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Merner B, Schonfeld L, Virgona A, Lowe D, Walsh L, Wardrope C, Graham-Wisener L, Xafis V, Colombo C, Refahi N, Bryden P, Chmielewski R, Martin F, Messino NM, Mussared A, Smith L, Biggar S, Gill M, Menzies D, Gaulden CM, Earnshaw L, Arnott L, Poole N, Ryan RE, Hill S. Consumers' and health providers' views and perceptions of partnering to improve health services design, delivery and evaluation: a co-produced qualitative evidence synthesis. Cochrane Database Syst Rev 2023; 3:CD013274. [PMID: 36917094 PMCID: PMC10065807 DOI: 10.1002/14651858.cd013274.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Partnering with consumers in the planning, delivery and evaluation of health services is an essential component of person-centred care. There are many ways to partner with consumers to improve health services, including formal group partnerships (such as committees, boards or steering groups). However, consumers' and health providers' views and experiences of formal group partnerships remain unclear. In this qualitative evidence synthesis (QES), we focus specifically on formal group partnerships where health providers and consumers share decision-making about planning, delivering and/or evaluating health services. Formal group partnerships were selected because they are widely used throughout the world to improve person-centred care. For the purposes of this QES, the term 'consumer' refers to a person who is a patient, carer or community member who brings their perspective to health service partnerships. 'Health provider' refers to a person with a health policy, management, administrative or clinical role who participates in formal partnerships in an advisory or representative capacity. This QES was co-produced with a Stakeholder Panel of consumers and health providers. The QES was undertaken concurrently with a Cochrane intervention review entitled Effects of consumers and health providers working in partnership on health services planning, delivery and evaluation. OBJECTIVES 1. To synthesise the views and experiences of consumers and health providers of formal partnership approaches that aimed to improve planning, delivery or evaluation of health services. 2. To identify best practice principles for formal partnership approaches in health services by understanding consumers' and health providers' views and experiences. SEARCH METHODS We searched MEDLINE, Embase, PsycINFO and CINAHL for studies published between January 2000 and October 2018. We also searched grey literature sources including websites of relevant research and policy organisations involved in promoting person-centred care. SELECTION CRITERIA We included qualitative studies that explored consumers' and health providers' perceptions and experiences of partnering in formal group formats to improve the planning, delivery or evaluation of health services. DATA COLLECTION AND ANALYSIS Following completion of abstract and full-text screening, we used purposive sampling to select a sample of eligible studies that covered a range of pre-defined criteria, including rich data, range of countries and country income level, settings, participants, and types of partnership activities. A Framework Synthesis approach was used to synthesise the findings of the sample. We appraised the quality of each study using the CASP (Critical Appraisal Skill Program) tool. We assessed our confidence in the findings using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach. The Stakeholder Panel was involved in each stage of the review from development of the protocol to development of the best practice principles. MAIN RESULTS We found 182 studies that were eligible for inclusion. From this group, we selected 33 studies to include in the final synthesis. These studies came from a wide range of countries including 28 from high-income countries and five from low- or middle-income countries (LMICs). Each of the studies included the experiences and views of consumers and/or health providers of partnering in formal group formats. The results were divided into the following categories. Contextual factors influencing partnerships: government policy, policy implementation processes and funding, as well as the organisational context of the health service, could facilitate or impede partnering (moderate level of confidence). Consumer recruitment: consumer recruitment occurred in different ways and consumers managed the recruitment process in a minority of studies only (high level of confidence). Recruiting a range of consumers who were reflective of the clinic's demographic population was considered desirable, particularly by health providers (high level of confidence). Some health providers perceived that individual consumers' experiences were not generalisable to the broader population whereas consumers perceived it could be problematic to aim to represent a broad range of community views (high level of confidence). Partnership dynamics and processes: positive interpersonal dynamics between health providers and consumers facilitated partnerships (high level of confidence). However, formal meeting formats and lack of clarity about the consumer role could constrain consumers' involvement (high level of confidence). Health providers' professional status, technical knowledge and use of jargon were intimidating for some consumers (high level of confidence) and consumers could feel their experiential knowledge was not valued (moderate level of confidence). Consumers could also become frustrated when health providers dominated the meeting agenda (moderate level of confidence) and when they experienced token involvement, such as a lack of decision-making power (high level of confidence) Perceived impacts on partnership participants: partnering could affect health provider and consumer participants in both positive and negative ways (high level of confidence). Perceived impacts on health service planning, delivery and evaluation: partnering was perceived to improve the person-centredness of health service culture (high level of confidence), improve the built environment of the health service (high level of confidence), improve health service design and delivery e.g. facilitate 'out of hours' services or treatment closer to home (high level of confidence), enhance community ownership of health services, particularly in LMICs (moderate level of confidence), and improve consumer involvement in strategic decision-making, under certain conditions (moderate level of confidence). There was limited evidence suggesting partnering may improve health service evaluation (very low level of confidence). Best practice principles for formal partnering to promote person-centred care were developed from these findings. The principles were developed collaboratively with the Stakeholder Panel and included leadership and health service culture; diversity; equity; mutual respect; shared vision and regular communication; shared agendas and decision-making; influence and sustainability. AUTHORS' CONCLUSIONS Successful formal group partnerships with consumers require health providers to continually reflect and address power imbalances that may constrain consumers' participation. Such imbalances may be particularly acute in recruitment procedures, meeting structure and content and decision-making processes. Formal group partnerships were perceived to improve the physical environment of health services, the person-centredness of health service culture and health service design and delivery. Implementing the best practice principles may help to address power imbalances, strengthen formal partnering, improve the experiences of consumers and health providers and positively affect partnership outcomes.
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Affiliation(s)
- Bronwen Merner
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Lina Schonfeld
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Ariane Virgona
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Dianne Lowe
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
- Child and Family Evidence, Australian Institute of Family Studies, Melbourne, Australia
| | - Louisa Walsh
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Cheryl Wardrope
- Clinical Governance, Metro South Hospital and Health Service, Eight Mile Plains, Australia
| | | | - Vicki Xafis
- The Sydney Children's Hospitals Network, Sydney, Australia
| | - Cinzia Colombo
- Laboratory for medical research and consumer involvement, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Nora Refahi
- Consumer Representative, Melbourne, Australia
| | - Paul Bryden
- Consumer Representative, Caboolture, Australia
| | - Renee Chmielewski
- Planning and Patient Experience, The Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | | | | | | | - Lorraine Smith
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Susan Biggar
- Consumer Representative, Melbourne, Australia
- Australian Health Practitioner Regulation Agency (AHPRA), Melbourne, Australia
| | - Marie Gill
- Gill and Wilcox Consultancy, Melbourne, Australia
| | - David Menzies
- Chronic Disease Programs, South Eastern Melbourne Primary Health Network, Heatherton, Australia
| | - Carolyn M Gaulden
- Detroit Wayne County Authority Health Residency Program, Michigan State University, Providence Hospital, Southfield, Michigan, USA
| | | | | | - Naomi Poole
- Strategy and Innovation, Australian Commission on Safety and Quality in Health Care, Sydney, Australia
| | - Rebecca E Ryan
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Sophie Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
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Bonin L, Levasseur-Puhach S, Guimond M, Gabbs M, Wicklow B, Vandenbroeck B, Copenace S, Delaronde M, Mosienko L, McGavock J, Katz LY, Roos LE, Diffey L, Dart A. Walking in two worlds with type 2 diabetes: a scoping review of prevention and management practices incorporating traditional indigenous approaches. Int J Circumpolar Health 2022; 81:2141182. [DOI: 10.1080/22423982.2022.2141182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Lynette Bonin
- University of Manitoba, Faculty of Arts, Department of Psychology Winnipeg, Manitoba Canada
| | - Sydney Levasseur-Puhach
- University of Manitoba, Faculty of Arts, Department of Psychology Winnipeg, Manitoba Canada
- Children’s Hospital Research Institute of Manitoba, and DREAM Theme, Diabetes Research Envisioned and Accomplished in Manitoba, Winnipeg, Manitoba, Canada
| | - Michelle Guimond
- Children’s Hospital Research Institute of Manitoba, and DREAM Theme, Diabetes Research Envisioned and Accomplished in Manitoba, Winnipeg, Manitoba, Canada
| | - Melissa Gabbs
- Children’s Hospital Research Institute of Manitoba, and DREAM Theme, Diabetes Research Envisioned and Accomplished in Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba, Max Rady College of Medicine, Department of Pediatric and Child Health, Winnipeg, Manitoba, Canada
| | - Brandy Wicklow
- Children’s Hospital Research Institute of Manitoba, and DREAM Theme, Diabetes Research Envisioned and Accomplished in Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba, Max Rady College of Medicine, Department of Pediatric and Child Health, Winnipeg, Manitoba, Canada
| | - Belinda Vandenbroeck
- University of Manitoba, Faculty of Arts, Department of Psychology Winnipeg, Manitoba Canada
| | - Sherry Copenace
- University of Manitoba, Faculty of Arts, Department of Psychology Winnipeg, Manitoba Canada
| | - Meagan Delaronde
- Children’s Hospital Research Institute of Manitoba, and DREAM Theme, Diabetes Research Envisioned and Accomplished in Manitoba, Winnipeg, Manitoba, Canada
| | - Lucas Mosienko
- Children’s Hospital Research Institute of Manitoba, and DREAM Theme, Diabetes Research Envisioned and Accomplished in Manitoba, Winnipeg, Manitoba, Canada
| | - Jonathan McGavock
- Children’s Hospital Research Institute of Manitoba, and DREAM Theme, Diabetes Research Envisioned and Accomplished in Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba, Max Rady College of Medicine, Department of Pediatric and Child Health, Winnipeg, Manitoba, Canada
| | - Laurence Y. Katz
- University of Manitoba, Max Rady College of Medicine, Department of Psychiatry, Winnipeg, Manitoba, Canada
| | - Leslie E. Roos
- University of Manitoba, Faculty of Arts, Department of Psychology Winnipeg, Manitoba Canada
- Children’s Hospital Research Institute of Manitoba, and DREAM Theme, Diabetes Research Envisioned and Accomplished in Manitoba, Winnipeg, Manitoba, Canada
| | - Linda Diffey
- Children’s Hospital Research Institute of Manitoba, and DREAM Theme, Diabetes Research Envisioned and Accomplished in Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba, Max Rady College of Medicine, Department of Community Health Sciences, Winnipeg, Manitoba, Canada
| | - Allison Dart
- Children’s Hospital Research Institute of Manitoba, and DREAM Theme, Diabetes Research Envisioned and Accomplished in Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba, Max Rady College of Medicine, Department of Pediatric and Child Health, Winnipeg, Manitoba, Canada
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Boyd RC, Castro FG, Finigan-Carr N, Okamoto SK, Barlow A, Kim BKE, Lambert S, Lloyd J, Zhang X, Barksdale CL, Crowley DM, Maldonado-Molina M, Obasi EM, Kenney A. Strategic Directions in Preventive Intervention Research to Advance Health Equity. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 24:577-596. [PMID: 36469162 PMCID: PMC9734404 DOI: 10.1007/s11121-022-01462-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 12/09/2022]
Abstract
As commissioned by the Society for Prevention Research, this paper describes and illustrates strategic approaches for reducing health inequities and advancing health equity when adopting an equity-focused approach for applying prevention science evidence-based theory, methodologies, and practices. We introduce an ecosystemic framework as a guide for analyzing, designing, and planning innovative equity-focused evidence-based preventive interventions designed to attain intended health equity outcomes. To advance this process, we introduce a health equity statement for conducting integrative analyses of ecosystemic framework pathways, by describing the role of social determinants, mechanisms, and interventions as factors directly linked to specific health equity outcomes. As background, we present health equity constructs, theories, and research evidence which can inform the design and development of equity-focused intervention approaches. We also describe multi-level interventions that when coordinated can produce synergistic intervention effects across macro, meso, and micro ecological levels. Under this approach, we encourage prevention and implementation scientists to apply and extend these strategic directions in future research to increase our evidence-based knowledge and theory building. A general goal is to apply prevention science knowledge to design, widely disseminate, and implement culturally grounded interventions that incrementally attain specific HE outcomes and an intended HE goal. We conclude with recommendations for conducting equity-focused prevention science research, interventions, and training.
