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Wilson J, Thomson C, Sabo S, Edleman A, Kahn-John M. Development of an American Indian Diabetes Education Cultural Supplement: A Qualitative Approach. Front Public Health 2022; 10:790015. [PMID: 35211438 PMCID: PMC8860978 DOI: 10.3389/fpubh.2022.790015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/04/2022] [Indexed: 11/29/2022] Open
Abstract
Objective The purpose of this study was to culturally enhance a diabetes education program for Diné (Navajo) community members with Type 2 diabetes. Though the recommendation to culturally adapt health education curricula was meant to improve health education for American Indians and Alaskan Natives (AIANs), it has inadvertently created a “one size fits all” approach. This approach does not properly address the need for tribe-specific cultural health messaging, defined as incorporating cultural elements deemed relevant to the population. Tribe-specific health information and programming, such as integrating Diné worldviews and Indigenous knowledge among Diné people as described here, are essential to creating a culturally relevant and effective and meaningful approach to disease self-management. Methods A conversation guide, based on the Hózhó Resilience Model—a Diné framework on healthy living, was used to engage key cultural experts in interviews about traditional stories and teachings regarding health and wellness. Three specific self-care behaviors relevant to Type 2 diabetes self-management were discussed: (1) healthy eating, (2) physical activity, and (3) healthy coping. Interviews were audio-recorded, transcribed and analyzed using a qualitative thematic analysis method. Results Diné healers and cultural experts informed the development of an educational tool called Diné Health. Key themes that emerged from the data included the importance of discipline, positivity and mindfulness in the context of Hózhó. Conclusion Culturally safe and meaningful engagement with cultural leaders and the use of qualitative research methods can inform deep-level cultural adaptations essential to developing tribe-specific diabetes education programs. The approaches used here can guide the development, implementation, and testing of culturally-informed health education for AIAN populations.
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Affiliation(s)
- Jamie Wilson
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Cynthia Thomson
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Samantha Sabo
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States
| | - Anathea Edleman
- Diabetes Education and Clinical Education, Tuba City, AZ, United States
| | - Michelle Kahn-John
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States
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Chat VS, Hekmatjah J, Sierro TJ, Kassardjian AA, Read C, Armstrong AW. Language proficiency and biologics access: a population study of psoriasis patients in the United States. J DERMATOL TREAT 2022; 33:1413-1417. [DOI: 10.1080/09546634.2020.1820936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Vipawee S. Chat
- Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Joshua Hekmatjah
- Homer Stryker M.D. Schoolof Medicine, Western Michigan University, Kalamazoo, MI, USA
| | - Tiffany J. Sierro
- Department of Dermatology, Keck School of Medicine, University of Southern California Los Angeles, CA, USA
| | - Ari A. Kassardjian
- Department of Dermatology, Keck School of Medicine, University of Southern California Los Angeles, CA, USA
| | - Charlotte Read
- Department of Dermatology, Keck School of Medicine, University of Southern California Los Angeles, CA, USA
- Department of Medicine, Imperial College London, London, UK
| | - April W. Armstrong
- Department of Dermatology, Keck School of Medicine, University of Southern California Los Angeles, CA, USA
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Culturally Sensitive Behavior Intervention Materials: a Tutorial for Practicing Behavior Analysts. Behav Anal Pract 2022; 15:516-540. [PMID: 35692529 PMCID: PMC9120287 DOI: 10.1007/s40617-022-00703-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 10/18/2022] Open
Abstract
Behavior analytic interventions for people with disabilities often rely on implementation by novice caregivers and staff. However, behavior intervention documents are ineffective at evoking the level of performance needed for behavior change, and intensive training is often needed (Dogan et al., 2017; Ward-Horner & Sturmey, 2012). The cost and time requirements of intensive training may not be viable options for some clients, leading to nonadherence or attrition (Raulston et al., 2019). In addition, others may feel that prescribed interventions are not appropriate or will not work (Moore & Symons, 2011). These barriers may reflect a cultural mismatch (Rathod et al., 2018). One potential way to increase efficacy of intervention materials is to improve the cultural sensitivity and comprehensibility of these documents. Although the body of research on cultural adaptation of behavioral interventions is becoming more robust, adaptation of behavior intervention documents as a means to create effective behavior change when cultural and linguistic diversity are factors, is an area of behavior analytic practice that is not well researched and there remains a need for cultural humility. Because diversity can include expansive differences between individuals, such as race/ethnicity, socioeconomic status, religion, gender and sexuality; understanding and adapting to each of these areas may be best done through separate reviews. It is the intent of this article to focus on ethnic diversity in the United States as a starting point and frame of reference for cultural adaptation. This tutorial includes tips learned from health communication research to give step-by-step guidance on creating comprehensible, culturally adapted intervention plans through the example of training for parents of autistic children.
