A culturally focused exercise program in Hispanic adults with type 2 diabetes: a pilot study

The association of obesity with health insurance coverage and demographic characteristics: a statewide cross-sectional study

We evaluated the statewide burden of obesity and its complications among government and state funded programs (Medicare and Medicaid) and commercial insurance.We calculated the prevalence of obesity and the prevalence of relevant comorbidities among different demographic groups and based on health insurance, among adults (18-65 years old) who visited a statewide health network in the state of Rhode Island, in 2017.The overall prevalence of obesity among 74,089 individuals was 38.88% [Asians 16.77%, Whites 37.49%, Hispanics 44.23%, and Blacks 48.44%]. Medicare or Medicaid beneficiaries were 26% and 27%, respectively, more likely to have obesity than those who had commercial insurance (Odds Ratio:1.26, 95% confidence interval [CI]:1.20-1.32; Odds Ratio:1.27, 95%CI:1.22-1.32). Moreover, Medicaid and Medicare beneficiaries with obesity had a higher prevalence of diabetes compared with privately insured with obesity (10.58% and 10.44% vs 4.45%). Medicare beneficiaries with obesity had a statistically higher prevalence of ischemic heart disease (4.34%, 95%CI: 3.77-4.91) than privately insured (3.21%, 95%CI: 2.94-3.47).Based on statewide data among 18 to 65 years old adults, Medicare and Medicaid provide health coverage to 40% of individuals with obesity and 46% of those with the obesity-related comorbidities and complications. State and federal health care programs need to support and expand obesity-related services and coverage.

Preparing Chinese patients with comorbid heart disease and diabetes for home management: a mixed methods study

OBJECTIVE

To explore how health education received by patients with acute coronary syndrome (ACS) and type 2 diabetes mellitus (T2DM) influences patients' self-efficacy and self-management and changes in behaviour at, and following, hospital discharge.

DESIGN

This study used a convergent mixed methods design.

PARTICIPANTS

Twenty-one participants with completed surveys and interviews at discharge and home follow-up were included in the analysis.

SETTING

At a coronary care unit of a major hospital in Shanghai, China.

RESULTS

Most participants (n=17) did not perceive they had sufficient education or ability to manage both conditions. More concerning was that most participants (n=16) reported low self-efficacy in the management of ACS symptoms. Three major themes were identified: self-management of ACS and T2DM represents a complex interplay between individual self-efficacy, knowledge and skills, as individuals navigate shifting self-management priorities due to perceived condition severity; the social environment is integral to lifestyle and behaviour change and managing multiple health conditions requires body and mind systems' harmony.

CONCLUSIONS

The inpatient education received did not enhance participants' confidence to manage either condition on discharge. While an unhealthy lifestyle was embedded within social roles and norms, some social activities, such as square dancing, positively influenced health behaviour. Culturally appropriate education for Chinese people with diabetes and ACS should contain information on maintaining mind and body harmony. Family members should be involved in formal education.

Contribution of Psychosocial Factors to Physical Activity in Women of Color in the Saving Lives Staying Active (SALSA) Study

Culturally appropriate, innovative strategies to increase physical activity (PA) in women of color are needed. This study examined whether participation in SALSA, an 8-week randomized, crossover pilot study to promote PA, led to improved psychosocial outcomes and whether these changes were associated with changes in PA over time. Women of color (N = 50) completed Internet-based questionnaires on PA, exercise self-efficacy, motivational readiness, stress, and social support at three time points. Women reported high socioeconomic status, decreases in exercise self-efficacy, and increases in motivational readiness for exercise and a number of stressful events (p < .05); changes in motivational readiness for exercise varied by group (p = .043). Changes in psychosocial factors were associated with increases in PA. Latin dance improved motivational readiness for PA. Future studies are needed to determine whether Latin dance improves other psychological measures and quality of life in women of color in an effort to increase PA and reduce health disparities.

