1
|
Nsobundu C, Nmadu YW, Wagle NS, Foster MJ, McKyer ELJ, Sherman L, Ory MG, Burdine J(JN. Process Evaluations of Diabetes Self-Management Programs: A Systematic Review of the Literature. Am J Health Promot 2024; 38:1048-1067. [PMID: 38648265 PMCID: PMC11348640 DOI: 10.1177/08901171241238554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To conduct a systematic review of process evaluations (PEs) of diabetes self-management programs (DSMPs). DATA SOURCE An electronic search using Medline (Ovid), Embase (Ovid), CINAHL (Ensco), Academic Search (Ebsco), and APA PsycInfo (Ebsco). STUDY INCLUSION AND EXCLUSION CRITERIA Peer-reviewed, empirical quantitative, qualitative, or mixed-method studies were included if they (1) were a traditional, group-based DSMP, (2) involved adults at least 18 years with T1DM or T2DM, (3) were a stand-alone or embedded PE, and (4) published in English. DATA EXTRACTION The following process evaluation outcomes were extracted: fidelity, dose delivered, dose received, reach, recruitment, retention, and context. Additional items were extracted, (eg, process evaluation type, data collection methods; theories; frameworks or conceptual models used to guide the process evaluation, and etc). DATA SYNTHESIS Due to heterogeneity across studies, studies were synthesized qualitatively (narratively). RESULTS Sixty-eight studies (k) in 78 articles (n) (k = 68; n = 78) were included. Most were mixed methods of low quality. Studies were typically integrated into outcome evaluations vs being stand-alone, lacked theoretical approaches to guide them, and incorporated limited outcomes such as dose received, reach, and retention. CONCLUSION Future research should 1) implement stand-alone theoretically grounded PE studies and 2) provide a shared understanding of standardized guidelines to conduct PEs. This will allow public health practitioners and researchers to assess and compare the quality of different programs to be implemented.
Collapse
Affiliation(s)
- Chinelo Nsobundu
- Center for Community Health & Aging, School of Public Health, Texas A&M University, College Station, TX, USA
- School of Medicine, St George’s University, St George’s, Grenada
| | - Yeka W. Nmadu
- Department of Pediatrics, University of Florida College of Medicine- Jacksonville, Jacksonville, FL, USA
| | - Nikita Sandeep Wagle
- Population Informatics Lab, Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Margaret J. Foster
- Department of Medical Education, Texas A&M College of Medicine, College Station, TX, USA
| | - Ellisa Lisako Jones McKyer
- Vice Dean Faculty Affairs & Diversity, Equity, and Inclusion, Alice L. Walton School of Medicine, Bentonville, AR, USA
| | - Ledric Sherman
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Marcia G. Ory
- Department of Environmental & Occupational Health, School of Public Health, Texas A&M University, College Station, TX, USA
| | - James (Jim) N. Burdine
- Department of Health Behavior, Director of the Center for Community Health & Aging, School of Public Health, Texas A&M University, College Station, TX, USA
| |
Collapse
|
2
|
Emad-Eldin M, Balata GF, Elshorbagy EA, Hamed MS, Attia MS. Insulin therapy in type 2 diabetes: Insights into clinical efficacy, patient-reported outcomes, and adherence challenges. World J Diabetes 2024; 15:828-852. [PMID: 38766443 PMCID: PMC11099362 DOI: 10.4239/wjd.v15.i5.828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 02/01/2024] [Accepted: 03/20/2024] [Indexed: 05/10/2024] Open
Abstract
Insulin therapy plays a crucial role in the management of type 2 diabetes as the disease progresses. Over the past century, insulin formulations have undergone significant modifications and bioengineering, resulting in a diverse range of available insulin products. These products show distinct pharmacokinetic and pharmacodynamic profiles. Consequently, various insulin regimens have em-erged for the management of type 2 diabetes, including premixed formulations and combinations of basal and bolus insulins. The utilization of different insulin regimens yields disparate clinical outcomes, adverse events, and, notably, patient-reported outcomes (PROs). PROs provide valuable insights from the patient's perspective, serving as a valuable mine of information for enhancing healthcare and informing clinical decisions. Adherence to insulin therapy, a critical patient-reported outcome, significantly affects clinical outcomes and is influenced by multiple factors. This review provides insights into the clinical effectiveness of various insulin preparations, PROs, and factors impacting insulin therapy adherence, with the aim of enhancing healthcare practices and informing clinical decisions for individuals with type 2 diabetes.
Collapse
Affiliation(s)
- Mahmoud Emad-Eldin
- Department of Pharmacy Practice, Faculty of Pharmacy, Zagazig University, Zagazig HFQM+872, Al-Sharqia Governorate, Egypt
| | - Gehan F Balata
- Department of Pharmacy Practice, Faculty of Pharmacy, Heliopolis University, Cairo 44519, Egypt
- Department of Pharmaceutics, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Al-Sharqia Governorate, Egypt
| | - Eman A Elshorbagy
- Department of Internal Medicine, Faculty of Medicine, Zagazig University, Zagazig 44519, Al-Sharqia Governorate, Egypt
| | - Mona S Hamed
- Department of Community at Faculty of Medicine, Zagazig University, Zagazig 44519, Al-Sharqia Governorate, Egypt
| | - Mohamed S Attia
- Department of Pharmaceutics, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Al-Sharqia Governorate, Egypt
| |
Collapse
|
3
|
Ewen AM, Hawkins JM, Kloss KA, Nwankwo R, Funnell MM, Sengupta S, Jean Francois N, Piatt G. The Michigan Men's Diabetes Project Randomized Clinical Control Trial: A Pilot/Feasibility Study of a Peer-Led Diabetes Self-Management and Support Intervention for Black Men With Type 2 Diabetes. Am J Mens Health 2024; 18:15579883241258318. [PMID: 38879823 PMCID: PMC11181889 DOI: 10.1177/15579883241258318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/07/2024] [Accepted: 05/13/2024] [Indexed: 06/19/2024] Open
Abstract
Black men are disproportionately affected by type 2 diabetes (T2D) and experience higher diabetes-related complications than non-Hispanic White men. To address the complex barriers in diabetes self-management for Black men, we implemented a 3-month peer-led and empowerment-based Diabetes Self-Management Education (DSME) and Support (DSMS) intervention in Metro Detroit. Twenty-five Black men ≥55 years of age with self-reported T2D were randomized to the intervention group (n=12)-10 hr of DSME and 9 hr of DSMS-or enhanced usual care (EUC) group (n=13)-10 hr of DSME. Peer leaders (n = 3) were trained by certified diabetes care and education specialists (CDCESs) to cofacilitate the support sessions. Outcomes (hemoglobin A1c [HbA1c], diabetes self-care activities, and diabetes distress) were assessed preintervention and postintervention. In the intervention and EUC groups, mean HbA1c decreased by 0.20% (p = .52, SD = 0.99) and 0.13% (p = .68), respectively. General diet (p = .03, M change: 1.32, SD = 1.71) and blood glucose monitoring (p < .05, M change: 0.50, SD = 0.74) scores improved among those in the intervention group. General diet scores also improved in the EUC group: mean change: 1.77, p = .08, although changes were not statistically significant. Changes in diabetes distress scores differed based on the number of sessions attended, with a significant decrease in those attending 7 to 12 sessions (n = 7), >50%, (p = .003, M change: -5.71, SD = 3.20). Implementing a peer-led DSMS program for Black men was feasible, adopted, and led to positive changes in outcomes. Scaling up the intervention and assessing sustainability is warranted.