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Affiliation(s)
- Rhonda C Boyd
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | | | - Allison Barlow
- John Hopkins Center for American Indian Health, Baltimore, MD, USA
| | | | | | - Jacqueline Lloyd
- Office of Disease Prevention, National Institutes of Health, Rockville, MD, USA
| | - Xinzhi Zhang
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Crystal L Barksdale
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | | | | | | | - Anne Kenney
- John Hopkins Center for American Indian Health, Baltimore, MD, USA
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Gruß I, Mayhew M, Firemark A, Fitzpatrick SL. Participants' perspectives on perceived usefulness of digital and in-person diabetes prevention programs: A qualitative study to inform decisions related to program participation. Obes Sci Pract 2022; 8:176-184. [PMID: 35388343 PMCID: PMC8976540 DOI: 10.1002/osp4.562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/05/2021] [Accepted: 09/01/2021] [Indexed: 11/10/2022] Open
Abstract
Objective Given the effectiveness of both in-person and digital diabetes prevention programs (DPPs), participants have an opportunity to select a delivery mode based on their needs and preferences. The objective of this study was to understand and compare participants' experiences with digital and in-person DPPs to identify factors that affected how useful participants perceived these two program delivery modes. Methods Semi-structured interviews with participants who were enrolled in DPPs as either a digital (n = 23) or in-person (n = 20) program within one health care system were conducted. Data were analyzed following the template method using the qualitative software NVivo 12. Results Findings from the interviews indicated that creating accountability for weight loss was crucial for all program participants. In the digital program, weight and food tracking played a central role in creating accountability, while in the in-person program, group interactions fostered accountability. The digital program was perceived to encourage self-monitoring, oftentimes resulting in participants' reflection on their habits. The in-person program provided a platform for group support and mutual encouragement. Conclusions Participants perceived both programs as similarly useful. Yet program characteristics such as the ability to engage with other participants in-person or to seamlessly track weight on a daily basis appealed to different participants. It may be beneficial to align participants' preferences with programs' characteristics and strengths.
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Affiliation(s)
- Inga Gruß
- Center for Health ResearchKaiser Permanente NorthwestPortlandOregonUSA
| | - Meghan Mayhew
- Center for Health ResearchKaiser Permanente NorthwestPortlandOregonUSA
| | - Alison Firemark
- Center for Health ResearchKaiser Permanente NorthwestPortlandOregonUSA
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Mandoh M, Redfern J, Mihrshahi S, Cheng HL, Phongsavan P, Partridge SR. Shifting From Tokenism to Meaningful Adolescent Participation in Research for Obesity Prevention: A Systematic Scoping Review. Front Public Health 2022; 9:789535. [PMID: 35004591 PMCID: PMC8734426 DOI: 10.3389/fpubh.2021.789535] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/30/2021] [Indexed: 12/21/2022] Open
Abstract
Background: Traditionally, adolescent participation in research has been tokenistic. Adolescents are rarely afforded the opportunity to influence decision-making in research designed to prevent obesity. Engaging adolescents in meaningful decision-making may enhance research translation. This review aimed to analyze the current modes and nature of adolescent participation in obesity prevention research decision-making. Methods: A systematic scoping review was conducted using Arksey and O'Malley's six-stage framework. Six major databases were searched for peer-reviewed primary research studies with adolescent participation related to obesity, physical activity, and diet. Modes of adolescent participation were categorized based on the Lansdown-UNICEF conceptual framework for measuring outcomes of adolescent participation. The framework outlines three modes of meaningful participation: (i) consultative, which involves taking opinions and needs into consideration; (ii) collaborative, where adolescents are partners in the decision-making process; and (iii) adolescent-led participation where adolescents have the capacity to influence the process and outcomes. The degree of involvement in research cycles was classified based on the National Health and Medical Research Council consumer engagement framework. Five stages of the research cycle were determined: identify, design and develop, conduct, analyze and disseminate. Results: In total, 126 papers describing 71 unique studies were identified. Of these, 69% (49/71) took place in the USA, and 85% (52/61) were conducted in minority or underserved communities, while males were more likely to be under-represented. In 49% (35/71) of studies, participation was consultative and 9% (6/71) of studies involved an adolescent-led approach. Furthermore, 87% (62/71) of studies incorporated adolescent participation in one or more of the research cycle's formative phases, which involve eliciting views, opinions and idea generation. Only 11% of studies engaged adolescents in all five stages of the research cycle where adolescents could have more influence over the research process. Conclusion: Meaningful adolescent participation in the obesity prevention research cycle is limited. Empowering and mobilizing equal partnership with adolescents should be at the forefront of all adolescent-related obesity prevention research.
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Affiliation(s)
- Mariam Mandoh
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Julie Redfern
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,The George Institute for Global Health, The University of New South Wales, Camperdown, NSW, Australia
| | - Seema Mihrshahi
- Department of Health Systems and Populations, Macquarie University, Sydney, NSW, Australia.,Prevention Research Collaboration, Charles Perkins Centre, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Hoi Lun Cheng
- Sydney Medical School, Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia.,The Children's Hospital at Westmead, Academic Department of Adolescent Medicine, Sydney, NSW, Australia
| | - Philayrath Phongsavan
- Prevention Research Collaboration, Charles Perkins Centre, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Stephanie R Partridge
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Prevention Research Collaboration, Charles Perkins Centre, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
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Howell BM. Interactions Between Diet, Physical Activity, and the Sociocultural Environment for Older Adult Health in the Urban Subarctic. J Community Health 2021; 45:252-263. [PMID: 31512112 DOI: 10.1007/s10900-019-00737-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This study sought to examine the relationship between the sociocultural factors that shape diet, physical activity, and nutritional status outcomes among seniors in Anchorage, Alaska. Alaskan seniors are an ideal study population because the state has the fastest growing senior population in the United States. Since much health research in the circumpolar north focuses on the influence of the economic or rural environment on nutrition, there is a need to investigate the ways social relationships shape diet, physical activity patterns, and nutritional status in urban spaces. This cross-sectional study included 82 community-living men and women (mean age = 74 years) in Anchorage. Participants underwent anthropometric measurements and completed questionnaires on their dietary intake, physical activity, and the sociocultural influences on their diet and exercise practices. T-tests indicate that diet and physical activity practices in this sample do not meet national recommendations and that diet differs adversely from national reference samples. Mann-Whitney U tests indicate the media and friends are associated with increases in energy expenditure. Family influences increased fruit consumption, while participation in cultural and social events increased intake of fats and sweets. Reaching older adults through a variety of channels, including the media, social networks, and culturally responsive programs can alleviate some of the barriers to healthy diet and exercise patterns.
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Affiliation(s)
- Britteny M Howell
- Division of Population Health Sciences, University of Alaska Anchorage, BOC 233, 3211 Providence Drive, Anchorage, AK, 99508, USA. .,National Resource Center for Alaska Native Elders, University of Alaska Anchorage, Anchorage, AK, 99508, USA.
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Seear KH, Atkinson DN, Henderson-Yates LM, Lelievre MP, Marley JV. Maboo wirriya, be healthy: Community-directed development of an evidence-based diabetes prevention program for young Aboriginal people in a remote Australian town. EVALUATION AND PROGRAM PLANNING 2020; 81:101818. [PMID: 32512400 DOI: 10.1016/j.evalprogplan.2020.101818] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 12/17/2019] [Accepted: 04/18/2020] [Indexed: 06/11/2023]
Abstract
Supporting healthy lifestyle behaviours is a key aspect of preventing type 2 diabetes which disproportionately affects disadvantaged groups from a younger age. Formative participatory research was undertaken to design a program for young Aboriginal people in a remote town in North West Australia with a high level of health needs and relatively few prevention initiatives. Focus groups and advisory discussions with Aboriginal community members were used to determine the nature of the program. The need for a comprehensive program was consistently expressed and limited healthy lifestyle knowledge and difficulties with healthy eating influenced by food environments were noted to be important. With guidance from the Derby Aboriginal Health Service, findings were integrated with previous international research evidence to develop a program tailored to local Aboriginal people aged 15-25 years and refine it after piloting. This 8-session program, 'Maboo wirriya, be healthy' involved an education component consistent with the US Diabetes Prevention Program and practical activities including group exercise. Changes to program structure and documentation were made after piloting for future use. The community-directed approach used in this study is vital to ensure relevance of localised chronic disease prevention programs in a range of settings.