Improved Physical Activity Screening Enhances Intervention Effectiveness in Ethnic Minority Women

This study identified inconsistencies in physical activity (PA) reported at screening and baseline of a 6-month health promotion intervention and explored how these inconsistencies influenced intervention effectiveness in African American and Hispanic women. Participants completed a telephone screener to determine eligibility for a PA intervention. Inactive participants (≤90 minutes of PA/week) were invited to a baseline assessment, where they completed the International Physical Activity Questionnaire, measuring work, transportation, gardening/housework, and leisure-time PA. Women returned after 6 months to complete an identical post-intervention assessment. Despite being screened as inactive, baseline Questionnaire data indicated that 85.0% of participants (N = 274, M age = 44.6 years, M body mass index = 34.8 kg/m2) were active (>90 minutes of PA/week). Women who reported any work-related PA were 20.9 times more likely to be active at baseline than those who did not (p < .001). Participants who were inactive at both screening and baseline reported greater increases in domestic and gardening PA and total PA from baseline to postintervention (ps < .05). Overweight/obese ethnic minority women may misreport being physically inactive during screening if specific questions about type of PA are not included. Post hoc analyses controlling for screening inaccuracies may improve effectiveness of PA interventions and help intervention programs reach women who may benefit the most.

The Social Ecological Model and Physical Activity Interventions for Hispanic Women With Type 2 Diabetes: A Review

Hispanic women are less physically active and have higher rates of type 2 diabetes (DM2) when compared with other population groups. This review uses the social ecological model as a framework to identify the individual and social environmental factors associated with successful physical activity (PA) interventions for Hispanic women with DM2. Research questions include (a) Which social ecological levels have been applied to PA interventions? (b) Which individual and social environmental intervention strategies are associated with successful PA outcomes? Database searches using CINAHL, PubMed, and Scopus for the years 2000 to 2015 identified 10 studies; with 6 using quasi-experimental study designs and 4 using randomized controlled designs. Inclusion criteria were Hispanic/Latina women with DM2, ≥70% women, PA interventions, measures of PA, and quantitative designs. Future research should focus on a combination of intervention levels, and DM2 programs should place a greater emphasis on PA intervention strategies.

Health Beliefs and Practices of African Immigrants in Canada

A purposive sample of 14 immigrants living in Ontario, Canada, participated in two focus groups. The researchers used semi-structured interviews to collect data and five themes emerged from the data: beliefs about diabetes were centered on diverse factors, preserving culture through food preferences and preparation, cultural practices to stay healthy, cultural practices determined number of servings of fruit and vegetables per day, and engaging in physical activity to stay healthy. Findings indicated how health beliefs and cultural practices influenced behavior in preventing type 2 diabetes (T2D). Future research should focus on other high-risk minority groups (South Asian, Caribbean, and Latin American) to examine their health beliefs and cultural practices and use these finding to develop best practice guidelines, which should be incorporated into culturally tailored interventions.

Improving Physical Activity in Hispanics with Diabetes and their Families

OBJECTIVE

This study examined changes in physical activity among Hispanics with diabetes and their families who received an 8-week diabetes self-management intervention.

DESIGN

A quasi-experimental design was used to conduct a secondary analysis of physical activity data from two intervention studies that used the same protocols and measures.

SAMPLE

A total of 65 patients and 66 family members participated in the studies.

MEASURES

Physical activity was measured with the International Physical Activity Questionnaire (IPAQ) and pedometers. Self-report of physical activity was collected pre- and postintervention, and pedometer data for the 8 weeks of the intervention period.

INTERVENTION

The interventions consisted of 8 weeks of educational sessions.

RESULTS

IPAQ walking Metabolic Equivalent of Task (MET)-minutes per week significantly increased for patients (p < .001) and family members (p < .001) from pre- to postintervention as did moderate activity MET-minutes/week for family members (p = .004). Based on pedometer steps, the percentage of sedentary patients declined from 38% to 17% over the intervention record; differences in pedometer steps over time were not significant for patients (p = .803) or family members (p = .144).

CONCLUSIONS

Pedometers are a cost effective and user-friendly method of measuring physical activity. Pedometers can also serve as a motivator to help increase physical activity among Hispanics with diabetes and their family members.

Engaging South Asian women with type 2 diabetes in a culturally relevant exercise intervention: a randomized controlled trial

BACKGROUND

We examined the efficacy of a culturally relevant exercise program in improving glycated hemoglobin (HbA1c) among South Asian women with type 2 diabetes, compared with usual care.

METHODS

This was a randomized controlled 8-week pilot study of Bollywood dance among South Asian women with type 2 diabetes. The intervention consisted of 1 h Bollywood dance classes offered twice per week. The primary outcome was change in HbA1c. The effect of attendance on this outcome was also examined.