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Joachim-Célestin M, Gamboa-Maldonado T, Dos Santos H, Montgomery SB. Delivering the Same Intervention to Hispanic/Latinos With Pre-diabetes and Diabetes. Early Evidence of Success in a Longitudinal Mixed Method Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211055595. [PMID: 34825596 PMCID: PMC8673885 DOI: 10.1177/00469580211055595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite nationwide efforts to address the diabetes epidemic and reduce prevalence disparities, higher rates persist among the poor, especially those with limited literacy. Currently, individuals with abnormal glycemia who have pre-diabetes and diabetes qualify for different programs. However, evidence suggests that, for low-income Hispanic/Latinos, offering a single intervention to all those with abnormal glycemia may provide a more culturally acceptable and effective approach. Our objective was to explore the feasibility of such an intervention led by community health workers (CHWs) among low-income Hispanic/Latinos with diabetes and at risk for diabetes. METHODS Using a quasi-experimental mixed method design, we assessed weight, glycosylated hemoglobin, diabetes knowledge, and behavior changes of Hispanic/Latinos participants with pre-diabetes and diabetes living in Southern California. Biometric measurements, blood tests, and surveys were collected at baseline and 3 months post-intervention. Interviews and focus group discussions provided qualitative data. RESULTS Although the program was less costly, results exceeded those reported for low-income H/L attending the National Diabetes Prevention Program and did not differ between pre-diabetes and diabetes groups. Instead, including individuals at different stages of the dysglycemic spectrum seemed to have enhanced the intervention. Physician referral and attendance of family/friends were associated with better outcomes. CONCLUSION Our findings indicate that a joint prevention/self-management intervention led by CHWs for low-income Hispanic/Latinos with diabetes and with pre-diabetes is feasible and cost-effective, providing results that could help reduce the success gap. Incorporating suggestions and replicating this study on a larger scale could help determine whether or not results are reproducible.
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Affiliation(s)
- Maud Joachim-Célestin
- Loma Linda University School of Behavioral Health, Loma Linda, CA, USA
- Loma Linda University School of Medicine, Loma Linda, CA, USA
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Kaushik P, Reed B, Kalirai S, Perez-Nieves M. Challenges in insulin initiation among Hispanics/Latinos with diabetes in the United States. Prim Care Diabetes 2020; 14:401-412. [PMID: 32063507 DOI: 10.1016/j.pcd.2019.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 10/08/2019] [Accepted: 12/26/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE The prevalence of diagnosed diabetes in the United States (U.S.) is particularly high among people of Hispanic/Latino ethnicity, placing this population at risk of developing diabetes-related complications. We conducted a systematic literature review to understand and communicate the current gaps and disparities, including myths and misconceptions, regarding insulin initiation among the Hispanic/Latino population in the U.S. METHODS We searched MEDLINE and MEDLINE In-process, e-pubs ahead of print (OvidSP), EMBASE (OvidSP), and the Cochrane Central Register of Controlled Trials (CENTRAL). The search strategy combined free text and controlled vocabulary terms and was developed to identify challenges associated with insulin use and initiation, as well as myths/misconceptions associated with insulin use. The quality of included studies was assessed using the National Institutes of Health (NIH) quality assessment tool. PRINCIPAL RESULTS In total, 777 articles were identified, with 13 articles included for data synthesis. Frequently reported barriers to initiating diabetes treatment among the Hispanic/Latino community related to socioeconomic and sociocultural factors. In particular, limited health literacy and access to health care, as well as low education and economic status, were common factors preventing treatment initiation for diabetes. Cultural factors, including language, food preferences, and lack of family support were also evident, with misconceptions and fears concerning insulin being commonly reported. Patients also described barriers concerning health care providers, including interpersonal issues and difficulties with communication and language. MAJOR CONCLUSIONS Overall, the current literature highlights many obstacles facing Hispanic/Latino patients in initiating insulin treatment for diabetes. Although limited research was identified, we describe common barriers and themes among this minority population. Awareness of these barriers is important for health care providers, enabling them to identify and address insulin-related fears and misconceptions and to be mindful of their cultural competency. Additionally, knowledge of current barriers will guide further research aimed at developing tailored strategies and tools to improve long-term health outcomes and quality of life in this population.