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Affiliation(s)
- Kimberley H Seear
- The Rural Clinical School of Western Australia, University of Western Australia, 12 Napier Terrace (PO Box 1377), Broome WA 6725, Australia.
| | - David N Atkinson
- The Rural Clinical School of Western Australia, University of Western Australia, 12 Napier Terrace (PO Box 1377), Broome WA 6725, Australia.
| | | | - Matthew P Lelievre
- Derby Aboriginal Health Service, 1 Stanley Street (PO Box 1155) Derby WA 6728, Australia.
| | - Julia V Marley
- The Rural Clinical School of Western Australia, University of Western Australia, 12 Napier Terrace (PO Box 1377), Broome WA 6725, Australia; Kimberley Aboriginal Medical Services, 12 Napier Terrace (PO Box 1377), Broome WA 6725, Australia.
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Abstract
American Indians/Alaska Natives experience significant health disparities in many areas including metabolic and mental health disorders. The basis for these differences is grounded in the lasting effects of historical trauma. NPs have the opportunity to understand the underlying causes of these disparities and provide health interventions that promote wellness.
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Affiliation(s)
- Rebecca Carron
- Rebecca Carron is an assistant professor at the Fay W. Whitney School of Nursing, University of Wyoming, Laramie, Wyo
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LaVeaux D, Simonds VW, Picket V, Cummins J, Calkins E. Developing a Curriculum for Change: Water and Environmental Health Literacy in a Native American Community. Prog Community Health Partnersh 2019; 12:441-449. [PMID: 30739898 DOI: 10.1353/cpr.2018.0069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Knowing about risks of water contamination is the first step in making informed choices to protect our health and environment. Researchers were challenged with sharing water quality research this information with local communities. OBJECTIVES The purpose of this article is to describe the formative evaluation used to develop and implement an Environmental Health Literacy (EHL) summer camp and afterschool water curriculum for Native American (NA) children in the fourth through sixth grades. METHODS Community and university scientists, elders, and educators came together and co-developed a summer camp and afterschool program for local youth to address the issues of water and its importance to the tribal community. LESSONS LEARNED Research partners must continually balance research needs with relationships and service to the community. The health literacy framework used to develop our curriculum also complemented our community-based participatory research (CBPR) approach and may benefit other partnerships. CBPR helped to build trust and culturally center the intervention. CONCLUSIONS Project partners built on the mutual commitment to "do what we say we will do" within the community context. Using the CBPR approach provided a strong framework for the collaboration necessary for this project. Trust relationships were key to the successes experienced during the development, implementation, and multiple revisions of this intervention.
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Woodbury RB, Ketchum S, Hiratsuka VY, Spicer P. Health-Related Participatory Research in American Indian and Alaska Native Communities: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2969. [PMID: 31426579 PMCID: PMC6719130 DOI: 10.3390/ijerph16162969] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 08/15/2019] [Accepted: 08/15/2019] [Indexed: 12/15/2022]
Abstract
A scoping review was conducted to assess the state of the literature on health-related participatory research involving American Indian and Alaska Native communities. Online databases were searched for relevant articles published between 1/1/2000 and 5/31/2017. 10,000+ data points relevant to community-level engagement in and regulation of research, community research capacity and cultural adaptation were extracted from 178 articles. Community engagement varied across study components: 136 (76%) articles reported community participation in research-related meetings and other events and 49 (27%) articles reported community involvement in initiation of research. 156 (88%) articles reported use of community-level tools to guide or regulate research. 93 (52%) articles reported that community members received research-related training. 147 (82%) articles described some type of cultural adaptation. Across all articles, data points on community engagement were not reported in 3061 (40%) out of 7740 cases. Findings suggest a need for increased community engagement in early stages of the research process and for reporting guidelines for participatory research involving American Indian and Alaska Native communities. There is also need to further existing research on the impact of different components of participatory research on process and outcome measures and to develop funding mechanisms that account for the time and resource intensive nature of participatory research.
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Affiliation(s)
- R Brian Woodbury
- Southcentral Foundation Research Department, 4085 Tudor Centre Dr., Anchorage, AK 99508, USA.
| | - Scott Ketchum
- University of Oklahoma, 5 Partners Place, Stephenson Pkwy, Suite 4100, Norman, OK 73019, USA
| | - Vanessa Y Hiratsuka
- Southcentral Foundation Research Department, 4085 Tudor Centre Dr., Anchorage, AK 99508, USA
| | - Paul Spicer
- Department of Anthropology, University of Oklahoma, 5 Partners Place, 201 Stephenson Pkwy, Suite 4100, Norman, OK 73019, USA
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Abstract
Experiences with unethical research practices have caused some American
Indian and Alaska Native (AIAN) individuals, organizations, and tribes to
mistrust health research. To build trust and repair relationships, current
research with AIAN peoples often involves participatory research (PR)
approaches. This article assesses community-level protections described in the
scientific literature on PR involving AIAN communities. A scoping review search
in PubMed and PsychInfo for articles published between January 2000 and June
2017 yielded an AIAN PR article dataset. Of 178 articles, a subset of 23
articles that described aspects of community protections were analyzed for
descriptions of community-level protection practices. We identified the presence
or absence of a description of four community protection measures in each
article: a tribal research department, the development of community-level
mechanisms for research regulation if not present, community collaboration
throughout the research process, and project employment of a community member.
The development of community-level mechanisms for research regulation was
described in 39% of the articles. Ninety-one percent of these articles described
community collaboration during the research process. Seventeen percent included
descriptions of all four community-level protection measures. The extent and
consistency to which community-level protections are described is variable; the
current literature lacks reporting on community-level protection practices
specific to tribal communities.
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Wardian JL, True MW, Sauerwein TJ, Watson NA, Hoover AM. Evaluation of the Group Lifestyle Balance Program in a Military Setting: An Investment Worth Expanding. Mil Med 2019; 183:e138-e143. [PMID: 29401348 DOI: 10.1093/milmed/usx058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 10/27/2017] [Indexed: 02/01/2023] Open
Abstract
Introduction The Diabetes Prevention Program (DPP) demonstrated that lifestyle intervention programs were effective in preventing or delaying the onset of diabetes. The Group Lifestyle Balance (GLB) program translated the DPP curriculum into a 12-wk group intervention for those at risk for diabetes. This retrospective evaluation examined clinical outcomes for patients in the Diabetes Center of Excellence GLB program located at Wilford Hall Ambulatory Surgical Center from 2009 to 2013. Objectives included determining rates of retention, demographic characteristics of program completers, and changes in metabolic surrogates of disease prevalence. Study Design Adults with prediabetes or metabolic syndrome (MetS) were referred to the GLB program. Updated participant metabolic data were collected at regular intervals during their participation. Results During the 5-yr study, 704 patients attended the initial class. Overall, 52% of all participants completed the program with the greatest decline in participation occurring by the fourth week (30%). Baseline prevalence of conditions of interest for those who completed the program was prediabetes (93.2%), obesity (56.1%), and MetS (31.5%). GLB completers were older and retired (p < 0.05). A significant number of active duty military members (44.9%, p < 0.01, n = 53) dropped out of the program before the fourth week. Furthermore, those who completed the program saw a 2.0% reduction in prediabetes prevalence (p < 0.001), obesity decreased by 8.7% (p < 0.001), and MetS decreased by 6.8% (p < 0.01). Significant differences were found for central obesity, triglycerides, and fasting blood sugar (p < 0.001). Conclusions The GLB program is a valuable DPP and was effective at improving clinical outcomes and reducing the incidence of prediabetes, obesity, and MetS for participants who completed the program. Every effort should be made to support and encourage GLB participants to complete the program.
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Affiliation(s)
- Jana L Wardian
- Diabetes Center of Excellence (DCOE), Wilford Hall Ambulatory Surgical Center (WHASC), 2200 Bergquist, Joint Base San Antonio-Lackland, TX 78236
| | - Mark W True
- Endocrinology Service, San Antonio Military Medical Center, 3551 Roger Brooke Dr., Joint Base San Antonio, Fort Sam Houston, TX 78253
| | - Tom J Sauerwein
- Diabetes Center of Excellence (DCOE), Wilford Hall Ambulatory Surgical Center (WHASC), 2200 Bergquist, Joint Base San Antonio-Lackland, TX 78236
| | - Nina A Watson
- Diabetes Center of Excellence (DCOE), Wilford Hall Ambulatory Surgical Center (WHASC), 2200 Bergquist, Joint Base San Antonio-Lackland, TX 78236
| | - Austin M Hoover
- Diabetes Center of Excellence (DCOE), Wilford Hall Ambulatory Surgical Center (WHASC), 2200 Bergquist, Joint Base San Antonio-Lackland, TX 78236
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Brown B, Harris KJ, Heil D, Tryon M, Cooksley A, Semmens E, Davis J, Gandhi K. Feasibility and outcomes of an out-of-school and home-based obesity prevention pilot study for rural children on an American Indian reservation. Pilot Feasibility Stud 2018; 4:129. [PMID: 30065847 PMCID: PMC6062940 DOI: 10.1186/s40814-018-0322-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 07/18/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Children living in rural areas are at higher risk for obesity compared to urban children, and Native American (NA) children have the highest prevalence of overweight/obesity for all races combined. Out-of-school programs (OOSPs) are a promising setting to improve children's health. Parents are important in supporting their child's obesity-related behaviors, yet it remains unclear what combination and dose of parent engagement strategies is feasible and optimal. This study's primary objective was to assess the feasibility of an OOSP and home-based obesity prevention intervention for rural NA and non-NA children. METHODS This was an 11-week, two group, randomized feasibility study. Participants were children and their parents at one OOSP on a rural American Indian reservation. Children, ages 6-9, were randomized to receive the Generations Health (GH) intervention or comparison condition. The GH group received daily activities focused on physical activity (PA), nutrition, sleep, and reducing TV/screen time, and frequently engaged parents. The comparison group received usual OOSP activities. To assess intervention feasibility, we measured recruitment and participation rates and program satisfaction. We assessed pre- to posttest changes in body composition, PA and sleep patterns, dietary intake and Healthy Eating Index-2010 (HEI-2010) scores, TV/screen time, and nutrition knowledge. We report recruitment and participation rates as percentages and participants' program satisfaction as means. Two-tailed paired t tests and 95% confidence intervals were used to detect changes in behavioral and health outcome variables. RESULTS Forty-six children met age eligibility criteria; following screening, 52% (24/46) met the inclusion criteria and 96% (23/24) were randomized to the study. Overall, 91% of the children participated in the intervention and 100% participated in at least some of the posttest assessments. Parents reported high program satisfaction (mean rating of 4, on a 1-5 scale). Our outcome measure for child adiposity, zBMI, was reduced by 0.15 in the GH group, but increased by 0.13 in the comparison condition. Meaningful changes were evident for total kilocalories, HEI-2010 scores, PA, TV/screen time, and nutrition knowledge. CONCLUSIONS High recruitment, participation and program satisfaction and positive health and behavioral outcomes at 11 weeks provide encouraging indications of the feasibility and potential effectiveness of the intervention. TRIAL REGISTRATION ISRCTN24274245.