Collapse
Affiliation(s)
- Alana M. Ewen
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Robin Nwankwo
- Department of Learning Health Sciences, School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Martha M. Funnell
- Department of Learning Health Sciences, School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Srijani Sengupta
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | | | - Gretchen Piatt
- Department of Learning Health Sciences, School of Medicine, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
4
|
Goldstein J, Robinson JL, Hart MH, Nallamothu N, Ohl SV, Wiener JS, Streur CS. Codevelopment of an illustration representative of people living with spina bifida for health educational materials. Disabil Health J 2023; 16:101475. [PMID: 37142458 PMCID: PMC10335040 DOI: 10.1016/j.dhjo.2023.101475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND The lack of health education resources specific to people with disabilities contributes to disparities in outcomes. Developing user-centered materials with representative images tailored to people with disabilities could help improve knowledge and outcomes. OBJECTIVE As a first step in developing an online sexual health resource for adolescents with physical disabilities, we sought end-user feedback to create illustrated characters for use in educational materials. METHODS Two styles of characters were developed by the research team, which included a professional disability artist. Verbal and online survey feedback was obtained at the Spina Bifida Association's Clinical Care Conference. A new image was created incorporating initial feedback. The new image and favored image from the first round were then tested through an online survey advertised on the Spina Bifida Association's Instagram story feed. Open-ended comments were organized by categories and overlapping themes. RESULTS Feedback was obtained from 139 audience members and 25 survey respondents from the conference and 156 Instagram survey respondents. Themes included depiction of disability, nondisability diversity, other physical appearance, emotional response, and design style. Most frequently, participants suggested the inclusion of characters with a range of accurately depicted mobility aids and of characters without mobility aids. Participants also wanted a larger, more diverse group of happy, strong people of all ages. CONCLUSIONS This work culminated in the codevelopment of an illustration that represents how people impacted by spina bifida view themselves and their community. We anticipate that using these images in educational materials will improve their acceptance and effectiveness.
Collapse
Affiliation(s)
- Jenna Goldstein
- University of Michigan Medical School, 1500 E Medical Center Drive, F3055 Taubman Center Ann Arbor, MI 48109, USA
| | | | - Mieke H Hart
- University of Michigan, Ann Arbor, 1500 E Medical Center Drive, F3055 Taubman Center Ann Arbor, MI 48109, USA
| | - Neela Nallamothu
- University of Michigan, Ann Arbor, 1500 E Medical Center Drive, F3055 Taubman Center Ann Arbor, MI 48109, USA
| | - Sydney V Ohl
- Michigan State University College of Human Medicine, 15 Michigan St. NE, Grand Rapids, MI 49503, USA
| | - John S Wiener
- Department of Urology, Duke University, 2301 Erwin Rd. Durham, North Carolina 27710, USA; Department of Surgery, Duke University, 2301 Erwin Rd. Durham, North Carolina 27710, USA
| | - Courtney S Streur
- Department of Urology, University of Michigan, 1500 E Medical Center Drive, F3055 Taubman Center Ann Arbor, MI 48109, USA; Department of Pediatrics, University of Michigan, 1500 E Medical Center Drive, F3055 Taubman Center Ann Arbor, MI 48109, USA.
| |
Collapse
|
5
|
Farnesi BC, Kaffash K, Cohen TR, Alberga AS. A qualitative exploration on the needs of health care providers working with adolescents who are undergoing bariatric surgery. OBESITY PILLARS (ONLINE) 2023; 6:100067. [PMID: 37990654 PMCID: PMC10661974 DOI: 10.1016/j.obpill.2023.100067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 04/20/2023] [Indexed: 11/23/2023]
Abstract
Background With increasing prevalence of severe obesity in youth, more adolescents are becoming candidates for bariatric surgery. In Canada, bariatric surgery in adolescents is in its infancy, and long-term health outcomes are not well known. It is unknown what health care providers (HCPs) are using to prepare and guide their adolescent patients for bariatric surgery. The needs of HCPs should be explored with the aim to improve patient outcomes. Therefore, the purpose of this study was to investigate the resource needs of HCPs working with adolescents living with severe obesity who are undergoing bariatric surgery. Methods This qualitative study consisted of a focus group with seven HCPs from an adolescent bariatric program using a semi-structured interview guide. The focus group discussion was audio-recorded, and the recording was transcribed verbatim. A thematic analysis was conducted. Results Four data-generated themes emerged highlighting the perceived needs and challenges faced by HCPs. These included (1) gaps in patient education materials on the subject of the bariatric surgery process, obesity as a chronic disease and mental health, (2) the need for designing resources that are teen-friendly, adaptable, and accessible, (3) the need for resources to facilitate decision-making and patient evaluation delivering more streamlined care and; (4) challenges to addressing resource needs due to limited clinical time and budgets. Conclusion This needs assessment study highlights the need for appropriate resources for patient education, as well as pre and post-operative preparation. The hope is that HCPs can improve quality of care delivered and positively impact surgical outcomes in their patients.