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Affiliation(s)
- Puneet Kaushik
- Eli Lilly Services India Private Limited, Building Primrose (7B), Embassy Tech Village, Outer Ring Road, Bengaluru, India.
| | - Beverly Reed
- Eli Lilly and Company, Global Headquarters Lilly Corporate Center, Indianapolis, IN, 46285, USA.
| | - Samaneh Kalirai
- Eli Lilly and Company, Global Headquarters Lilly Corporate Center, Indianapolis, IN, 46285, USA.
| | - Magaly Perez-Nieves
- Eli Lilly and Company, Global Headquarters Lilly Corporate Center, Indianapolis, IN, 46285, USA.
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Resnicow K, Patel MR, Green M, Smith A, Bacon E, Goodell S, Tariq M, Alhawli A, Syed N, Van Horn ML, Stiffler M. Development of an Ethnic Identity Measure for Americans of Middle Eastern and North African Descent: Initial Psychometric Properties, Sociodemographic, and Health Correlates. J Racial Ethn Health Disparities 2020; 8:1067-1078. [PMID: 32974877 PMCID: PMC8285340 DOI: 10.1007/s40615-020-00863-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/26/2020] [Accepted: 09/01/2020] [Indexed: 11/30/2022]
Abstract
Background Southeast Michigan is home to the second largest Middle Eastern and North African (MENA) US population. There is increasing interest in understanding correlates of psychosocial outcomes and health behaviors in this growing population. One potentially important health correlate is ethnic identity (EI). This paper reports the development, validity, and initial correlates of a new measure of MENA identity named the MENA-IM. Methods We used convenience sampling at locations frequented by individuals of MENA descent in southeast Michigan. We also measured EI centrality, religiosity, cultural mistrust, substance use, and health status to assess convergent and divergent validity. Exloratory and Confirmatory Factor Analysis identified three subscales, which were valid for both Arab and Chaldean respondents and were named (1) MENA cultural affiliation, (2) MENA media use, and (3) multicultural affiliation. We also created and tested a 20-item, single-factor version. Results We obtained data from 378 adults, 73% of whom identified as Arab and 27% as Chaldean. MENA-IM scores were higher among older, lower-educated, lower-income, non-US born, and Arabic-speaking respondents. Arab respondents reported significantly higher scores than Chaldeans. MENA-IM scores were positively associated with EI centrality and religiosity. Higher MENA-IM scores were found among those not reporting use of marijuana, alcohol, and opiates. Higher MENA-IM scores were also found among those without a self-reported history of heart disease and among those with better mental health status. Discussion The MENA-IM has strong psychometric properties and demonstrated initial evidence of convergent and discriminant validity. In general, values on the measure were associated with better psychosocial and health status. How the measure performs with MENA populations outside of Michigan and how it may relate to other health outcomes merit investigation.
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Affiliation(s)
- Ken Resnicow
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, 109 Observatory Street, Room 3867 SPH I, Ann Arbor, MI, 48109-2029, USA. .,University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA.