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Affiliation(s)
- Blakely Brown
- Department of Health and Human Performance, The University of Montana, McGill Hall 206, 32 Campus Drive Missoula, Missoula, MT 59812 USA
| | - Kari Jo Harris
- School of Public and Community Health Sciences, University of Montana, 32 Campus Drive, Missoula, MT 59812 USA
| | - Daniel Heil
- Department Health and Human Development, Montana State University, 210 Romney Gym, Bozeman, MT 59715 USA
| | - Michael Tryon
- Polson Medical Fitness Center, Summit Medical Fitness Center, 205 Sunnyview Lane, Kalispell, MT 59901 USA
| | - Aric Cooksley
- Boys and Girls Club of the Flathead Reseration and Lake County, 63055 US-93, Ronan, MT 59864 USA
| | - Erin Semmens
- Department of Health and Human Performance, The University of Montana, McGill Hall 206, 32 Campus Drive Missoula, Missoula, MT 59812 USA
| | - James Davis
- Department of Complementary and Integrative Medicine, University of Hawaii John A. Burns School of Medicine, Biosciences Building Suite 211, 651 Ilalo Street, Honolulu, HI 96813 USA
| | - Krupa Gandhi
- Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Thomas Jefferson University, 1015 Chestnut Street, Suite 520, Philadelphia, PA 19107 USA
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Abstract
PURPOSE OF REVIEW Community-engaged research (CER), which is characterized by collaborations between researchers and community partners, is a promising approach to bridge the gaps in translating research evidence into care settings and to address health disparities. This review describes CER in investigations focused on pediatric diabetes. RECENT FINDINGS Studies were focused on African American, Hispanic, and Native American youth. Most studies aimed to develop and evaluate preventive interventions for type 2 diabetes. Across studies, the community partners and organizations that collaborated with researchers were diverse (e.g., youth, schools). In most studies, community partners participated in developing behavioral, psychosocial, or public health interventions, and/or participant recruitment. Fewer studies reported intensive involvement in other aspects of the research (e.g., grant writing, publication). The findings suggested that CER is a feasible approach for engaging community partners in the development of interventions and participant recruitment in studies focused on diabetes among minority youth.
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Affiliation(s)
- Ashley M Butler
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Feigin Building, 1102 Bates Street, Suite 940, Houston, TX, 77030, USA.
| | - Marisa E Hilliard
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Feigin Building, 1102 Bates Street, Suite 940, Houston, TX, 77030, USA
| | - DeLawnia Comer-HaGans
- College of Health and Human Services, Department of Health Administration, Governors State University, 1 University Parkway, G-176, University Parkway, IL, 60484-0975, USA
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Keith JF, Stastny S, Brunt A, Agnew W. Barriers and Strategies for Healthy Food Choices among American Indian Tribal College Students: A Qualitative Analysis. J Acad Nutr Diet 2018; 118:1017-1026. [PMID: 29066177 DOI: 10.1016/j.jand.2017.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 08/02/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND American Indian and Alaskan Native individuals experience disproportionate levels of chronic health conditions such as type 2 diabetes and overweight and obesity that are influenced by dietary patterns and food choices. Understanding factors that influence healthy food choices among tribal college students can enrich education and programs that target dietary intake. OBJECTIVE To build an understanding of factors that influence healthy food choices among tribal college students at increased risk for college attrition. DESIGN A nonexperimental cohort design was used for qualitative descriptive analysis. PARTICIPANTS/SETTING Participants (N=20) were purposively sampled, newly enrolled, academically underprepared tribal college students enrolled in a culturally relevant life skills course at an upper Midwest tribal college between September 2013 and May 2015. Participant demographic characteristics included various tribal affiliations, ages, and number of dependents. MAIN OUTCOME MEASURES Participant responses to qualitative research questions about dietary intake, food choices, self-efficacy for healthy food choices, psychosocial determinants, and barriers to healthy food choices during telephone interviews were used as measures. ANALYSIS Qualitative analysis included prestudy identification of researcher bias/assumptions, audiorecording and transcription, initial analysis (coding), secondary analysis (sorting and identifying meaning), and verification (comparative pattern analysis). RESULTS Qualitative analysis revealed a variety of themes and subthemes about healthy food choices. Main themes related to barriers included taste, food gathering and preparation, and difficulty clarifying healthy food choices. Main themes related to strategies included taste, cultural traditions and practices, and personal motivation factors. CONCLUSIONS Qualitative analysis identified barrier and strategy themes that may assist nutrition and dietetics practitioners working with tribal/indigenous communities, tribal college educators and health specialists, and tribal community health workers who target health and dietary intake of American Indian and Alaskan Native students.
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Cultural adaptation of a peer-led lifestyle intervention program for diabetes prevention in India: the Kerala diabetes prevention program (K-DPP). BMC Public Health 2018; 17:974. [PMID: 29298703 PMCID: PMC6389141 DOI: 10.1186/s12889-017-4986-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 12/08/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is now one of the leading causes of disease-related deaths globally. India has the world's second largest number of individuals living with diabetes. Lifestyle change has been proven to be an effective means by which to reduce risk of T2DM and a number of "real world" diabetes prevention trials have been undertaken in high income countries. However, systematic efforts to adapt such interventions for T2DM prevention in low- and middle-income countries have been very limited to date. This research-to-action gap is now widely recognised as a major challenge to the prevention and control of diabetes. Reducing the gap is associated with reductions in morbidity and mortality and reduced health care costs. The aim of this article is to describe the adaptation, development and refinement of diabetes prevention programs from the USA, Finland and Australia to the State of Kerala, India. METHODS The Kerala Diabetes Prevention Program (K-DPP) was adapted to Kerala, India from evidence-based lifestyle interventions implemented in high income countries, namely, Finland, United States and Australia. The adaptation process was undertaken in five phases: 1) needs assessment; 2) formulation of program objectives; 3) program adaptation and development; 4) piloting of the program and its delivery; and 5) program refinement and active implementation. RESULTS The resulting program, K-DPP, includes four key components: 1) a group-based peer support program for participants; 2) a peer-leader training and support program for lay people to lead the groups; 3) resource materials; and 4) strategies to stimulate broader community engagement. The systematic approach to adaptation was underpinned by evidence-based behavior change techniques. CONCLUSION K-DPP is the first well evaluated community-based, peer-led diabetes prevention program in India. Future refinement and utilization of this approach will promote translation of K-DPP to other contexts and population groups within India as well as other low- and middle-income countries. This same approach could also be applied more broadly to enable the translation of effective non-communicable disease prevention programs developed in high-income settings to create context-specific evidence in rapidly developing low- and middle-income countries. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Registry: ACTRN12611000262909 . Registered 10 March 2011.
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Fleischhacker S, Roberts E, Camplain R, Evenson KR, Gittelsohn J. Promoting Physical Activity Among Native American Youth: a Systematic Review of the Methodology and Current Evidence of Physical Activity Interventions and Community-wide Initiatives. J Racial Ethn Health Disparities 2016; 3:608-624. [PMID: 27294756 PMCID: PMC4911341 DOI: 10.1007/s40615-015-0180-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 10/13/2015] [Accepted: 10/29/2015] [Indexed: 10/22/2022]
Abstract
Promoting physical activity using environmental, policy, and systems approaches could potentially address persistent health disparities faced by American Indian and Alaska Native children and adolescents. To address research gaps and help inform tribally led community changes that promote physical activity, this review examined the methodology and current evidence of physical activity interventions and community-wide initiatives among Native youth. A keyword-guided search was conducted in multiple databases to identify peer-reviewed research articles that reported on physical activity among Native youth. Ultimately, 20 unique interventions (described in 76 articles) and 13 unique community-wide initiatives (described in 16 articles) met the study criteria. Four interventions noted positive changes in knowledge and attitude relating to physical activity but none of the interventions examined reported statistically significant improvements on weight-related outcomes. Only six interventions reported implementing environmental, policy, and system approaches relating to promoting physical activity and generally only shared anecdotal information about the approaches tried. Using community-based participatory research or tribally driven research models strengthened the tribal-research partnerships and improved the cultural and contextual sensitivity of the intervention or community-wide initiative. Few interventions or community-wide initiatives examined multi-level, multi-sector interventions to promote physical activity among Native youth, families, and communities. More research is needed to measure and monitor physical activity within this understudied, high risk group. Future research could also focus on the unique authority and opportunity of tribal leaders and other key stakeholders to use environmental, policy, and systems approaches to raise a healthier generation of Native youth.
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Affiliation(s)
- Sheila Fleischhacker
- Senior Public Health & Science Policy Advisor, Office of Nutrition Research, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Department of Health and Human Services, Two Democracy Plaza, Room 635, 6707 Democracy Boulevard MSC 5461, Bethesda, Maryland 20892-5461, – office 301-594-7440, mobile – 301-640-1396, fax – 301-480-3768
| | - Erica Roberts
- Doctoral Candidate, University of Maryland School of Public Health, Department of Behavioral and Community Health, 7923 Eastern Ave, Apt 1001, Silver Spring, MD 20910, voice – 410-236-7016
| | - Ricky Camplain
- Doctoral Student, University of North Carolina, Gillings School of Global Public Health, Department of Epidemiology, 137 East Franklin Street, Suite 303A, Chapel Hill, NC 27514, voice – 505-658-5262
| | - Kelly R. Evenson
- Research Professor of Epidemiology, University of North Carolina, Gillings School of Global Public Health, Department of Epidemiology, 137 E Franklin Street, Suite 306, Chapel Hill, NC 27514, voice – 919-966-4187
| | - Joel Gittelsohn
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Center for Human Nutrition, 615 N. Wolfe Street, Rm W2041, Baltimore, MD 21205, voice – 410-955-3927
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18
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Ingels JB, Walcott RL, Wilson MG, Corso PS, Padilla HM, Zuercher H, DeJoy DM, Vandenberg RJ. A Prospective Programmatic Cost Analysis of Fuel Your Life: A Worksite Translation of DPP. J Occup Environ Med 2016; 58:1106-1112. [PMID: 27820760 PMCID: PMC5927588 DOI: 10.1097/jom.0000000000000868] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE An accounting of the resources necessary for implementation of efficacious programs is important for economic evaluations and dissemination. METHODS A programmatic costs analysis was conducted prospectively in conjunction with an efficacy trial of Fuel Your Life (FYL), a worksite translation of the Diabetes Prevention Program. FYL was implemented through three different modalities, Group, Phone, and Self-study, using a micro-costing approach from both the employer and societal perspectives. RESULTS The Phone modality was the most costly at $354.6 per participant, compared with $154.6 and $75.5 for the Group and Self-study modalities, respectively. With the inclusion of participant-related costs, the Phone modality was still more expensive than the Group modality but with a smaller incremental difference ($461.4 vs $368.1). CONCLUSIONS This level of cost-related detail for a preventive intervention is rare, and our analysis can aid in the transparency of future economic evaluations.