RESULTS

The intervention group demonstrated a decrease in HbA1c from baseline (-0.18% (0.2%); p=0.018) compared with a non-significant increase in the usual care group (+0.03% (0.2%)); p value for difference between groups was 0.032. Participants attending at least 10 of 16 sessions had a statistically significant reduction in weight (-0.69 kg (0.76 kg)) compared with those attending fewer sessions (+0.86 kg (0.71 kg)).

CONCLUSIONS

These results support culturally relevant dance as a successful exercise intervention to promote HbA1c control, compared with usual care.

TRIAL REGISTRATION NUMBER

NCT02061618.

Designing a Culturally Appropriate Visually Enhanced Low-Text Mobile Health App Promoting Physical Activity for Latinos: A Qualitative Study

Rapid proliferation of smartphone ownership and use among Latinos offers a unique opportunity to employ innovative visually enhanced low-text (VELT) mobile health applications (mHealth app) to promote health behavior change for Latinos at risk for lifestyle-related diseases. Using focus groups and in-depth interviews with 16 promotores and 5 health care providers recruited from California clinics, this qualitative study explored perceptions of visuals for a VELT mHealth app promoting physical activity (PA) and limiting sedentary behavior (SB) for Latinos. In this Phase 1 study, participants endorsed visuals portraying PA guidelines and recommended visuals depicting family and socially oriented PA. Overall, participants supported a VELT mHealth app as an alternative to text-based education. Findings will inform the future Phase 2 study development of a culturally appropriate VELT mHealth app to promote PA for Latinos, improve health literacy, and provide an alternative to traditional clinic text-based health education materials.

What are successful recruitment and retention strategies for underserved populations? Examining physical activity interventions in primary care and community settings

The purposes of this review are to (1) describe recruitment and retention strategies for physical activity interventions focusing on underserved populations and (2) identify successful strategies which show the most promise for "best practices" recommendations to guide future research. The method used was systematic review. Data on recruitment and retention strategies were abstracted and analyzed according to participant characteristics, types of strategies used, and effectiveness using an ecological framework. Thirty-eight studies were identified. Populations included African American (n = 25), Hispanic (n = 8), or Asian (n = 3) groups. Successful recruitment strategies consisted of partnering with respected community stakeholders and organizations, well-trained study staff ethnically, linguistically, and culturally matched to the population of interest, and use of multiple advertising channels. Successful retention strategies included efficient administrative tracking of participants, persistence, skillful teamwork, and demonstrating a positive, caring attitude towards participants. Promising recruitment and retention strategies correspond to all levels of ecological influence: individual, interpersonal, organizational, and societal.

Physical activity promotion in Latin American populations: a systematic review on issues of internal and external validity

The purpose of this review was to determine the degree to which physical activity interventions for Latin American populations reported on internal and external validity factors using the RE-AIM framework (reach & representativeness, effectiveness, adoption, implementation, maintenance). We systematically identified English (PubMed; EbscoHost) and Spanish (SCIELO; Biblioteca Virtual en Salud) language studies published between 2001 and 2012 that tested physical activity, exercise, or fitness promotion interventions in Latin American populations. Cross-sectional/descriptive studies, conducted in Brazil or Spain, published in Portuguese, not including a physical activity/fitness/exercise outcome, and with one time point assessment were excluded. We reviewed 192 abstracts and identified 46 studies that met the eligibility criteria (34 in English, 12 in Spanish). A validated 21-item RE-AIM abstraction tool was used to determine the quality of reporting across studies (0-7 = low, 8-14 = moderate, and 15-21 = high). The number of indicators reported ranged from 3–14 (mean = 8.1 ± 2.6), with the majority of studies falling in the moderate quality reporting category. English and Spanish language articles did not differ on the number of indicators reported (8.1 vs. 8.3, respectively). However, Spanish articles reported more across reach indicators (62% vs. 43% of indicators), while English articles reported more across effectiveness indicators (69% vs 62%). Across RE-AIM dimensions, indicators for reach (48%), efficacy/effectiveness (67%), and implementation (41%) were reported more often than indicators of adoption (25%) and maintenance (10%). Few studies reported on the representativeness of participants, staff that delivered interventions, or the settings where interventions were adopted. Only 13% of the studies reported on quality of life and/or potential negative outcomes, 20% reported on intervention fidelity, and 11% on cost of implementation. Outcomes measured after six months of intervention, information on continued delivery and institutionalization of interventions, were also seldom reported. Regardless of language of publication, physical activity intervention research for Latin Americans should increase attention to and measurement of external validity and cost factors that are critical in the decision making process in practice settings and can increase the likelihood of translation into community or clinical practice.