| | - Minal R Patel
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, 109 Observatory Street, Room 3867 SPH I, Ann Arbor, MI, 48109-2029, USA.,University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | - Molly Green
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, 109 Observatory Street, Room 3867 SPH I, Ann Arbor, MI, 48109-2029, USA
| | - Alyssa Smith
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, 109 Observatory Street, Room 3867 SPH I, Ann Arbor, MI, 48109-2029, USA
| | - Elizabeth Bacon
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | | | - Madiha Tariq
- ACCESS, 6450 Maple St., Dearborn, MI, 48126, USA
| | | | - Nadia Syed
- ACCESS, 6450 Maple St., Dearborn, MI, 48126, USA
| | - M Lee Van Horn
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
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Joachim-Célestin M, Gamboa-Maldonado T, Dos Santos H, Montgomery SB. A Qualitative Study on the Perspectives of Latinas Enrolled in a Diabetes Prevention Program: Is the Cost of Prevention Too High? J Prim Care Community Health 2020; 11:2150132720945423. [PMID: 32755275 PMCID: PMC7543125 DOI: 10.1177/2150132720945423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Latinas are among the groups most affected by diabetes health disparities, yet they often benefit less from diabetes interventions even when these are culturally adapted. The purpose of this qualitative study was to explore readiness of Latinas enrolled in a diabetes prevention program to adopt recommended preventive behaviors, and to identify factors associated with the adoption and maintenance of these recommended lifestyle changes. Insights gained will be used to inform future efforts at reducing diabetes disparities and the burden of chronic diseases among Latinas. Methods: Nine focus group discussions (FGDs) and 3 key informant interviews (KIIs) were conducted after the completion of a culturally adapted diabetes prevention program led by Latino community health workers. A grounded theory approach by Charmaz informed by the transtheoretical model guided the questions. Discussions and interviews were audio-taped with participants’ permission, transcribed, coded, and themed. Results: Forty low-income Latinas contributed to FGDs and KIIs. Baseline readiness to engage in new behaviors varied. Negative personal and family health events and physician referral impacted most readiness to enroll and to adopt preventive behaviors. Built environment, financial constraints, and threat of social alienation constituted major barriers to behavior adoption and maintenance, while physician involvement, awareness of diabetes complications, and social support partially mitigated these impediments. Conclusions: Our results suggest that timing of enrollment, physician-patient dynamics, and the emotional personal/family cost of behavior modification should all be considered when planning diabetes prevention programs for low-income Latinas. Besides appropriately timing referrals to accessible culturally informed prevention programs, health educators and health care providers should be aware of the potentially negative impact of behavior modification on family dynamics and be prepared to address resulting repercussions. Future research on Latinas should also include and report data on physician involvement, family context, and social determinants of health for more consistent program comparisons.
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8
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An Exploration of Latina/o Respondent Scores on the Personality Assessment Inventory. CURRENT PSYCHOLOGY 2019. [DOI: 10.1007/s12144-017-9652-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Leung MM, Mateo KF, Verdaguer S, Wyka K. Testing a Web-Based Interactive Comic Tool to Decrease Obesity Risk Among Minority Preadolescents: Protocol for a Pilot Randomized Control Trial. JMIR Res Protoc 2018; 7:e10682. [PMID: 30413399 PMCID: PMC6251980 DOI: 10.2196/10682] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 08/09/2018] [Accepted: 08/14/2018] [Indexed: 12/15/2022] Open
Abstract
Background Childhood obesity is a public health crisis, particularly in low-income, minority populations in the United States. Innovative and technology-enhanced interventions may be an engaging approach to reach at-risk youth and their parents to improve dietary behaviors and feeding practices. However, such tools are limited, especially ones that are theory-based; co-developed with user-centered approaches; tailored to low-income, minority preadolescents; and include parent-focused content. Objective The objectives of this study include assessing the feasibility and acceptability and exploring the potential impact of the Intervention INC (Interactive Nutrition Comics for urban, minority preadolescents) Web-based tool, which is focused on decreasing childhood obesity risk in black/African American and Latino children aged 9 to 12 years. Methods Intervention INC is underpinned by the narrative transportation theory, social cognitive theory, and health belief model, and it was co-developed by children and parents from the intended population. The child component consists of a 6-chapter interactive nutrition comic optimized for use on tablet devices, a goal-setting and self-assessment feature, and weekly text/email messages and reminders. The parental component consists of 6 Web-based newsletters, access to the child comic, and weekly text/email messages and reminders. The tool was evaluated using a pilot, single-blind, 2-group randomized controlled study design. Child-parent dyads were randomized to either the experimental or comparison group and assigned to a targeted behavior (increase fruit/vegetable or water intake) based on initial screening questions. Data were collected at 4 time points: baseline (T1), intervention midpoint (T2), intervention endpoint (T3), and 3 months postintervention (T4). Primary measures comprise usage, usability, and feasibility of the Web-based tool. Secondary measures comprise dietary knowledge, preferences, and intake and anthropometric measures (for child) and feeding practices and home food environment (for parent). Results Study enrollment was completed in November 2017. A total of 89 child-parent dyads were randomized to either the experimental (n=44) or comparison (n=45) group. Data analysis is currently being conducted. Conclusions This study aims to implement and assess an innovative approach to deliver health messages and resources to at-risk minority preadolescents and their parents. If found to be acceptable, engaging, feasible, and a potential approach to improve dietary behaviors, a full-fledged randomized controlled trial will be conducted to assess its efficacy and potential impact. Trial Registration ClinicalTrials.gov NCT03165474; https://clinicaltrials.gov/ct2/show/NCT03165474 (Archived by WebCite at http://www.webcitation.org/73122IjgP) International Registered Report Identifier (IRRID) RR1-10.2196/10682