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Affiliation(s)
- Justin B Ingels
- Economic Evaluation Research Group, College of Public Health (Drs Ingels, Walcott, Corso); Workplace Health Group, College of Public Health (Mr Wilson, Ms Padilla, Drs Zuercher, DeJoy); and Department of Management, Terry College of Business, University of Georgia, Athens, Georgia (Dr Vandenberg)
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Assessing Barriers and Enhancers to Increasing Physical Activity during the School Day in Children on an American Indian Reservation: A Qualitative Research Study. HEALTH BEHAVIOR AND POLICY REVIEW 2016; 3:429-438. [PMID: 34109254 DOI: 10.14485/hbpr.3.5.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective We attempted to determine factors that enhance or limit physical activity (PA) in children living on an American Indian (AI) reservation. Methods Six audio-recorded focus groups (FGs) were conducted. Each group included 6 - 8 participants (N = 42) with 3 grade specific FGs (4th - 6th grade students) and 3 adult FGs. Results FG analysis identified 4 main barriers to PA: school environment; community and school resources; electronic devices; and the role of parents and family. Analysis revealed 3 main strategies to increase PA: structured/non-competitive activities; structured/competitive activities; and increasing school and community-wide capacity. Conclusion The results from this study provide a school health perspective on the 4-day school week.
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Gefter L, Morioka-Douglas N, Srivastava A, Rodriguez E. Supporting At-Risk Youth and Their Families to Manage and Prevent Diabetes: Developing a National Partnership of Medical Residency Programs and High Schools. PLoS One 2016; 11:e0158477. [PMID: 27383902 PMCID: PMC4934855 DOI: 10.1371/journal.pone.0158477] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 06/16/2016] [Indexed: 12/01/2022] Open
Abstract
Background The Stanford Youth Diabetes Coaches Program (SYDCP) is a school based health program in which Family Medicine residents train healthy at-risk adolescents to become diabetes self-management coaches for family members with diabetes. This study evaluates the impact of the SYDCP when disseminated to remote sites. Additionally, this study aims to assess perceived benefit of enhanced curriculum. Methods From 2012–2015, 10 high schools and one summer camp in the US and Canada and five residency programs were selected to participate. Physicians and other health providers implemented the SYDCP with racial/ethnic-minority students from low-income communities. Student coaches completed pre- and posttest surveys which included knowledge, health behavior, and psychosocial asset questions (i.e., worth and resilience), as well as open-ended feedback questions. T-test pre-post comparisons were used to determine differences in knowledge and psychosocial assets, and open and axial coding methods were used to analyze qualitative data. Results A total of 216 participating high school students completed both pre-and posttests, and 96 nonparticipating students also completed pre- and posttests. Student coaches improved from pre- to posttest significantly on knowledge (p<0.005 in 2012–13, 2014 camp, and 2014–15); worth (p<0.1 in 2014–15); problem solving (p<0.005 in 2014 camp and p<0.1 in 2014–15); and self-efficacy (p<0.05 in 2014 camp). Eighty-two percent of student coaches reported that they considered making a behavior change to improve their own health as a result of program participation. Qualitative feedback themes included acknowledgment of usefulness and relevance of the program, appreciation for physician instructors, knowledge gain, pride in helping family members, improved relationships and connectedness with family members, and lifestyle improvements. Conclusion Overall, when disseminated, this program can increase health knowledge and some psychosocial assets of at-risk youth and holds promise to empower these youth with health literacy and encourage them to adopt healthy behaviors.
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Affiliation(s)
- Liana Gefter
- Center for Primary Care Research, Division of General Medical Disciplines, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
- * E-mail:
| | - Nancy Morioka-Douglas
- Center for Primary Care Research, Division of General Medical Disciplines, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Ashini Srivastava
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Eunice Rodriguez
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States of America
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Neamah HH, Sebert Kuhlmann AK, Tabak RG. Effectiveness of Program Modification Strategies of the Diabetes Prevention Program: A Systematic Review. DIABETES EDUCATOR 2016; 42:153-65. [PMID: 26879459 DOI: 10.1177/0145721716630386] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE The purpose of this study is to review the effectiveness of commonly used program modifications classified under cultural adaptation and program translational strategies for the Diabetes Prevention Program (DPP) in terms of risk reduction for type 2 diabetes. METHODS Authors extracted data about weight, body mass index (BMI), and 5 areas of program modification strategies from 28 interventions and analyzed them in SPSS software. Bivariate analyses examined the odds of achieving a significant reduction in outcomes by each modification of the DPP and by presence of a maintenance component, as well as the mean reduction of weight and BMI by more versus fewer modifications and by the presence of a maintenance component. RESULTS There were no statistically significant differences in achieving a significant reduction in weight or BMI by any type of modification or by the presence of a maintenance component. Programs with fewer modifications reported significantly greater reduction in mean weight at 12 months postintervention and the furthest time point extracted. Programs with a maintenance component achieved significantly greater reduction in mean weight measured at the furthest time point extracted. CONCLUSIONS The DPP appears to be programmatically robust to a variety of cultural adaptation and translational strategies. Potentially cost-saving modifications do not seem to reduce effectiveness, which should encourage implementation on a broader scale. Program planners should, however, make efforts to include maintenance components because they appear to significantly reduce risk for acquiring type 2 diabetes.
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Affiliation(s)
- Hind H Neamah
- Brown School, Washington University in St Louis, St Louis, Missouri, USA (Dr Neamah, Dr Sebert Kuhlmann)
| | - Anne K Sebert Kuhlmann
- Brown School, Washington University in St Louis, St Louis, Missouri, USA (Dr Neamah, Dr Sebert Kuhlmann),Behavioral Sciences and Health Education, College for Public Health and Social Justice, Saint Louis University, St Louis, Missouri, USA (Dr Sebert Kuhlmann)
| | - Rachel G Tabak
- Prevention Research Center in St Louis, Brown School, Washington University in St Louis, St Louis, Missouri, USA (Dr Tabak)
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Fleischhacker S. Emerging Opportunities for Registered Dietitian Nutritionists to Help Raise a Healthier Generation of Native American Youth. J Acad Nutr Diet 2016; 116:219-225. [PMID: 26680608 PMCID: PMC4733391 DOI: 10.1016/j.jand.2015.10.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 10/22/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Sheila Fleischhacker
- Corresponding Author and Reprint Contact, Sheila Fleischhacker, PhD, JD, Senior Public Health & Science Policy Advisor, Office of Nutrition Research, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Department of Health and Human Services, Two Democracy Plaza, Room 635, 6707 Democracy Boulevard MSC 5461, Bethesda, Maryland 20892-5461, voice – 301-594-7440, blackberry – 301-640-1396, fax – 301-480-3768,
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Chambers RA, Rosenstock S, Neault N, Kenney A, Richards J, Begay K, Blackwater T, Laluk O, Duggan C, Reid R, Barlow A. A Home-Visiting Diabetes Prevention and Management Program for American Indian Youth: The Together on Diabetes Trial. DIABETES EDUCATOR 2015; 41:729-47. [PMID: 26450222 DOI: 10.1177/0145721715608953] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE The purpose of this study was to test the feasibility of a family-based, home-visiting diabetes prevention/management intervention for American Indian (AI) youth with or at risk for type 2 diabetes. METHODS The Together on Diabetes program, developed through community-based participatory research, enrolled 255 AI youth (aged 10-19 years) with or at risk for type 2 diabetes and 223 support persons. Delivered by local AI paraprofessionals in 4 rural AI communities, the program included home-based lifestyle education and psychosocial support, facilitated referrals, and community-based healthy living activities. Changes in AI youth participants' knowledge, behavior, psychosocial status, and physiological measurements were assessed over 12 months. RESULTS Over one-half (56.1%) of youth were boys. The median age was 13.2 years. At baseline, 68.0% of youth reported no physical activity in the past 3 days; median percentages of kilocalories from fat (36.18%) and sweets (13.67%) were higher than US Department of Agriculture recommendations. Nearly 40% of participants reported food insecurity in the past month; 17.1% screened positive for depression. Support persons were predominantly family members, few reported having home Internet access (38.6%), and the majority reported being long distances (>30 minutes) from food stores. Whereas support persons were primarily responsible (≥69%) for obtaining medical care for the youth, the youth had a greater role in behavioral outcomes, indicating joint diabetes prevention/management responsibility. CONCLUSIONS Baseline results confirmed the need for family-based youth diabetes prevention interventions in rural AI communities and indicated that enrolling at-risk youth and family members is feasible and acceptable.