Collapse
Affiliation(s)
- Biagina-Carla Farnesi
- Centre of Excellence in Adolescent Severe Obesity, Adolescent Medicine, Montreal Children's Hospital, 1040 Ave Atwater W-105, H3Z 1X3, Montreal, Quebec, Canada
| | - Kimiya Kaffash
- Department of Health, Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street West, H4B 1R6, Montreal, Quebec, Canada
| | - Tamara R. Cohen
- Food, Nutrition and Health, Faculty of Land and Food Systems, The University of British Columbia, 218-2205 East Mall, V6T 1Z4, Vancouver, British Columbia, Canada
- Department of Pediatrics, Faculty of Medicine, McGill University, 3605 Rue de la Montagne, Montreal, Quebec, Canada
- BC Children’s Hospital Research Institute, Healthy Starts, 938 West 28th Avenue, Vancouver, BC V5Z 4H4, Canada
| | - Angela S. Alberga
- Department of Health, Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke Street West, H4B 1R6, Montreal, Quebec, Canada
- Department of Pediatrics, Faculty of Medicine, McGill University, 3605 Rue de la Montagne, Montreal, Quebec, Canada
| |
Collapse
|
6
|
Alawode O, Humble S, Herrick CJ. Food insecurity, SNAP participation and glycemic control in low-income adults with predominantly type 2 diabetes: a cross-sectional analysis using NHANES 2007-2018 data. BMJ Open Diabetes Res Care 2023; 11:e003205. [PMID: 37220963 PMCID: PMC10230897 DOI: 10.1136/bmjdrc-2022-003205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/25/2023] [Indexed: 05/25/2023] Open
Abstract
INTRODUCTION Diabetes, characterized by elevated blood glucose levels, affects 13% of US adults, 95% of whom have type 2 diabetes (T2D). Social determinants of health (SDoH), such as food insecurity, are integral to glycemic control. The Supplemental Nutrition Assistance Program (SNAP) aims to reduce food insecurity, but it is not clear how this affects glycemic control in T2D. This study investigated the associations between food insecurity and other SDoH and glycemic control and the role of SNAP participation in a national socioeconomically disadvantaged sample. RESEARCH DESIGN AND METHODS Adults with likely T2D and income <185% of the federal poverty level (FPL) were identified using cross-sectional National Health and Nutrition Examination Survey (NHANES) data (2007-2018). Multivariable logistic regression assessed the association between food insecurity, SNAP participation and glycemic control (defined by HbA1c 7.0%-8.5% depending on age and comorbidities). Covariates included demographic factors, clinical comorbidities, diabetes management strategies, and healthcare access and utilization. RESULTS The study population included 2084 individuals (90% >40 years of age, 55% female, 18% non-Hispanic black, 25% Hispanic, 41% SNAP participants, 36% low or very low food security). Food insecurity was not associated with glycemic control in the adjusted model (adjusted OR (aOR) 1.181 (0.877-1.589)), and SNAP participation did not modify the effect of food insecurity on glycemic control. Insulin use, lack of health insurance, and Hispanic or another race and ethnicity were among the strongest associations with poor glycemic control in the adjusted model. CONCLUSIONS For low-income individuals with T2D in the USA, health insurance may be among the most critical predictors of glycemic control. Additionally, SDoH associated with race and ethnicity plays an important role. SNAP participation may not affect glycemic control because of inadequate benefit amounts or lack of incentives for healthy purchases. These findings have implications for community engaged interventions and healthcare and food policy.
Collapse
Affiliation(s)
- Oluwatobi Alawode
- Department of Obstetrics and Gynecology, Meharry Medical College, Nashville, Tennessee, USA
| | - Sarah Humble
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Cynthia J Herrick
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
- Department of Medicine, Division of Endocrinology, Metabolism, and Lipid Research, Washington University in St Louis, St Louis, Missouri, USA
| |
Collapse
|
7
|
Niu L, Li Y, Hwang WC, Song G, Xie B. Prevalence and management of type 2 diabetes among Chinese Americans. ETHNICITY & HEALTH 2023:1-13. [PMID: 36803178 DOI: 10.1080/13557858.2023.2179020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 02/02/2023] [Indexed: 06/18/2023]
Abstract
AIMS : This study examines: (a) the prevalence rate of type 2 diabetes mellitus (T2DM) in Chinese Americans (CAs); (b) the influence of acculturative status (i.e. generational status and linguistic fluency) on T2DM prevalence; (c) and differences in diabetes management between CAs and Non-Hispanic Whites (NHWs). METHODS : We used 2011-2018 data from the California Health Interview Survey (CHIS) to analyze the prevalence rate and management of diabetes among the CAs. Chi-squares, linear regressions, and logistic regressions were used to analyze the data. RESULTS : After controlling for demographic, socioeconomic, and health behaviors, there were no significant differences in the T2DM prevalence rate between CAs overall or of varying acculturative statuses compared with NHWs. However, there were differences in diabetes management, with first-generation CAs being less likely to exam glucose daily, have medical care plans developed by medical providers, or have confidence in controlling diabetes compared to NHWs. CAs with limited English proficiency (LEP) were less likely to perform self-monitoring of blood glucose or have confidence in managing their diabetes care compared to NHWs. Finally, non-first generation CAs were also more likely to take diabetes medication compared to NHWs. CONCLUSIONS : Although the prevalence rate of T2DM was found to be similar between CAs and NHWs, significant differences were found in diabetes care and management. Specifically, those who were less acculturated (e.g. first generation and those with LEP) were less likely to actively manage and have confidence in managing their T2DM. These results highlight the importance of targeting immigrants with LEP in prevention and intervention efforts.
Collapse
Affiliation(s)
- Lijie Niu
- School of Community & Global Health, Claremont Graduate University, Claremont, CA, USA
| | - Yawen Li
- School of Social Work, California State University San Bernardino, San Bernardino, CA, USA
| | - Wei-Chin Hwang
- Department of Psychological Science, Claremont McKenna College, Claremont, CA, USA
| | - Gaole Song
- School of Community & Global Health, Claremont Graduate University, Claremont, CA, USA
| | - Bin Xie
- School of Community & Global Health, Claremont Graduate University, Claremont, CA, USA
| |
Collapse
|
8
|
Hu L, Islam N, Zhang Y, Shi Y, Li H, Wang C, Sevick MA. Leveraging Social Media to Increase Access to an Evidence-Based Diabetes Intervention Among Low-Income Chinese Immigrants: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e42554. [PMID: 36306161 PMCID: PMC9652737 DOI: 10.2196/42554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) in Chinese Americans is a rising public health concern for the US health care system. The majority of Chinese Americans with T2D are foreign-born older immigrants and report limited English proficiency and health literacy. Multiple social determinants of health limit access to evidence-based diabetes interventions for underserved Chinese immigrants. A social media-based diabetes intervention may be feasible to reach this community. OBJECTIVE The purpose of the Chinese American Research and Education (CARE) study was to examine the potential efficacy of a social media-based intervention on glycemic control in Chinese Americans with T2D. Additionally, the study aimed to explore the potential effects of the intervention on psychosocial and behavioral factors involved in successful T2D management. In this report, we describe the design and protocol of the CARE trial. METHODS CARE was a pilot randomized controlled trial (RCT; n=60) of a 3-month intervention. Participants were randomized to one of two arms (n=30 each): wait-list control or CARE intervention. Each week, CARE intervention participants received two culturally and linguistically tailored diabetes self-management videos for a total of 12 weeks. Video links were delivered to participants via WeChat, a free and popular social media app among Chinese immigrants. In addition, CARE intervention participants received biweekly phone calls from the study's community health workers to set goals related to T2D self-management and work on addressing goal-achievement barriers. Hemoglobin A1c (HbA1c), self-efficacy, diabetes self-management behaviors, dietary intake, and physical activity were measured at baseline, 3 months, and 6 months. Piecewise linear mixed-effects modeling will be performed to examine intergroup differences in HbA1c and psychosocial and behavioral outcomes. RESULTS This pilot RCT study was approved by the Institutional Review Board at NYU Grossman School of Medicine in March 2021. The first participant was enrolled in March 2021, and the recruitment goal (n=60) was met in March 2022. All data collection is expected to conclude by November 2022, with data analysis and study results ready for reporting by December 2023. Findings from this pilot RCT will further guide the team in planning a future large-scale study. CONCLUSIONS This study will serve as an important first step in exploring scalable interventions to increase access to evidence-based diabetes interventions among underserved, low-income, immigrant populations. This has significant implications for chronic care in other high-risk immigrant groups, such as low-income Hispanic immigrants, who also bear a high T2D burden, face similar barriers to accessing diabetes programs, and report frequent social media use (eg, WhatsApp). TRIAL REGISTRATION ClinicalTrials.gov NCT03557697; https://clinicaltrials.gov/ct2/show/NCT03557697. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/42554.