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Affiliation(s)
- May May Leung
- School of Urban Public Health, Hunter College, New York, NY, United States
| | - Katrina F Mateo
- School of Urban Public Health, Hunter College, New York, NY, United States.,Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Sandra Verdaguer
- School of Urban Public Health, Hunter College, New York, NY, United States.,Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Katarzyna Wyka
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
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Gollenberg A, Fendley K. Is it Time for a Sudden Infant Death Syndrome (SIDS) Awareness Campaign? Community Stakeholders' Perceptions of SIDS. ACTA ACUST UNITED AC 2017; 24:53-64. [PMID: 29249897 DOI: 10.1080/13575279.2016.1259155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background Sudden infant death syndrome (SIDS) remains a leading cause of infant death in the United States and in Virginia, the SIDS rate is higher than the national average. We sought to gauge the perceptions among community-identified stakeholders as to community resource needs to reduce SIDS. Methods We used snowball sampling to identify important community stakeholders to be interviewed as key informants. A semi-structured interview lasting 45 min-2 hours was delivered to determine resource needs to reduce SIDS, and whether high-risk community members were aware of SIDS risk factors among stakeholders representing a variety of disciplines. Interviews were conducted in two geographic areas with higher than average rates of infant mortality, an urban district, Winchester City, VA and a rural district, Page County, VA. Results A total of 74 interviews were completed with stakeholders in healthcare, health departments, social services, law enforcement, education/childcare, faith-based institutions, non-profit agencies and non-affiliated community members. The majority of respondents perceive that high-risk community members are not aware of factors that can lead to SIDS (50%). Participants suggested that more "education" is needed to further reduce the rates of SIDS in their communities (73%). Respondents detailed that more pervasive, strategic, and multi-channeled education is necessary to reduce cases of SIDS. Conclusion Community leaders perceive that high-risk community members are not fully aware of risk factors that can lead to SIDS. Maternal/child health stakeholders in these Virginia locales suggested more community-based education as a potential solution to SIDS.
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Affiliation(s)
- Audra Gollenberg
- Associate Professor of Public Health, Shenandoah University, College of Arts & Sciences, Public Health Program, Winchester, VA 22601
| | - Kim Fendley
- Associate Professor of Sociology, Shenandoah University, College of Arts & Sciences, Sociology Program, Winchester, VA 22601
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Tziomalos K. Barriers to insulin treatment in patients with type 2 diabetes mellitus. Expert Opin Pharmacother 2017; 18:233-234. [PMID: 28067057 DOI: 10.1080/14656566.2017.1280462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Konstantinos Tziomalos
- a First Propedeutic Department of Internal Medicine , Medical School, Aristotle University of Thessaloniki, AHEPA Hospital , Thessaloniki , Greece
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Nguyen H, Sorkin DH, Billimek J, Kaplan SH, Greenfield S, Ngo-Metzger Q. Complementary and alternative medicine (CAM) use among non-Hispanic white, Mexican American, and Vietnamese American patients with type 2 diabetes. J Health Care Poor Underserved 2016; 25:1941-55. [PMID: 25418251 DOI: 10.1353/hpu.2014.0178] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE This study examines the use of complementary and alternative medicine (CAM) by ethnicity/race among patients with type 2 diabetes. SUBJECTS AND METHODS Four hundred and ten (410) patients with type 2 diabetes recruited from an academic-medical center completed a survey assessing CAM use, diabetes status, and sociodemographic characteristics. RESULTS Several significant ethnic/racial differences were observed in CAM use (both in the types of providers seen as well as in the herbs and dietary supplements used). Although White patients reported using CAM in addition to their diabetes medication (mean [SD] 4.9 [0.4] on a scale from 1=never to 5=always) more frequently than Mexican American patients (3.1 [1.6], p<.05), Mexican American patients (1.4 [1.1]) used CAM instead of their diabetes medications more frequently than non-Hispanic White patients (1.0 [0.1], p<.05). More Mexican American (66.7%) and Vietnamese American patients (73.7%) than non-Hispanic Whites (11.8%, p=.002) described CAM practitioners as being closer to their cultural traditions than Western practitioners, whereas Vietnamese [End Page 1941] patients were more likely to describe use of herbs and supplements as closer to their cultural traditions (84.5% versus 15.3% for White and 30.9% for Mexican American patients, p <.001). CONCLUSIONS Considering the variability and perceptions in CAM use, providers should discuss with their patients how their CAM use may influence diabetes management behaviors.