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Affiliation(s)
- Rachel A Chambers
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ms Chambers, Dr Rosenstock, Ms Kenney, Dr Barlow)
| | - Summer Rosenstock
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ms Chambers, Dr Rosenstock, Ms Kenney, Dr Barlow)
| | - Nicole Neault
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Albuquerque, New Mexico (Ms Neault)
| | - Anne Kenney
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ms Chambers, Dr Rosenstock, Ms Kenney, Dr Barlow)
| | - Jennifer Richards
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Tuba City, Arizona (Ms Richards)
| | - Kendrea Begay
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Chinle, Arizona (Ms Begay)
| | - Thomasina Blackwater
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Shiprock, New Mexico (Ms Blackwater, Dr Reid)
| | - Owen Laluk
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Whiteriver, Arizona (Mr Laluk)
| | - Christopher Duggan
- Boston Children's Hospital, Division of Gastroenterology, Hepatology and Nutrition, Center for Nutrition, Boston, Massachusetts (Dr Duggan)
| | - Raymond Reid
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Shiprock, New Mexico (Ms Blackwater, Dr Reid)
| | - Allison Barlow
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ms Chambers, Dr Rosenstock, Ms Kenney, Dr Barlow)
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24
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A review of diabetes prevention program translations: use of cultural adaptation and implementation research. Transl Behav Med 2015; 5:401-14. [PMID: 26622913 DOI: 10.1007/s13142-015-0341-0] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The Diabetes Prevention Program (DPP) has been shown to prevent type 2 diabetes through lifestyle modification. The purpose of this study was to describe the literature on DPP translation, synthesizing studies using cultural adaptation and implementation research. A systematic search was conducted. Original studies evaluating DPP implementation and/or cultural adaptation were included. Data about cultural adaptation, implementation outcomes, and translation strategies was abstracted. A total of 44 were included, of which 15 reported cultural adaptations and 38 explored implementation. Many studies shortened the program length and reported a group format. The most commonly reported cultural adaptation (13 of 15) was with content. At the individual level, the most frequently assessed implementation outcome (n = 30) was adoption. Feasibility was most common (n = 32) at the organization level. The DPP is being tested in a variety of settings and populations, using numerous translational strategies and cultural adaptations. Implementation research that identifies, evaluates, and reports efforts to translate the DPP into practice is crucial.
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Anderson LM, Adeney KL, Shinn C, Safranek S, Buckner‐Brown J, Krause LK. Community coalition-driven interventions to reduce health disparities among racial and ethnic minority populations. Cochrane Database Syst Rev 2015; 2015:CD009905. [PMID: 26075988 PMCID: PMC10656573 DOI: 10.1002/14651858.cd009905.pub2] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Racial and ethnic disparities in health status are pervasive at all stages of the life cycle. One approach to reducing health disparities involves mobilizing community coalitions that include representatives of target populations to plan and implement interventions for community level change. A systematic examination of coalition-led interventions is needed to inform decision making about the use of community coalition models. OBJECTIVES To assess effects of community coalition-driven interventions in improving health status or reducing health disparities among racial and ethnic minority populations. SEARCH METHODS We searched MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, Social Science Citation Index, Dissertation Abstracts, System for Information on Grey Literature in Europe (SIGLE) (from January 1990 through September 30, 2013), and Global Health Library (from January 1990 through March 31, 2014). SELECTION CRITERIA Cluster-randomized controlled trials, randomized controlled trials, quasi-experimental designs, controlled before-after studies, interrupted time series studies, and prospective controlled cohort studies. Only studies of community coalitions with at least one racial or ethnic minority group representing the target population and at least two community public or private organizations are included. Major outcomes of interest are direct measures of health status, as well as lifestyle factors when evidence indicates that these have an effect on the direct measures performed. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risk of bias for each study. MAIN RESULTS Fifty-eight community coalition-driven intervention studies were included. No study was considered to be at low risk of bias. Behavioral change outcomes and health status change outcomes were analyzed separately. Outcomes are grouped by intervention type. Pooled effects across intervention types are not presented because the diverse community coalition-led intervention studies did not examine the same constructs or relationships, and they used dissimilar methodological designs. Broad-scale community system level change strategies led to little or no difference in measures of health behavior or health status (very low-certainty evidence). Broad health and social care system level strategies leds to small beneficial changes in measures of health behavior or health status in large samples of community residents (very low-certainty evidence). Lay community health outreach worker interventions led to beneficial changes in health behavior measures of moderate magnitude in large samples of community residents (very low-certainty evidence). Lay community health outreach worker interventions may lead to beneficial changes in health status measures in large samples of community residents; however, results were not consistent across studies (low-certainty evidence). Group-based health education led by professional staff resulted in moderate improvement in measures of health behavior (very low-certainty evidence) or health status (low-certainty evidence). Adverse outcomes of community coalition-led interventions were not reported. AUTHORS' CONCLUSIONS Coalition-led interventions are characterized by connection of multi-sectoral networks of health and human service providers with ethnic and racial minority communities. These interventions benefit a diverse range of individual health outcomes and behaviors, as well as health and social care delivery systems. Evidence in this review shows that interventions led by community coalitions may connect health and human service providers with ethnic and racial minority communities in ways that benefit individual health outcomes and behaviors, as well as care delivery systems. However, because information on characteristics of the coalitions themselves is insufficient, evidence does not provide an explanation for the underlying mechanisms of beneficial effects. Thus, a definitive answer as to whether a coalition-led intervention adds extra value to the types of community engagement intervention strategies described in this review remains unattainable.
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Affiliation(s)
- Laurie M Anderson
- University of WashingtonDepartment of Epidemiology, School of Public HealthP.O. Box 357236SeattleWAUSA98195‐7236
| | - Kathryn L Adeney
- Washington State Institute for Public PolicyEpidemiology and Public Health110 Fifth Avenue SE, Suite 214SeattleWAUSA98504
| | - Carolynne Shinn
- New Hampshire Department of Health and Human ServicesNew Hampshire Division of Public Health ServicesConcordNew HampshireUSA03301‐3852
| | - Sarah Safranek
- University of WashingtonHealth Sciences Library1959 NE Pacific StreetSeattleWAUSA98195‐7155
| | - Joyce Buckner‐Brown
- Centers for Disease Control and PreventionNational Center for Chronic Disease Prevention and Health Promotion, Division of Community Health, Research Surveillance & Evaluation Branch4770 Buford Hwy NE, Mailstop K81AtlantaGeorgiaUSA30341
| | - L Kendall Krause
- Bill & Melinda Gates FoundationEpidemiology and Surveillance DivisionSeattleWAUSA
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Sanders Thompson VL, Johnson-Jennings M, Bauman AA, Proctor E. Use of culturally focused theoretical frameworks for adapting diabetes prevention programs: a qualitative review. Prev Chronic Dis 2015; 12:E60. [PMID: 25950567 PMCID: PMC4436044 DOI: 10.5888/pcd12.140421] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction Diabetes disproportionately affects underserved racial/ethnic groups in the United States. Diabetes prevention interventions positively influence health; however, further evaluation is necessary to determine what role culture plays in effective programming. We report on the status of research that examines cultural adaptations of diabetes prevention programs. Methods We conducted database searches in March and April 2014. We included studies that were conducted in the United States and that focused on diabetes prevention among African Americans, American Indians/Alaska Natives, Asian Americans/Pacific Islanders, and Latinos. Results A total of 58 studies were identified for review; 29 were excluded from evaluation. Few adaptations referenced or followed recommendations for cultural adaptation nor did they justify the content modifications by providing a rationale or evidence. Cultural elements unique to racial/ethnic populations were not assessed. Conclusion Future cultural adaptations should use recommended processes to ensure that culture’s role in diabetes prevention–related behavioral changes contributes to research.
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Affiliation(s)
- Vetta L Sanders Thompson
- Washington University in St. Louis, Brown School, One Brookings Dr, CB 1196, St. Louis, MO, 63130.
| | | | - Ana A Bauman
- Washington University in St. Louis, Brown School, St. Louis, Missouri
| | - Enola Proctor
- Washington University in St. Louis, Brown School, St. Louis, Missouri
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Calancie L, Leeman J, Jilcott Pitts SB, Khan LK, Fleischhacker S, Evenson KR, Schreiner M, Byker C, Owens C, McGuirt J, Barnidge E, Dean W, Johnson D, Kolodinsky J, Piltch E, Pinard C, Quinn E, Whetstone L, Ammerman A. Nutrition-related policy and environmental strategies to prevent obesity in rural communities: a systematic review of the literature, 2002-2013. Prev Chronic Dis 2015; 12:E57. [PMID: 25927605 PMCID: PMC4416478 DOI: 10.5888/pcd12.140540] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Residents of rural communities in the United States are at higher risk for obesity than their urban and suburban counterparts. Policy and environmental-change strategies supporting healthier dietary intake can prevent obesity and promote health equity. Evidence in support of these strategies is based largely on urban and suburban studies; little is known about use of these strategies in rural communities. The purpose of this review was to synthesize available evidence on the adaptation, implementation, and effectiveness of policy and environmental obesity-prevention strategies in rural settings. METHODS The review was guided by a list of Centers for Disease Control and Prevention Recommended Community Strategies and Measurements to Prevent Obesity in the United States, commonly known as the "COCOMO" strategies. We searched PubMed, Cumulative Index of Nursing and Allied Health Literature, Public Affairs Information Service, and Cochrane databases for articles published from 2002 through 2013 that reported findings from research on nutrition-related policy and environmental strategies in rural communities in the United States and Canada. Two researchers independently abstracted data from each article, and resolved discrepancies by consensus. RESULTS Of the 663 articles retrieved, 33 met inclusion criteria. The interventions most commonly focused on increasing access to more nutritious foods and beverages or decreasing access to less nutritious options. Rural adaptations included accommodating distance to food sources, tailoring to local food cultures, and building community partnerships. CONCLUSIONS Findings from this literature review provide guidance on adapting and implementing policy and environmental strategies in rural communities.
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Affiliation(s)
- Larissa Calancie
- Department of Nutrition, University of North Carolina, Chapel Hill, Gillings School of Global Public Health, CB No 7426, 1700 MLK/Airport Rd, Room 239, Chapel Hill, NC 27599-7426. Telephone: 315-350-1689.
| | - Jennifer Leeman
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Laura Kettel Khan
- Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity, Atlanta, Georgia
| | - Sheila Fleischhacker
- National Institutes of Health, Division on Nutrition Research Coordination, Bethesda, Maryland
| | - Kelly R Evenson
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michelle Schreiner
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Carmen Byker
- Montana State University, Billings, Montana; Ellen Barnidge, Saint Louis University, St. Louis, Missouri
| | - Clint Owens
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jared McGuirt
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Wesley Dean
- US Department of Agriculture Food and Nutrition Service, Washington, DC
| | | | | | | | | | | | | | - Alice Ammerman
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Abstract
Within most developed countries, rural residents are more likely to be obese and overweight compared to their urban counterparts. Studies of specific rural communities have found that the limited availability of healthy foods in the community and home as well as individual characteristics and preferences contribute to poor diet and overweight. The rural food environment is varied and may be affected by climate, regional and cultural preferences, transportation access, and remoteness among other factors. Given this diversity and the vulnerabilities of rural residents, who are more likely to have low-income, substandard housing or low educational attainment compared to their urban counterparts, policy and programmatic interventions should target specific needs and communities. This review will describe the rural community, home, and individual food environments and what is known about their roles in healthy eating.