Collapse
Affiliation(s)
- Lu Hu
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, New York, NY, United States
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States
| | - Nadia Islam
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States
| | - Yiyang Zhang
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, New York, NY, United States
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States
| | - Yun Shi
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, New York, NY, United States
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States
| | - Huilin Li
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States
| | - Chan Wang
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States
| | - Mary Ann Sevick
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, New York, NY, United States
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States
- Department of Medicine, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States
| |
Collapse
|
9
|
Mavragani A, Islam N, Trinh-Shevrin C, Wu B, Feldman N, Tamura K, Jiang N, Lim S, Wang C, Bubu OM, Schoenthaler A, Ogedegbe G, Sevick MA. A Social Media-Based Diabetes Intervention for Low-Income Mandarin-Speaking Chinese Immigrants in the United States: Feasibility Study. JMIR Form Res 2022; 6:e37737. [PMID: 35544298 PMCID: PMC9492091 DOI: 10.2196/37737] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/31/2022] [Accepted: 04/06/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Chinese immigrants bear a high diabetes burden and face significant barriers to accessing diabetes self-management education (DSME) and counseling programs. OBJECTIVE The goal of this study was to examine the feasibility and acceptability and to pilot test the potential efficacy of a social media-based DSME intervention among low-income Chinese immigrants with type 2 diabetes (T2D) in New York City. METHODS This was a single group pretest and posttest study in 30 Chinese immigrants with T2D. The intervention included 24 culturally and linguistically tailored DSME videos, focusing on diabetes education and behavioral counseling techniques. Over 12 weeks, participants received 2 brief videos each week via WeChat, a free social media app popular among Chinese immigrants. Primary outcomes included the feasibility and acceptability of the intervention. Feasibility was evaluated by recruitment processes, retention rates, and the video watch rate. Acceptability was assessed via a satisfaction survey at 3 months. Secondary outcomes, that is, hemoglobin A1c (HbA1c), self-efficacy, dietary intake, and physical activity, were measured at baseline, 3 months, and 6 months. Descriptive statistics and paired 2-sided t tests were used to summarize the baseline characteristics and changes before and after the intervention. RESULTS The sample population (N=30) consisted of mostly females (21/30, 70%) who were married (19/30, 63%), with limited English proficiency (30/30, 100%), and the mean age was 61 (SD 7) years. Most reported an annual household income of <US $25,000 (24/30, 80%) and a high school education or less (19/30, 63%). Thirty participants were recruited within 2 months (January and February 2020), and 97% (29/30) of the participants were retained at 6 months. A video watch rate of 92% (28/30) was achieved. The mean baseline HbA1c level was 7.3% (SD 1.3%), and this level declined by 0.5% (95% CI -0.8% to -0.2%; P=.003) at 6 months. The mean satisfaction score was 9.9 (SD 0.6) out of 10, indicating a high level of satisfaction with the program. All strongly agreed or agreed that they preferred this video-based DSME over face-to-face visits. Compared to baseline, there were significant improvements in self-efficacy, dietary, and physical activity behaviors at 6 months. CONCLUSIONS This pilot study demonstrated that a social media-based DSME intervention is feasible, acceptable, and potentially efficacious in a low-income Chinese immigrant population with T2D. Future studies need to examine the efficacy in an adequately powered clinical trial.
Collapse
Affiliation(s)
| | - Nadia Islam
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Chau Trinh-Shevrin
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Naumi Feldman
- Charles B Wang Community Health Center, New York, NY, United States
| | - Kosuke Tamura
- Socio-Spatial Determinants of Health (SSDH) Laboratory, Population and Community Health Sciences Branch, Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institute of Health, Bethesda, MD, United States
| | - Nan Jiang
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Sahnah Lim
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Chan Wang
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Omonigho M Bubu
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States.,Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, United States
| | - Antoinette Schoenthaler
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, New York, NY, United States.,Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States.,Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Gbenga Ogedegbe
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, New York, NY, United States.,Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States.,Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Mary Ann Sevick
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, New York, NY, United States.,Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States.,Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
| |
Collapse
|
10
|
Deng F, Mahmoodi B, Chan CB. Effectiveness and Acceptability of a Nutrition Intervention Targeting Chinese Adult Immigrants With Type 2 Diabetes in Canada: A Study Using Mixed Methods Analysis. Can J Diabetes 2022; 46:S1499-2671(22)00090-9. [PMID: 35927169 DOI: 10.1016/j.jcjd.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 04/14/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Although culturally tailored diabetes treatment is recommended, there is a lack of relevant dietary resources for the Chinese population in Canada. In this study we assessed the feasibility and efficacy of a culturally tailored menu plan combined with nutrition education on clinical outcomes, diet quality and qualitative outcomes among Chinese immigrants with type 2 diabetes. METHODS Participants were 17 Chinese immigrants living with type 2 diabetes in Edmonton, Alberta, Canada. The design was a 12-week, single-arm intervention that included weekly nutrition education supported by a culturally tailored menu plan with mixed methods evaluation. Diet quality, clinical and other outcomes were assessed pre- and postintervention. One-on-one interviews were conducted postintervention to identify program feasibility and obstacles to adherence. RESULTS Waist circumference (mean ± standard deviation: -2.0±2.5 cm; p=0.004), total cholesterol (-21.4±28.2 mg/dL; p=0.007) and low-density lipoprotein cholesterol (-18.4±24.6 mg/dL; p=0.007) were decreased when compared with baseline. No significant change was detected in glycated hemoglobin. Postintervention, the Healthy Eating Index (p=0.01) and diabetes knowledge score (p=0.009) also increased. Participants reported that the program was culturally acceptable, easily understood and feasible to implement. Participants indicated the program helped them to improve their diabetes knowledge, adhere to the dietary guidelines, choose low glycemic index food and read food labels when shopping. CONCLUSIONS A flexible, culturally tailored menu plan was a feasible and effective tool for improving diabetes knowledge, diet quality and metabolic outcomes among Chinese immigrants with type 2 diabetes.
