnicity and Health, Diabetes, Endocrinology and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health (NIH), 9000 Rockville Pike, Bethesda, Maryland 20892, USA
| | - Amy R Bentley
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health (NIH), 9000 Rockville Pike, Bethesda, Maryland 20892, USA
| | - Margaret Udahogora
- Dietetics Program, University of Maryland, College Park, 0112 Skinner Building, Office 0125 Skinner Building, College Park, Maryland 20742, USA
| | - Anne E Sumner
- Section on Ethnicity and Health, Diabetes, Endocrinology and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health (NIH), 9000 Rockville Pike, Bethesda, Maryland 20892, USA
- National Institute of Minority Health and Health Disparities, National Institutes of Health (NIH), 9000 Rockville Pike, Bethesda, Maryland 20892, USA
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Spencer-Bonilla G, Ponce OJ, Rodriguez-Gutierrez R, Alvarez-Villalobos N, Erwin PJ, Larrea-Mantilla L, Rogers A, Montori VM. A systematic review and meta-analysis of trials of social network interventions in type 2 diabetes. BMJ Open 2017; 7:e016506. [PMID: 28827256 PMCID: PMC5629689 DOI: 10.1136/bmjopen-2017-016506] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 06/22/2017] [Accepted: 07/07/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES In the care of patients with type 2 diabetes, self-management is emphasised and studied while theory and observations suggest that patients also benefit from social support. We sought to assess the effect of social network interventions on social support, glycaemic control and quality of life in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS We searched Ovid MEDLINE, Ovid EBM Reviews, Cochrane Central Register of Controlled Trials, EMBASE, PsycINFO and CINAHL through April 2017 for randomised clinical trials (RCTs) of social network interventions in patients with type 2 diabetes. Reviewers working independently and in duplicate assessed eligibility and risk of bias, and extracted data from eligible RCTs. We pooled estimates using inverse variance random effects meta-analysis. RESULTS We found 19 eligible RCTs enrolling 2319 participants. Social network interventions were commonly based on individual behaviour change rather than social or interpersonal theories of self-management, were educational, and sought to engage social network members for their knowledge and experience. Interventions improved social support (0.74 SD (95% CI 0.32 to 1.15), I2=89%, 8 RCTs) and haemoglobin A1c at 3 months (-0.25 percentage points (95% CI -0.40 to -0.11), I2=12%, 9 RCTs), but not quality of life. CONCLUSIONS Despite a compelling theoretical base, researchers have only minimally studied the value of interventions targeting patients' social networks on diabetes care. Although the body of evidence to date is limited, and based on individual behaviour change theories, the results are promising. This review challenges the scientific community to design and test theory-based interventions that go beyond self-management approaches to focus on the largely untapped potential of social networks to improve diabetes care. PROSPERO REGISTRATION CRD42016036117.
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Affiliation(s)
| | - Oscar J Ponce
- Department of Medicine, Mayo Clinic, Rochester, USA
- Department of Medicine, Universidad Peruana Cayetano Heredia, Lima, USA
| | - Rene Rodriguez-Gutierrez
- Department of Medicine, Mayo Clinic, Rochester, USA
- Department of Internal Medicine, University Hospital Dr Jose E. Gonzalez, Autonomous University of Nuevo Leon, Mexico
| | - Neri Alvarez-Villalobos
- Department of Medicine, Mayo Clinic, Rochester, USA
- Department of Medical Statistics, University Hospital Dr Jose E. Gonzalez Autonomous,University of Nuevo Leo, Mexico, USA
| | | | - Laura Larrea-Mantilla
- Department of Medicine, Mayo Clinic, Rochester, USA
- Evidence-Based Practice Centre Mayo Clinic, Rochester, USA
| | - Anne Rogers
- NIHR CLAHRC Wessex, Health Sciences, University of Southampton, Southampton, UK
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Whitney E, Kindred E, Pratt A, O'Neal Y, Harrison RCP, Peek ME. Culturally Tailoring a Patient Empowerment and Diabetes Education Curriculum for the African American Church. DIABETES EDUCATOR 2017; 43:441-448. [PMID: 28793835 DOI: 10.1177/0145721717725280] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The African American church has long been recognized as a valuable partner for health interventions in the community. While an extensive literature exists documenting the potential efficacy of diabetes education programs in church settings, there has yet to be an effort to leverage spiritual beliefs and practices to promote diabetes self-management and shared decision making within a faith-based framework that is culturally tailored to the African American church. The purpose of this article is to describe the translation of a clinic-based diabetes education program into faith-based education curriculum tailored for use in the African American church. Conclusions Themes extracted from focus groups and input from a faith-based community partner provided a methodical and patient-informed foundation for culturally tailoring and piloting a diabetes self-management curriculum for the African American church setting. This study illustrates how spirituality can be incorporated into interventions to enhance health promotion and behavioral change among African Americans with diabetes. Participants in our study described how religious beliefs play an active role in many aspects of diabetes care, including self-management behaviors, coping strategies, and patient/provider communication. In addition, this intervention can serve as a model for the development of patient-centered health interventions.