Physical Activity in Latino Men and Women

Latinos report less leisure time physical activity (PA) than non–Latino Whites and suffer disproportionately from diseases related to sedentary lifestyle, yet remain underserved and understudied. Gaining a better understanding of PA behavior in Latinos is critical to intervene on this significant public health issue. This article discusses the growing literature on the facilitators and barriers of PA in Latino men and women and reviews recent interventions to promote activity. Apart from acculturation influences, facilitators of PA in Latinos are similar to those of non–Latino Whites, with most research focusing on self-efficacy and social support. Barriers for Latinas, however, are more culturally distinct, such as a focus on caregiving and cultural standards for body shape. Barriers unique to Latino men largely have not been studied. Researchers have adopted a variety of approaches to increase PA, including using promotores and incorporating culturally appropriate activities, and have had mixed success. However, the community and randomized controlled trials almost exclusively included only women. Studies reviewed here suggest that interventions should target culturally specific barriers beyond language to successfully increase PA in Latinos and highlight a need for formative research and design of interventions for Latino men.

Community-based physical activity interventions for treatment of type 2 diabetes: a systematic review with meta-analysis

Evidence suggests engaging in regular physical activity (PA) can have beneficial outcomes for adults with type 2 diabetes (TD2), including weight loss, reduction of medication usage and improvements in hemoglobin A1c (HbA1c)/fasting glucose. While a number of clinical-based PA interventions exist, community-based approaches are limited. The objective of this study is to conduct a systematic review with meta-analysis to assess the effectiveness of community-based PA interventions for the treatment of TD2 in adult populations. A search of peer-reviewed publications from 2002 to June 2012 was conducted across several electronic databases to identify interventions evaluated in community settings. Twenty-two studies were identified, and 11 studies reporting HbA1c as an outcome measure were pooled in the meta-analysis. Risk of bias assessment was also conducted. The findings demonstrate community-based PA interventions can be effective in producing increases in PA. Meta-analysis revealed a lowering of HbA1c levels by -0.32% [95% CI -0.65, 0.01], which approached statistical significance (p < 0.06). Our findings can guide future PA community-based interventions in adult populations diagnosed with TD2.

Attitudes of women in midlife to web-based interventions for promoting physical activity

We explored the attitudes of women at midlife to web-based interventions for promoting physical activity. 145 women volunteered to participate in one of four online forums. The forums were for four major racial/ethnic groups. 90 volunteers were recruited for the online forums (29 Whites, 23 Hispanics, 21 African Americans, and 17 Asians). Two sets of topics on attitudes to physical activity and racial/ethnic contexts were used. Each topic had some introductory questions and related prompts, and these were posted on the online forum sites in a serial fashion during the six-month period. We used a thematic analysis. Four major themes emerged: (1) ‘a matter of the source of the information’; (2) ‘I can pace myself’; (3) ‘lack of interpersonal interactions’; and (4) ‘culture-specificity and low cost.’ The women in all ethnic groups thought that the source of the information was much more important than the medium of the information (e.g. web-based, booklet or face-to-face). They liked the self-controllability in web-based interventions. They preferred web-based interventions to other types of interventions because of easy accessibility, but they were concerned about lack of interpersonal interaction. None of the White or African American women indicated the need for culture-specificity in web-based interventions, but Hispanic and Asian women indicated that culture-specific interventions should be provided. Web-based interventions appear to have several advantages over conventional approaches to promoting physical activity.

A systematic review of physical activity interventions in Hispanic adults

Healthy People 2020 aims to achieve health equity, eliminate disparities, and improve the health of all groups. Regular physical activity (PA) improves overall health and fitness and has the capability to reduce risk for chronic diseases. Identifying barriers which relate to the Hispanic population is important when designing PA interventions. Therefore, the purpose was to review existing PA interventions targeting Hispanic adults published between 1988 and 2011. This paper was limited to interventions which included more than 35% Hispanic adults (n = 20). Most of the interventions were community based (n = 16), although clinical, family-based, and faith-based settings were also represented. Interventions incorporated theory (n = 16), with social cognitive theory and transtheoretical model being used most frequently. Social support was integral, building on the assumption that it is a strong motivator of PA. Each of the interventions reported success related to PA, social support, and/or BMI. Lessons learned should be incorporated into future interventions.