Collapse
Affiliation(s)
- Feiyue Deng
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Behnaz Mahmoodi
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Catherine B Chan
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada; Department of Physiology, University of Alberta, Edmonton, Alberta, Canada.
| |
Collapse
|
11
|
Wu VS, Smith A'B, Girgis A. Moving beyond translation: Development of WeCope, a self-management resource for Chinese-Australian immigrants affected by cancer. Eur J Cancer Care (Engl) 2021; 31:e13531. [PMID: 34697854 DOI: 10.1111/ecc.13531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 09/08/2021] [Accepted: 10/07/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Currently, there are no self-management resources in Australia that support both Chinese immigrant patients affected by cancer and their caregivers. This paper reports on the development and acceptability assessment of a self-management intervention (WeCope) in terms of its scope, social and cultural relevance and sensitivity. METHODS Using a community participatory approach in this qualitative study, patients, caregivers and community members took part in semi-structured focus groups or interviews in Cantonese, Mandarin or English to develop and provide feedback on the acceptability of 'WeCope'. Content analysis was performed on the transcripts using inductive (codes) and deductive (themes and categories) methods. RESULTS Patients (n = 17), caregivers (n = 10) and community members (n = 2) participated. Four themes were developed, guided by the framework of cultural sensitivity in interventions: (1) content preference and satisfaction; (2) perceived usefulness and usability; (3) cultural relevance and acceptability; and (4) layout and presentation. Participants most commonly wanted more information about treatment-related issues (n = 14) and available support services (n = 14). CONCLUSION Chinese patients and caregivers expressed overall satisfaction with the WeCope resource and provided suggestions for improvement, including provision of more treatment-related information and contact details for available support while reducing the overall resource length.
Collapse
Affiliation(s)
- Verena Shuwen Wu
- Psycho-Oncology Research Group, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, The University of New South Wales, Liverpool, Australia
| | - Allan 'Ben' Smith
- Psycho-Oncology Research Group, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, The University of New South Wales, Liverpool, Australia
| | - Afaf Girgis
- Psycho-Oncology Research Group, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, The University of New South Wales, Liverpool, Australia
| |
Collapse
|
12
|
Garizábalo-Dávila CM, Rodríguez-Acelas AL, Mattiello R, Cañon-Montañez W. Social Support Intervention for Self-Management of Type 2 Diabetes Mellitus: Study Protocol for a Randomized Controlled Trial. OPEN ACCESS JOURNAL OF CLINICAL TRIALS 2021. [DOI: 10.2147/oajct.s314030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
13
|
Ho EY, Leung G, Chao MT, Chan D, Hsieh E, Pritzker S, Chi HL, Huang S, Ruan Q, Seligman HK. Integrative Nutritional Counseling Combining Chinese Medicine and Biomedicine for Chinese Americans with Type 2 Diabetes: A Mixed-Methods Feasibility Study. J Altern Complement Med 2021; 27:657-668. [PMID: 33979531 DOI: 10.1089/acm.2020.0558] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Objectives: This study describes the development and feasibility of Integrative Nutritional Counseling (INC), a Chinese medicine (CM)+biomedicine-based nutrition curriculum for Chinese Americans with type 2 diabetes. Although Chinese Americans often incorporate CM principles into their diet, scant research has explored how to integrate CM with biomedical nutrition standards in a culturally appropriate manner or if such a program could improve diabetes self-management. Design: This is a 1-month pre-post study design including three points of contact: baseline, in-person class, and 1-month follow-up. Subjects: Participants (n = 15) were Cantonese-speaking/reading Chinese Americans diagnosed with type 2 diabetes who had used some form of CM/medicinal foods in the last 12 months. Interventions and Outcome Measures: The INC program included baseline surveys and a CM intake interview conducted by a licensed acupuncturist. The acupuncturist generated a CM diagnosis, which was shared with the participant, and used this diagnosis to tailor brief nutrition education. To bolster this brief education, a bilingual registered dietitian provided a 2-h group education class in Cantonese to all participants, during which time participants also received a Chinese/English INC booklet. Participants completed surveys immediately after the class and at 1-month follow-up, with qualitative exit interviews. Results: Participants reported improved attitudes and dietary habits aligning directly with INC, and improvement in biomedically valued measures of type 2 diabetes, such as weight loss, and CM-valued measures of digestion/elimination and hot/cold feeling. Satisfaction with INC was high, but challenges included confusion with some INC information, structural barriers, and comorbidities. Conclusions: Chinese Americans with type 2 diabetes and interventionists found integrative nutrition approaches acceptable and feasible. Future research should examine INC with a larger population and explore optimal delivery of INC given reported challenges.
Collapse
Affiliation(s)
- Evelyn Y Ho
- Department of Communication Studies, University of San Francisco, San Francisco, CA, USA.,Asian American Research Center on Health, San Francisco, CA, USA
| | - Genevieve Leung
- Department of Rhetoric & Language, University of San Francisco, San Francisco, CA, USA
| | - Maria T Chao
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA.,Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, CA, USA.,Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, USA
| | - Donald Chan
- UT Southwestern Medical School, Dallas, TX, USA
| | - Elaine Hsieh
- Asian American Research Center on Health, San Francisco, CA, USA.,Department of Nutrition and Public Health, University of Saint Joseph, West Hartford, CT, USA
| | - Sonya Pritzker
- Department of Anthropology, University of Alabama, Tuscaloosa, AL, USA
| | - Han-Lin Chi
- School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Siyuan Huang
- Asia Pacific Studies Program, University of San Francisco, San Francisco, CA, USA
| | - Qiao Ruan
- David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Hilary K Seligman
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA.,Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
14
|
Kellow NJ, Palermo C, Choi TS. Not Scared of Sugar™: Outcomes of a structured type 2 diabetes group education program for Chinese Australians. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:2273-2281. [PMID: 32468678 DOI: 10.1111/hsc.13046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 03/23/2020] [Accepted: 05/11/2020] [Indexed: 06/11/2023]
Abstract
Type 2 diabetes disproportionately affects the Chinese population yet there are no structured diabetes education programs specifically designed for this community in Australia. This project aimed to develop and evaluate a pilot type 2 diabetes group education program designed specifically for Chinese migrants living in Australia. A non-randomised pre- versus post-intervention trial was conducted between March 2017 and November 2018. A culturally tailored group education program (Not Scared of Sugar™) was developed and piloted with Melbourne-based Cantonese-speaking people with type 2 diabetes. Program teaching styles were aligned with the Confucian cultural process of learning and incorporated culturally specific strategies to promote healthy behaviour change. Thirty-four individuals (35% male) attended five education sessions over ten weeks, delivered by a Cantonese-speaking facilitator and multidisciplinary clinicians. Data were collected from participants at baseline, on program completion and at 6 months follow-up. Mean (SD) participant age was 69 (9) years, with a mean time of 25.7 (10.8) years in Australia and a median duration of diabetes of 10 (IQR = 2.8-20.5) years. At program completion, mean participant waist circumference (90.5 versus 89.2 cm, p < .001) and waist-to-height ratio (0.574 vs. 0.566, p < .001) was significantly reduced and both were further reduced at 6-month follow-up (p < .05). There was a significant increase in the median frequency of diabetes self-care behaviours undertaken, with American Association of Diabetes Educators Questionnaire Score: 30 (22-32.3) versus 33 (29.8-35.0), p < .001 at 6-month follow-up. Diabetes-related distress assessed by PAID-C was also significantly reduced at 6-month follow-up (p < .05). Mean HbA1c was unchanged after 6 months; 51 (7.9) versus 50 (7.8) mmol/mol, p = .316. Program attrition was 6%. Not Scared of Sugar™ successfully reduced waist circumference, increased diabetes self-management behaviours and reduced diabetes distress in Cantonese-speaking Australians, which may positively impact long-term risk of vascular complications.