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Affiliation(s)
- Eric Whitney
- The Pritzker School of Medicine, The University of Chicago, Chicago, Illinois (Mr Whitney, Dr Pratt)
| | - Elijah Kindred
- The University of Chicago, Divinity School, Chicago, Illinois (Mr Kindred)
| | - Abdullah Pratt
- The Pritzker School of Medicine, The University of Chicago, Chicago, Illinois (Mr Whitney, Dr Pratt).,Department of Emergency Medicine, The University of Chicago Medical Center, Chicago, Illinois (Dr Pratt)
| | - Yolanda O'Neal
- The University of Chicago, Section of General Internal Medicine, Chicago, Illinois (Mrs O'Neal, Dr Peek)
| | - Rev Chauncey P Harrison
- New Beginnings Church of Chicago, Chicago, Illinois (Mr Harrison).,Trinity United Church of Christ, Chicago, Illinois (Mr Harrison)
| | - Monica E Peek
- The University of Chicago, Section of General Internal Medicine, Chicago, Illinois (Mrs O'Neal, Dr Peek)
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Saunders DM, Leak J, Carver ME, Smith SA. Application of a faith-based integration tool to assess mental and physical health interventions. JOURNAL OF THE GEORGIA PUBLIC HEALTH ASSOCIATION 2017; 7:26-38. [PMID: 29354795 PMCID: PMC5771442 DOI: 10.21633/jgpha.7.105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background To build on current research involving faith-based interventions (FBIs) for addressing mental and physical health, this study a) reviewed the extent to which relevant publications integrate faith concepts with health and b) initiated analysis of the degree of FBI integration with intervention outcomes. Methods Derived from a systematic search of articles published between 2007 and 2017, 36 studies were assessed with a Faith-Based Integration Assessment Tool (FIAT) to quantify faith-health integration. Basic statistical procedures were employed to determine the association of faith-based integration with intervention outcomes. Results The assessed studies possessed (on average) moderate, inconsistent integration because of poor use of faith measures, and moderate, inconsistent use of faith practices. Analysis procedures for determining the effect of FBI integration on intervention outcomes were inadequate for formulating practical conclusions. Conclusions Regardless of integration, interventions were associated with beneficial outcomes. To determine the link between FBI integration and intervention outcomes, additional analyses are needed.
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Affiliation(s)
| | - Jean Leak
- Refreshing Springs Outreach Sykesville, MD
| | | | - Selina A Smith
- Department of Family Medicine, Medical College of Georgia at Augusta University, Augusta, GA
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Lehrer HM, Dubois SK, Brown SA, Steinhardt MA. Resilience-based Diabetes Self-management Education: Perspectives From African American Participants, Community Leaders, and Healthcare Providers. DIABETES EDUCATOR 2017; 43:367-377. [PMID: 28614997 DOI: 10.1177/0145721717714894] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose The purpose of this qualitative, focus group study was to further refine the Resilience-based Diabetes Self-management Education (RB-DSME) recruitment process and intervention, build greater trust in the community, and identify strategies to enhance its sustainability as a community-based intervention in African American church settings. Methods Six 2-hour focus groups (N = 55; 10 men and 45 women) were led by a trained moderator with a written guide to facilitate discussion. Two sessions were conducted with individuals diagnosed with type 2 diabetes mellitus (T2DM) who participated in previous RB-DSME pilot interventions and their family members, two sessions with local church leaders, and two sessions with community healthcare providers who care for patients with T2DM. Two independent reviewers performed content analysis to identify major themes using a grounded theory approach. The validity of core themes was enhanced by external review and subsequent discussions with two qualitative methods consultants. Results There was expressed interest and acceptability of the RB-DSME program. Church connection and pastor support were noted as key factors in building trust and enhancing recruitment, retention, and sustainability of the program. Core themes across all groups included the value of incentives, the need for foundational knowledge shared with genuine concern, teaching with visuals, dealing with denial, balancing the reality of adverse consequences with hope, the importance of social support, and addressing healthcare delivery barriers. Conclusion Focus groups documented the feasibility and potential effectiveness of RB-DSME interventions to enhance diabetes care in the African American community. In clinical practice, inclusion of these core themes may enhance T2DM self-care and treatment outcomes.
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Affiliation(s)
- H Matthew Lehrer
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, Texas (Mr Lehrer, Dr Dubois, Prof Steinhardt)
| | - Susan K Dubois
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, Texas (Mr Lehrer, Dr Dubois, Prof Steinhardt)
| | - Sharon A Brown
- School of Nursing, The University of Texas at Austin, Austin, Texas (Dr Brown)
| | - Mary A Steinhardt
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, Texas (Mr Lehrer, Dr Dubois, Prof Steinhardt)
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