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López L, Tan-McGrory A, Horner G, Betancourt JR. Eliminating disparities among Latinos with type 2 diabetes: Effective eHealth strategies. J Diabetes Complications 2016; 30:554-60. [PMID: 26774790 PMCID: PMC5006182 DOI: 10.1016/j.jdiacomp.2015.12.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 11/16/2015] [Accepted: 12/03/2015] [Indexed: 11/19/2022]
Abstract
Latinos are at increased risk for obesity and type 2 diabetes (T2D). Well-designed information technology (IT) interventions have been shown to be generally efficacious in improving diabetes self-management. However, there are very few published IT intervention studies focused on Latinos. With the documented close of the digital divide, Latinos stand to benefit from such advances. There are limited studies on how best to address the unique socio-cultural-linguistic characteristics that would optimize adoption, use and benefit among Latinos. Successful e-health programs involve frequent communication, bidirectionality including feedback, and multimodal delivery of the intervention. The use of community health workers (CHWs) has been shown consistently to improve T2D outcomes in Latinos. Incorporating CHWs into eHealth interventions is likely to address barriers with technology literacy and improve patient activation, satisfaction and adherence. Additionally, tailored interventions are more successful in improving patient activation. It is important to note that tailoring is more than linguistic translation; tailoring interventions to the Latino population will need to address educational, language, literacy and acculturation levels, along with unique illness beliefs and attitudes about T2D found among Latinos. Interventions will need to go beyond the lone participant and include shared decision making models that incorporate family members and friends.
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Affiliation(s)
- Lenny López
- Disparities Solutions Center, Massachusetts General Hospital, Boston, MA; Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA; Department of General Internal Medicine, Massachusetts General Hospital, Boston, MA; Brigham and Women's Hospital, Boston, MA.
| | - Aswita Tan-McGrory
- Disparities Solutions Center, Massachusetts General Hospital, Boston, MA; Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA
| | - Gabrielle Horner
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA
| | - Joseph R Betancourt
- Disparities Solutions Center, Massachusetts General Hospital, Boston, MA; Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA
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14
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Adams WE, Todorova ILG, Guzzardo MT, Falcon LM. 'The problem here is that they want to solve everything with pills': medication use and identity among Mainland Puerto Ricans. SOCIOLOGY OF HEALTH & ILLNESS 2015; 37:904-919. [PMID: 25720591 PMCID: PMC4521983 DOI: 10.1111/1467-9566.12240] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Taking medications are complex symbolic acts, infused with diverse meanings regarding body and identity. This article focuses on the meanings of medications for older Puerto Ricans living on the United States mainland, a population experiencing stark health disparities. We aim to gain an understanding of the way multiple cultural and personal meanings of medications are related to and integrated in identity, and to understand how they are situated within Puerto Rican culture, history and circumstance on the US mainland. Data is drawn from thirty qualitative interviews, transcribed and translated, with older Puerto Ricans living on mainland United States. Thematic Analysis indicated four prevalent themes: embodiment of medication use; medications redefining self through the fabric of daily life; healthcare experience defined through medication; and medicine dividing the island and the mainland. While identity is impacted by experience of chronic illness, the experience of medication prescription and consumption is further related to the construction of the sense of self in distinct ways. For these individuals, medication use captures the dilemma of immigration. While cultural belonging and well-being remains on the island of Puerto Rico, the mainland hosts both easier access to and excess reliance on medication.