Collapse
Affiliation(s)
- Nicole J Kellow
- Department of Nutrition, Dietetics & Food, Monash University, Notting Hill, VIC, Australia
| | - Claire Palermo
- Department of Nutrition, Dietetics & Food, Monash University, Notting Hill, VIC, Australia
| | - Tammie St Choi
- Department of Nutrition, Dietetics & Food, Monash University, Notting Hill, VIC, Australia
- Carrington Health, Box Hill, VIC, Australia
| |
Collapse
|
15
|
Ho EY, Pak S, Leung G, Xu S, Yu CK, Hecht FM, Jih J, Chao MT. Pilot Cluster Randomized Controlled Trial of Integrative Nutritional Counseling Versus Standard Diabetes Self-Management Education for Chinese Americans with Type 2 Diabetes. Health Equity 2020; 4:410-420. [PMID: 33111026 PMCID: PMC7585608 DOI: 10.1089/heq.2020.0002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose: Chinese Americans (CAs) with diabetes and limited English proficiency often struggle to adhere to standard diabetes diets focused on food measurement/restriction. Chinese medicine principles commonly inform food choices among CAs but are rarely acknowledged in nutritional interventions. We developed and tested feasibility of a theoretically informed integrative nutritional counseling (INC) program that combines Chinese medicine principles with biomedical nutrition standards. Methods: We randomized diabetes self-management education (DSME) classes to include either: (1) usual nutrition curriculum based on American Diabetes Association (ADA) recommendations delivered by a diabetes educator (control) or (2) INC curriculum based on a combination of ADA recommendations and Chinese medicine principles delivered by a diabetes educator and a licensed acupuncturist (intervention). All DSME enrollees were invited to participate in research entailing data collection at three time points: baseline, after the DSME nutrition class, and at 6-month follow-up. Using validated measures, we collected dietary self-efficacy, diabetes distress, diet satisfaction, and dietary adherence. We also measured weight and glycemic control. Results: Study participants were 18 Cantonese-speaking patients with diabetes who were predominantly female and older, with low levels of income and acculturation. Intervention and control groups were similar at baseline. INC performed similarly to usual DSME with 100% of participants reporting the INC booklet helped their learning. Dietary adherence significantly improved in participants who received the INC curriculum. Conclusion: INC is feasible to implement as part of DSME classes and shows promise as a complementary culturally sensitive addition to usual diabetes nutrition education for CA patients.
Collapse
Affiliation(s)
- Evelyn Y Ho
- Department of Communication Studies, University of San Francisco, San Francisco, California, USA.,Asian American Research Center on Health, San Francisco, California, USA
| | - Sunny Pak
- Chinatown Public Health Center, San Francisco, California, USA
| | - Genevieve Leung
- Department of Rhetoric and Language, University of San Francisco, San Francisco, California, USA
| | - Shuwen Xu
- School of Nursing and Health Professions, University of San Francisco, San Francisco, California, USA
| | - Choi Kwun Yu
- School of Nursing and Health Professions, University of San Francisco, San Francisco, California, USA
| | - Frederick M Hecht
- Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, California, USA.,Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jane Jih
- Asian American Research Center on Health, San Francisco, California, USA.,Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, California, USA.,Multiethnic Health Equity Research Center, University of California San Francisco, San Francisco, California, USA
| | - Maria T Chao
- Asian American Research Center on Health, San Francisco, California, USA.,Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, California, USA.,Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
16
|
Beasley JM, Wagnild JM, Pollard TM, Roberts TR, Ahkter N. Effectiveness of diet and physical activity interventions among Chinese-origin populations living in high income countries: a systematic review. BMC Public Health 2020; 20:1019. [PMID: 32600296 PMCID: PMC7322842 DOI: 10.1186/s12889-020-08805-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 04/29/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND This review examines the effectiveness of diet and physical activity interventions to reduce cardiometabolic risk among Chinese immigrants and their descendants living in high income countries. The objective of this review is to provide information to help build future interventions aimed at improving diet and increasing physical activity levels among Chinese immigrants. METHODS Outcomes included BMI, weight, waist circumference (WC), waist-hip ratio (WHR), cholesterol (LDL, HDL), systolic and diastolic blood pressure (SBP, DBP), hemoglobin A1c (HgbA1c), fasting blood glucose (FBG), and HOMA-IR. Six databases were systematically searched from database inception to date of search (February 2020). Meta-analyses used random effect models to estimate pooled effects of outcomes with 95% confidence intervals. The outcomes assessed were changes in mean outcomes (post-intervention versus baseline) among the intervention group versus control groups. RESULTS Twenty-one articles were included for synthesis, and eight of these were included in the meta-analysis. Among children/adolescents, there were no significant effects of intervention for any of the outcomes having sufficient data for meta-analysis (BMI, WHR, SBP, and DBP). Among adults, the pooled effect including three studies showed significant changes in BMI (effect size = - 1.14 kg/m2; (95% CI: - 2.06, - 0.21), I2 = 31%). There were also significant effects of intervention among adults in terms of changes in SBP and DBP, as the pooled effect across three studies was - 6.08 mmHg (95% CI - 9.42, - 2.73), I2 = 0% and - 3.81 mmHg (95% CI: - 6.34, - 1.28), I2 = 0%, respectively. Among adults there were no other significant effects among the meta-analyses conducted (weight, WC, LDL, HgbA1c, and FBG). CONCLUSIONS This review is the first to summarize the effectiveness of diet and physical activity interventions specifically designed for Chinese immigrants living in high income countries. There were clinically meaningful changes in BMI and blood pressure among adults, but evidence was weak for other cardiometabolic outcomes (weight, WC, LDL, HgbA1c, and FBG), and among children, there was no evidence of effect for any cardiometabolic outcomes. Given our mixed findings, more work is needed to support the design of successful interventions, particularly those targeting children and their families. TRIAL REGISTRATION The systematic review protocol was registered in PROSPERO on December 17, 2018, the international prospective register of systematic reviews (registration number: CRD42018117842 ).