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Affiliation(s)
- Jennifer D Lenardson
- Maine Rural Health Research Center, University of Southern Maine, 432B Wishcamper Center, 34 Bedford Street, Portland, ME, 04104, USA.
| | - Anush Y Hansen
- Maine Rural Health Research Center, University of Southern Maine, 404G Wishcamper Center, 34 Bedford Street, Portland, ME, 04104, USA.
| | - David Hartley
- Maine Rural Health Research Center, University of Southern Maine, 418 Wishcamper Center, 34 Bedford Street, Portland, ME, 04104, USA.
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Whitegoat W, Vu J, Thompson K, Gallagher J. Mental Health in Diabetes Prevention and Intervention Programs in American Indian/Alaska Native Communities. WASHINGTON UNIVERSITY JOURNAL OF AMERICAN INDIAN & ALASKA NATIVE HEALTH 2015; 1:4. [PMID: 28451652 PMCID: PMC5404894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
American Indian and Alaska Natives youth and adults experience higher rates of type 2 diabetes and mental health problems than the general United States population. Few studies have explored the relationship other than detail the two issues independently. The present review aims to identify programs that seek to prevent/treat type 2 diabetes and mental health disorders in the American Indian and Alaska Native population. Available programs were reviewed for AI/AN adults and youth who suffer with both. As part of the review process, databases were searched for peer reviewed published studies. It was found that very few programs effectively incorporate mental health into the existing diabetes program. Four recommendations for future research are offered based on this literature review.
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Affiliation(s)
- Wynette Whitegoat
- Center for Diabetes Translation Research, George Warren Brown School of Social Work, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130-4899, Telephone: 928-225-9280
| | - Jeremy Vu
- Center for Diabetes Translation Research, George Warren Brown School of Social Work, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130-4899, Telephone: 314-935-3064
| | - Kellie Thompson
- Center for Diabetes Translation Research, George Warren Brown School of Social Work, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130-4899, Telephone: 314-935-3005
| | - Jennifer Gallagher
- Center for Diabetes Translation Research, George Warren Brown School of Social Work, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130-4899, Telephone: 314-935-7504
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Attridge M, Creamer J, Ramsden M, Cannings‐John R, Hawthorne K. Culturally appropriate health education for people in ethnic minority groups with type 2 diabetes mellitus. Cochrane Database Syst Rev 2014; 2014:CD006424. [PMID: 25188210 PMCID: PMC10680058 DOI: 10.1002/14651858.cd006424.pub3] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Ethnic minority groups in upper-middle-income and high-income countries tend to be socioeconomically disadvantaged and to have a higher prevalence of type 2 diabetes than is seen in the majority population. OBJECTIVES To assess the effectiveness of culturally appropriate health education for people in ethnic minority groups with type 2 diabetes mellitus. SEARCH METHODS A systematic literature search was performed of the following databases: The Cochrane Library, MEDLINE, EMBASE, PsycINFO, the Education Resources Information Center (ERIC) and Google Scholar, as well as reference lists of identified articles. The date of the last search was July 2013 for The Cochrane Library and September 2013 for all other databases. We contacted authors in the field and handsearched commonly encountered journals as well. SELECTION CRITERIA We selected randomised controlled trials (RCTs) of culturally appropriate health education for people over 16 years of age with type 2 diabetes mellitus from named ethnic minority groups residing in upper-middle-income or high-income countries. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. When disagreements arose regarding selection of papers for inclusion, two additional review authors were consulted for discussion. We contacted study authors to ask for additional information when data appeared to be missing or needed clarification. MAIN RESULTS A total of 33 trials (including 11 from the original 2008 review) involving 7453 participants were included in this review, with 28 trials providing suitable data for entry into meta-analysis. Although the interventions provided in these studies were very different from one study to another (participant numbers, duration of intervention, group versus individual intervention, setting), most of the studies were based on recognisable theoretical models, and we tried to be inclusive in considering the wide variety of available culturally appropriate health education.Glycaemic control (as measured by glycosylated haemoglobin A1c (HbA1c)) showed improvement following culturally appropriate health education at three months (mean difference (MD) -0.4% (95% confidence interval (CI) -0.5 to -0.2); 14 trials; 1442 participants; high-quality evidence) and at six months (MD -0.5% (95% CI -0.7 to -0.4); 14 trials; 1972 participants; high-quality evidence) post intervention compared with control groups who received 'usual care'. This control was sustained to a lesser extent at 12 months (MD -0.2% (95% CI -0.3 to -0.04); 9 trials; 1936 participants) and at 24 months (MD -0.3% (95% CI -0.6 to -0.1); 4 trials; 2268 participants; moderate-quality evidence) post intervention. Neutral effects on health-related quality of life measures were noted and there was a general lack of reporting of adverse events in most studies - the other two primary outcomes for this review. Knowledge scores showed improvement in the intervention group at three (standardised mean difference (SMD) 0.4 (95% CI 0.1 to 0.6), six (SMD 0.5 (95% CI 0.3 to 0.7)) and 12 months (SMD 0.4 (95% CI 0.1 to 0.6)) post intervention. A reduction in triglycerides of 24 mg/dL (95% CI -40 to -8) was observed at three months, but this was not sustained at six or 12 months. Neutral effects on total cholesterol, low-density lipoprotein (LDL) cholesterol or high-density lipoprotein (HDL) cholesterol were reported at any follow-up point. Other outcome measures (blood pressure, body mass index, self-efficacy and empowerment) also showed neutral effects compared with control groups. Data on the secondary outcomes of diabetic complications, mortality and health economics were lacking or were insufficient.Because of the nature of the intervention, participants and personnel delivering the intervention were rarely blinded, so the risk of performance bias was high. Also, subjective measures were assessed by participants who self-reported via questionnaires, leading to high bias in subjective outcome assessment. AUTHORS' CONCLUSIONS Culturally appropriate health education has short- to medium-term effects on glycaemic control and on knowledge of diabetes and healthy lifestyles. With this update (six years after the first publication of this review), a greater number of RCTs were reported to be of sufficient quality for inclusion in the review. None of these studies were long-term trials, and so clinically important long-term outcomes could not be studied. No studies included an economic analysis. The heterogeneity of the studies made subgroup comparisons difficult to interpret with confidence. Long-term, standardised, multi-centre RCTs are needed to compare different types and intensities of culturally appropriate health education within defined ethnic minority groups, as the medium-term effects could lead to clinically important health outcomes, if sustained.
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Affiliation(s)
- Madeleine Attridge
- 3rd Floor Neuadd Meirionnydd, Cardiff UniversityCochrane Institute of Primary Care and Public HealthHeath ParkCardiffUKCF14 4YS
| | | | - Michael Ramsden
- 8th Floor, Neuadd Meirionnydd, Cardiff UniversityWales DeaneryHeath ParkCardiffUKCF14 4YS
| | - Rebecca Cannings‐John
- 4th Floor, Neuadd Meirionnydd, Cardiff UniversitySouth East Wales Trials UnitHealth ParkCardiffUKCF14 4XN
| | - Kamila Hawthorne
- 5th Floor, Cochrane Building, School of Medicine, Cardiff UniversityInstitute of Medical EducationHeath ParkCardiffUKCF14 4XN
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Tapp H, White L, Steuerwald M, Dulin M. Use of community-based participatory research in primary care to improve healthcare outcomes and disparities in care. J Comp Eff Res 2014; 2:405-19. [PMID: 24236682 DOI: 10.2217/cer.13.45] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Community-based participatory research (CBPR) has emerged to bridge the gap between research and primary-care practice through community engagement and social action to increase health equity. It is widely acknowledged that access to high-quality primary care services is important to the overall health of a community. Here, CBPR studies in a primary care setting are reviewed to assess the use of CBPR associated with common health problems seen in primary care such as access to care and disparities in chronic disease management across vulnerable populations. CBPR involves building relationships with local communities, determining areas of need and establishing priorities for health concerns. Studies showing improved access to care for a Hispanic population, reduced asthma symptoms and weight loss are highlighted.
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Affiliation(s)
- Hazel Tapp
- Carolinas HealthCare System, PO Box 32861, NC, USA
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Kaholokula JK, Wilson RE, Townsend CKM, Zhang GX, Chen J, Yoshimura SR, Dillard A, Yokota JW, Palakiko DM, Gamiao S, Hughes CK, Kekauoha BK, Mau MK. Translating the Diabetes Prevention Program in Native Hawaiian and Pacific Islander communities: the PILI 'Ohana Project. Transl Behav Med 2014; 4:149-59. [PMID: 24904698 PMCID: PMC4041922 DOI: 10.1007/s13142-013-0244-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Native Hawaiians/Pacific Islanders experience a high prevalence of overweight/obesity. The Diabetes Prevention Program Lifestyle Intervention (DPP-LI) was translated into a 3-month community-based intervention to benefit these populations. The weight loss and other clinical and behavioral outcomes of the translated DPP-LI and the socio-demographic, behavioral, and biological factors associated with the weight loss were examined. A total of 239 Native Hawaiian/Pacific Islander adults completed the translated DPP-LI through four community-based organizations (CBOs). Changes from pre- to post-intervention assessments in weight, blood pressure, physical functioning, exercise frequency, and fat in diet were measured. Significant improvements on all variables were found, with differences observed across the four CBOs. CBOs with predominately Native Hawaiian and ethnically homogenous intervention groups had greater weight loss. General linear modeling indicated that larger baseline weight and CBO predicted weight loss. The translated DPP-LI can be effective for Native Hawaiians/Pacific Islanders, especially when socio-cultural, socio-economic, and CBO-related contextual factors are taken into account.