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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: 90] [Impact Index Per Article: 9.0] [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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Inam A, Tariq PN, Zaman S. Cultural adaptation of preschool PATHS (Promoting Alternative Thinking Strategies) curriculum for Pakistani children. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2014; 50:232-9. [PMID: 25130573 DOI: 10.1002/ijop.12090] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 06/25/2014] [Accepted: 06/25/2014] [Indexed: 02/03/2023]
Abstract
Cultural adaptation of evidence-based programmes has gained importance primarily owing to its perceived impact on the established effectiveness of a programme. To date, many researchers have proposed different frameworks for systematic adaptation process. This article presents the cultural adaptation of preschool Promoting Alternative Thinking Strategies (PATHS) curriculum for Pakistani children using the heuristic framework of adaptation (Barrera & Castro, 2006). The study was completed in four steps: information gathering, preliminary adaptation design, preliminary adaptation test and adaptation refinement. Feedbacks on programme content suggested universality of the core programme components. Suggested changes were mostly surface structure: language, presentation of materials, conceptual equivalence of concepts, training needs of implementation staff and frequency of programme delivery. In-depth analysis was done to acquire cultural equivalence. Pilot testing of the outcome measures showed strong internal consistency. The results were further discussed with reference to similar work undertaken in other cultures.
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Affiliation(s)
- Ayesha Inam
- National Institute of Psychology, Quaid-i-Azam University, Islamabad, Pakistan
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Torres ME, Smithwick-Leone J, Willms L, Franco MM, McCandless R, Lohman M. Developing a culturally appropriate preconception health promotion strategy for newly immigrated Latinos through a community-based program in South Carolina. Am J Health Promot 2013; 27:S7-9. [PMID: 23286667 DOI: 10.4278/ajhp.120117-cit-42] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Maternal and Child Health (MCH) experts emphasize the importance of preconception health (PCH) in achieving healthy pregnancies and positive birth outcomes. Research demonstrates that Latinas face significant PCH disparities, yet no comprehensive PCH promotion strategy exists to reach them. As a trusted community-based organization that uses culturally competent strategies to promote MCH in the Latino community, PASOs is well-positioned to address PCH among Latinos in South Carolina. With the input and support of Latino community members, PASOs is pioneering a PCH strategy using its successful model of education, outreach, partnerships and resource navigation.
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Affiliation(s)
- Myriam E Torres
- Arnold School of Public Health and Consortium forLatino Immigration Studies, University of South Carolina,Columbia, SC 29208, USA
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Barrera M, Castro FG, Strycker LA, Toobert DJ. Cultural adaptations of behavioral health interventions: a progress report. J Consult Clin Psychol 2013; 81:196-205. [PMID: 22289132 PMCID: PMC3965302 DOI: 10.1037/a0027085] [Citation(s) in RCA: 382] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To reduce health disparities, behavioral health interventions must reach subcultural groups and demonstrate effectiveness in improving their health behaviors and outcomes. One approach to developing such health interventions is to culturally adapt original evidence-based interventions. The goals of the article are to (a) describe consensus on the stages involved in developing cultural adaptations, (b) identify common elements in cultural adaptations, (c) examine evidence on the effectiveness of culturally enhanced interventions for various health conditions, and (d) pose questions for future research. METHOD Influential literature from the past decade was examined to identify points of consensus. RESULTS There is agreement that cultural adaptation can be organized into 5 stages: information gathering, preliminary design, preliminary testing, refinement, and final trial. With few exceptions, reviews of several health conditions (e.g., AIDS, asthma, diabetes) concluded that culturally enhanced interventions are more effective in improving health outcomes than usual care or other control conditions. CONCLUSIONS Progress has been made in establishing methods for conducting cultural adaptations and providing evidence of their effectiveness. Future research should include evaluations of cultural adaptations developed in stages, tests to determine the effectiveness of cultural adaptations relative to the original versions, and studies that advance our understanding of cultural constructs' contributions to intervention engagement and efficacy.
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Affiliation(s)
- Manuel Barrera
- Department of Psychology, Arizona State University (Tempe, Arizona) and Oregon Research Institute (Eugene, Oregon)
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