Collapse
Affiliation(s)
- Jeannette M. Beasley
- Department of Medicine, NYU Grossman School of Medicine, 462 First Avenue CD 673, New York, NY 10016 USA
| | - Janelle M. Wagnild
- Department of Anthropology, Durham University, South Road, Durham, DH1 3LE UK
| | - Tessa M. Pollard
- Department of Anthropology, Durham University, South Road, Durham, DH1 3LE UK
| | - Timothy R. Roberts
- NYU Health Sciences Library, NYU Grossman School of Medicine, 550 First Avenue, New York, NY 10016 USA
| | - Nasima Ahkter
- Department of Anthropology, Durham University, South Road, Durham, DH1 3LE UK
| |
Collapse
|
17
|
Huang YC, Garcia AA. Culturally-tailored interventions for chronic disease self-management among Chinese Americans: a systematic review. ETHNICITY & HEALTH 2020; 25:465-484. [PMID: 29385815 DOI: 10.1080/13557858.2018.1432752] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 12/21/2017] [Indexed: 06/07/2023]
Abstract
Objectives: Literature review evaluating the effectiveness and cultural surface and deep structures of interventions designed to improve Chinese Americans' chronic disease self-management.Method: PubMed, PsycINFO, CINAHL, and Health Source databases were searched for research conducted from 1990 to 2016 on self-management interventions for Chinese Americans with chronic disease.Results: Ten articles comprised eight interventions, which each addressed a dimension of cultural surface structure, all providing linguistically appropriate messages delivered via bilingual staff. Five interventions also addressed cultural deep structure dimensions by providing culturally congruent counsellors or educators, or incorporating Chinese cultural values and social customs. Six interventions resulted in significant improvements in major outcome variables. Participants also reported high satisfaction and retention rates were high.Conclusion: Culturally-tailored interventions that incorporate surface and deep structural elements of culture are sensitive and generally effective for Chinese Americans to improve access to health care, disease awareness, social environment, and participants' ability to practice self-management skills.
Collapse
Affiliation(s)
- Ya-Ching Huang
- The School of Nursing, The University of Texas at Austin, Austin, TX, USA
| | - Alexandra A Garcia
- Dell Medical School, The School of Nursing, The University of Texas at Austin, Austin, TX, USA
| |
Collapse
|
18
|
Li-Geng T, Kilham J, McLeod KM. Cultural Influences on Dietary Self-Management of Type 2 Diabetes in East Asian Americans: A Mixed-Methods Systematic Review. Health Equity 2020; 4:31-42. [PMID: 32195450 PMCID: PMC7081245 DOI: 10.1089/heq.2019.0087] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose: Many East Asian Americans (EAAs) (populations originating from China, Korea, Japan, and Taiwan) with type 2 diabetes mellitus (T2DM) experience unique challenges in managing their disease, including language barriers and traditional cultural beliefs, particularly among first-generation immigrants.. The purpose of this mixed-methods systematic review was to examine cultural perspectives of EAAs that influence dietary self-management of T2DM and identify education interventions and their approaches to enhance EAAs' dietary self-management of diabetes. Methods: A mixed-methods systematic review was conducted to examine EAAs' perspectives from qualitative studies and to identify education interventions and their approaches from quantitative studies. A literature search was conducted using PubMed/MEDLINE, SCOPUS, CINAHL, and Web of Science from 1995 to 2018. Sixteen studies (10 qualitative and 6 quantitative) met criteria for analysis. Thematic synthesis of qualitative data was conducted using a line-by-line coding strategy. Extracted quantitative data were assessed for cultural approaches used in the interventions and diabetes-related outcomes. Results: In the qualitative studies, beliefs about food impacted EAAs' abilities to adopt appropriate dietary recommendations for diabetes management. Requiring a specialized diet disrupted social harmony and made EAAs feel burdensome to others. Having bilingual and bicultural resources eased the stress of making dietary modifications. The most commonly incorporated approaches in diabetes education interventions were bilingual education and culturally specific dietary recommendations. Social roles and harmony were not discussed. Significant reductions in hemoglobin A1c and increases in diabetes knowledge were reported post-intervention. Conclusions: Beliefs about food, beliefs about social roles, and access to culturally competent care play an important role in dietary self-management of T2DM among EAAs. Understanding the cultural influences on dietary self-management of T2DM and tailoring interventions to meet the needs of EAAs are essential in effort to address the growing epidemic and improve patient outcomes.
Collapse
Affiliation(s)
- Tony Li-Geng
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, Connecticut
| | - Jessica Kilham
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, Connecticut.,University of Massachusetts Medical School, Worcester, Massachusetts
| | - Katherine M McLeod
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, Connecticut
| |
Collapse
|
19
|
Joo JY, Liu MF. Experience of Culturally-Tailored Diabetes Interventions for Ethnic Minorities: A Qualitative Systematic Review. Clin Nurs Res 2019; 30:253-262. [PMID: 31690114 DOI: 10.1177/1054773819885952] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This qualitative systematic review synthesizes recent qualitative studies of culturally tailored interventions to better understand the experiences that individuals who are members of ethnic minorities have when undergoing type 2 diabetes treatment in the United States. Such interventions have been shown to be effective among ethnic minority populations; however, no qualitative synthesis has reported on recent findings from studies of these interventions. This systematic review identified seven relevant qualitative studies from five electronic databases-CINAHL, PsycINFO, PubMed, Ovid, and Web of Science-published from 2009 to 2019, and used a thematic synthesis review methodology. Methodological rigor was assessed for an appraisal of study quality. Five themes were identified as experiences of culturally tailored diabetes interventions: culturally appropriate healthy lifestyle behaviors, knowledge about diabetes care, emotional supports, access to the healthcare system, and family involvement. The findings of this review can be utilized as resources for improving diabetes care for ethnic minorities.