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Affiliation(s)
- J K Kaholokula
- />Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai‘i, 677 Ala Moana Boulevard, Suite 1016B, Honolulu, HI 96813 USA
| | - R E Wilson
- />Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai‘i, 677 Ala Moana Boulevard, Suite 1016B, Honolulu, HI 96813 USA
| | - C K M Townsend
- />Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai‘i, 677 Ala Moana Boulevard, Suite 1016B, Honolulu, HI 96813 USA
| | - G X Zhang
- />Biostatistics and Data Management Core, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI USA
| | - J Chen
- />Biostatistics and Data Management Core, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI USA
| | - S R Yoshimura
- />Kōkua Kalihi Valley Comprehensive Family Services, Honolulu, HI USA
| | - A Dillard
- />Kula no nā Po‘e Hawai‘i, Honolulu, HI USA
| | - J W Yokota
- />Kōkua Kalihi Valley Comprehensive Family Services, Honolulu, HI USA
| | - D M Palakiko
- />Ke Ola Mamo, Native Hawaiian Health Care System O‘ahu, Honolulu, HI USA
| | - S Gamiao
- />Hawai‘i Maoli of the Association for Hawaiian Civic Clubs, Honolulu, HI USA
| | - C K Hughes
- />Hawai‘i Maoli of the Association for Hawaiian Civic Clubs, Honolulu, HI USA
| | | | - M K Mau
- />Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai‘i, 677 Ala Moana Boulevard, Suite 1016B, Honolulu, HI 96813 USA
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Tapp H, White L, Steuerwald M, Dulin M. Use of community-based participatory research in primary care to improve healthcare outcomes and disparities in care. J Comp Eff Res 2013. [PMID: 24236682 PMCID: PMC4042315 DOI: 10.2217/cer.13.45,] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Community-based participatory research (CBPR) has emerged to bridge the gap between research and primary-care practice through community engagement and social action to increase health equity. It is widely acknowledged that access to high-quality primary care services is important to the overall health of a community. Here, CBPR studies in a primary care setting are reviewed to assess the use of CBPR associated with common health problems seen in primary care such as access to care and disparities in chronic disease management across vulnerable populations. CBPR involves building relationships with local communities, determining areas of need and establishing priorities for health concerns. Studies showing improved access to care for a Hispanic population, reduced asthma symptoms and weight loss are highlighted.
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Affiliation(s)
- Hazel Tapp
- Carolinas HealthCare System, PO Box 32861, NC, USA
- Author for correspondence:
| | - Lauren White
- Carolinas HealthCare System, PO Box 32861, NC, USA
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Kalra S, Sridhar GR, Balhara YPS, Sahay RK, Bantwal G, Baruah MP, John M, Unnikrishnan AG, Madhu K, Verma K, Sreedevi A, Shukla R, Prasanna Kumar KM. National recommendations: Psychosocial management of diabetes in India. Indian J Endocrinol Metab 2013; 17:376-95. [PMID: 23869293 PMCID: PMC3712367 DOI: 10.4103/2230-8210.111608] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Although several evidence-based guidelines for managing diabetes are available, few, if any, focus on the psychosocial aspects of this challenging condition. It is increasingly evident that psychosocial treatment is integral to a holistic approach of managing diabetes; it forms the key to realizing appropriate biomedical outcomes. Dearth of attention is as much due to lack of awareness as due to lack of guidelines. This lacuna results in diversity among the standards of clinical practice, which, in India, is also due to the size and complexity of psychosocial care itself. This article aims to highlight evidence- and experience-based Indian guidelines for the psychosocial management of diabetes. A systemic literature was conducted for peer-reviewed studies and publications covering psychosocial aspects in diabetes. Recommendations are classified into three domains: General, psychological and social, and graded by the weight they should have in clinical practice and by the degree of support from the literature. Ninety-four recommendations of varying strength are made to help professionals identify the psychosocial interventions needed to support patients and their families and explore their role in devising support strategies. They also aid in developing core skills needed for effective diabetes management. These recommendations provide practical guidelines to fulfill unmet needs in diabetes management, and help achieve a qualitative improvement in the way physicians manage patients. The guidelines, while maintaining an India-specific character, have global relevance, which is bound to grow as the diabetes pandemic throws up new challenges.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India
| | - G. R. Sridhar
- Department of Endocrine and Diabetes Centre, Visakhapatnam, India
| | - Yatan Pal Singh Balhara
- Department of Psychiatry, National Drug Dependence Treatment Centre (NDDTC), AIIMS, New Delhi, India
| | | | - Ganapathy Bantwal
- Department of Endocrinology, St. John's Medical College, Bengaluru, India
| | - Manash P. Baruah
- Department of Endocrinology, Excel Centre Hospitals, Guwahati, India
| | - Mathew John
- Department of Endocrinology, Providence Endocrine and Diabetes Specialty Centre, Trivandrum, India
| | | | - K. Madhu
- Department of Psychology, Andhra University, Vishakhapatnam, India
| | - Komal Verma
- Department of Psychology, Consultant Psychologist, Noida, India
| | - Aswathy Sreedevi
- Department of Community Medicine, Amrita Institute of Medical Sciences, Kochi, India
| | - Rishi Shukla
- Department of Endocrinology, Center For Diabetes, Kanpur, Uttar Pradesh, India
| | - K. M. Prasanna Kumar
- Department of Endocrinology, CDEC and Bangalore Diabetes Hospital, Bengaluru, Karnataka, India
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Brown B, Noonan C, Harris KJ, Parker M, Gaskill S, Ricci C, Cobbs G, Gress S. Developing and piloting the Journey to Native Youth Health program in Northern Plains Indian communities. DIABETES EDUCATOR 2012; 39:109-18. [PMID: 23150531 DOI: 10.1177/0145721712465343] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to develop a lifestyle change program for Native American youth by modifying the Diabetes Prevention Program (DPP) and assess implementation indicators and short term behavioral and physiological outcomes of the intervention among a small pilot sample. METHODS Community members and project staff modified the original DPP to be developmentally and culturally appropriate for youth targeting healthy weight maintenance, lowering fat intake, and increasing physical activity. Modifications included incorporating cultural aspects and delivering the program in small groups led by community members. Sixty-four Native American youth, aged 10-14 years old were recruited from 2 Montana Indian reservations to participate in the project, titled "Journey to Native Youth Health." Participants were randomized to the Journey DPP or a health-oriented comparison condition. Pretest and posttest measures included body mass index (BMI), dietary intake, physical activity (PA), and nutrition knowledge, attitudes and beliefs (KAB). RESULTS The target number of participants was recruited and 84% completed the program and final measures. Changes favoring the Journey DPP group were observed on measures of PA, KAB, and kilocalories from fat consumed. As expected given the short (3-month) duration of treatment, there was no overall effect on BMI at end of treatment. Among youth who were overweight or obese at baseline, however, the Journey DPP had lower BMI growth. CONCLUSIONS Results suggest the Journey DPP is feasible to implement and has the potential to impact behaviors and weight gain associated with risk for type-2 diabetes in Native American youth.
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Affiliation(s)
- Blakely Brown
- Department Health and Human Performance, The University of Montana, Missoula, MT, USA
| | - Curtis Noonan
- Center for Environmental Health Sciences, The University of Montana, Missoula, MT, USA
| | - Kari Jo Harris
- School of Public and Community Health Sciences, The University of Montana, Missoula, MT, USA
| | - Martin Parker
- Chippewa Cree Tribal Health Center, Box Elder, MT, USA
| | - Steven Gaskill
- Department Health and Human Performance, The University of Montana, Missoula, MT, USA
| | - Christiana Ricci
- Department Health and Human Performance, The University of Montana, Missoula, MT, USA
| | - Georgia Cobbs
- Department of Curriculum and Instruction, The University of Montana, Missoula, MT, USA
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Joshi SR, Mohan V, Joshi SS, Mechanick JI, Marchetti A. Transcultural diabetes nutrition therapy algorithm: the Asian Indian application. Curr Diab Rep 2012; 12:204-12. [PMID: 22354498 PMCID: PMC3303049 DOI: 10.1007/s11892-012-0260-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
India and other countries in Asia are experiencing rapidly escalating epidemics of type 2 diabetes (T2D) and cardiovascular disease. The dramatic rise in the prevalence of these illnesses has been attributed to rapid changes in demographic, socioeconomic, and nutritional factors. The rapid transition in dietary patterns in India-coupled with a sedentary lifestyle and specific socioeconomic pressures-has led to an increase in obesity and other diet-related noncommunicable diseases. Studies have shown that nutritional interventions significantly enhance metabolic control and weight loss. Current clinical practice guidelines (CPGs) are not portable to diverse cultures, constraining the applicability of this type of practical educational instrument. Therefore, a transcultural Diabetes Nutrition Algorithm (tDNA) was developed and then customized per regional variations in India. The resultant India-specific tDNA reflects differences in epidemiologic, physiologic, and nutritional aspects of disease, anthropometric cutoff points, and lifestyle interventions unique to this region of the world. Specific features of this transculturalization process for India include characteristics of a transitional economy with a persistently high poverty rate in a majority of people; higher percentage of body fat and lower muscle mass for a given body mass index; higher rate of sedentary lifestyle; elements of the thrifty phenotype; impact of festivals and holidays on adherence with clinic appointments; and the role of a systems or holistic approach to the problem that must involve politics, policy, and government. This Asian Indian tDNA promises to help guide physicians in the management of prediabetes and T2D in India in a more structured, systematic, and effective way compared with previous methods and currently available CPGs.
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Affiliation(s)
- Shashank R Joshi
- Department of Endocrinology Grant Medical College and Sir J J Group of Hospitals, Lilavati Hospital, Bhatia Hospital, Joshi Clinic, Bandra Reclamation, Bandra West, Mumbai, India.
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Ricci CL, Brown BD, Noonan C, Harris KJ, Dybdal L, Parker M, Gress S. Parental influence on obesity in Northern Plains American Indian youth. FAMILY & COMMUNITY HEALTH 2012; 35:68-75. [PMID: 22143489 DOI: 10.1097/fch.0b013e3182385d64] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Little is known regarding American Indian (AI) parental influence on children's diet and physical activity (PA), or if this influence is associated with childhood weight. We compared AI parents' diet, PA, and support for these behaviors with the child's body mass index. Scores for parental support of positive PA and diet were higher among parents of overweight/obese children. Parent PA and nutrition behaviors were in a similar, but not significant, direction with respect to child body mass index. Findings suggest that future research is needed to determine what parental, societal, or community variables influence AI children to engage in healthy eating and PA, especially if they are overweight or obese, and the age at which these variables would have the most impact on these behaviors.
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Affiliation(s)
- Christiana L Ricci
- Department of Health & Human Performance, The University of Montana, Missoula, Montana 59812, USA.
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