Collapse
Affiliation(s)
- Jee Young Joo
- Associate Professor, College of Nursing, Gachon University, Incheon, Korea
| | - Megan F Liu
- Associate Professor, School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei
| |
Collapse
|
20
|
Pettersson S, Hadziabdic E, Marklund H, Hjelm K. Lower knowledge about diabetes among foreign-born compared to Swedish-born persons with diabetes-A descriptive study. Nurs Open 2019; 6:367-376. [PMID: 30918686 PMCID: PMC6419139 DOI: 10.1002/nop2.217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 06/15/2018] [Accepted: 10/15/2018] [Indexed: 11/25/2022] Open
Abstract
AIM To compare foreign- and Swedish-born persons, diagnosed with type 2 diabetes, to study whether there are dissimilarities in knowledge about diabetes and to study determinants of knowledge. DESIGN A cross-sectional descriptive study was conducted. METHOD Data were collected between September 2014 and March 2016, using the standardized Diabetes Knowledge Test (DKT), statistically analysed. RESULTS The results showed dissimilarities in knowledge between foreign- and Swedish-born persons, supporting the hypothesis that foreign-born persons had lower knowledge about diabetes than Swedish-born persons. There was a relationship between poor knowledge and country of birth, marital status and employment status. Country of birth was the strongest independent determinant of knowledge about diabetes. The risk of poor knowledge was ten times higher among persons born in the Middle East or in another country outside Europe compared with Swedish-born persons. Other influencing factors for poor knowledge about diabetes were being not gainfully employed and living alone.
Collapse
Affiliation(s)
- Sara Pettersson
- Department of Social and Welfare StudiesLinköping UniversityNorrkopingSweden
| | - Emina Hadziabdic
- Department of Social and Welfare StudiesLinköping UniversityNorrkopingSweden
- Department of Health and Caring Sciences, Faculty of Health and Life SciencesLinnaeus UniversityVaxjoSweden
| | - Helén Marklund
- Department of Social and Welfare StudiesLinköping UniversityNorrkopingSweden
| | - Katarina Hjelm
- Department of Social and Welfare StudiesLinköping UniversityNorrkopingSweden
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden
| |
Collapse
|
21
|
Deng F, Zhang A, Chan C. Nutrition Interventions for Type 2 Diabetes in Chinese Populations: A Scoping Review. J Immigr Minor Health 2018; 21:1416-1431. [PMID: 30515634 DOI: 10.1007/s10903-018-0845-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Developing culturally appropriate diabetes nutrition interventions for immigrants could be facilitated knowing what is successful in the home country and other relevant countries. The primary purpose of this scoping review was to identify the design and delivery methods of nutrition interventions for Chinese populations with type 2 diabetes, in their home countries and as immigrants to western countries. A total of 14 articles was retrieved and included. Overall, the approaches used in China often were modelled on intensive lifestyle programs although alternative strategies were also identified. Most interventions were not focussed solely on nutrition, and only a few were conducted in community settings. Most of the interventions were delivered in a group format, while those conducted in China also included individual counselling, particularly for nutrition. In addition, the diabetes and nutrition-related outcomes, cultural relevance and acceptability, and other factors that influenced protocol compliance were considered. Improvements in blood glucose control were observed in participants in all interventions where it was measured. Participants reported increased nutritional knowledge but nutritional behaviour was generally not well documented. Trials conducted in the United States emphasized the importance of cultural adaptation of intervention programs, particularly with respect to dietary patterns and specific foods. Practice-transferable characteristics are highlighted. Research gaps included trials conducted in community settings with pragmatic implementation and evaluation, comparative trials of interventions to gauge relative effectiveness, and measuring and reporting dietary outcomes for better understanding of the impact on dietary behaviours and their relationship to health outcomes.
Collapse
Affiliation(s)
- Feiyue Deng
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Anran Zhang
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Catherine Chan
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada. .,Department of Physiology, University of Alberta, Edmonton, AB, Canada. .,Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada. .,6-002 Li Ka Shing Centre for Health Innovation Research, University of Alberta, Edmonton, AB, T6G 2E3, Canada.
| |
Collapse
|
22
|
Grady PA, Gough LL. El automanejo de las enfermedades crónicas: un método integral de atención. Am J Public Health 2018. [DOI: 10.2105/ajph.2014.302041s] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Patricia A. Grady
- Instituto Nacional de Investigación en Enfermería, Institutos Nacionales de Salud, Bethesda, Maryland, Estados Unidos de América
| | - Lisa Lucio Gough
- Instituto Nacional de Investigación en Enfermería, Institutos Nacionales de Salud, Bethesda, Maryland, Estados Unidos de América
| |
Collapse
|
23
|
Self-Management: A Comprehensive Approach to Management of Chronic Conditions. Am J Public Health 2018; 108:S430-S436. [PMCID: PMC6291774 DOI: 10.2105/ajph.2014.302041r] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2014] [Indexed: 08/05/2023]
Abstract
For both clinical and economic reasons, the increasing number of persons living with chronic conditions represents a public health issue of growing importance. Emphasizing patient responsibility, and acting in concert with the provider community, self-management represents a promising strategy for treating chronic conditions—moving beyond education to teaching individuals to actively identify challenges and solve problems associated with their illness. Self-management also shows potential as an effective paradigm across the prevention spectrum (primary, secondary, and tertiary) by establishing a pattern for health early in life and providing strategies for mitigating illness and managing it in later life. We suggest ways to advance research methods and practical applications of self-management as steps in its future development and implementation.
Collapse
|
24
|
Gross O, de Andrade V, Gagnayre R. [Community-based research in therapeutic patient education: practices and contributions. A literature review]. SANTE PUBLIQUE 2017; 29:551-562. [PMID: 29034670 DOI: 10.3917/spub.174.0551] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Community-based research (CBR) in health involves both researchers and people concerned by the results of the research. It aims to empower populations, using their exposure to the phenomenon being studied as a starting point. The use of CBR in the field of therapeutic patient education (TPE) is of interest, as the two share such characteristics as the desire to foster self-reliance and participation and a culture of interdisciplinarity. AIM To characterize CBR in the therapeutic patient education field. METHODS A literature search on PUBMED using the keywords ?community-based (participatory) research?, ?patient education?, ?self-care? and ?self-management? retrieved 121 articles. The analysis looked at the type of research, the characteristics of both the populations involved and the co-researchers, the collaborative actions (analysed using a grid from the literature), and the difficulties in implementing these actions. RESULTS Thirty-one studies were included. Ten consisted of methodological studies, which tended to show the added value of collaborating with users in implementing TPE programmes compared to standard methods. The remaining 21 studies described the co-design and/or co-execution of new educational programmes. We identified 5 collaborative actions that involved a preparatory phase of the research, and 17 collaborative actions that involved the prioritization, conduct, and analysis of the research and dissemination of the results. Preventive measures are needed for potential methodological, organizational, ethical, and emotional difficulties. DISCUSSION The 22 identified actions need to be confirmed by other studies. The analysis grid could ultimately become a tool for guiding researchers for their researches within the CBR framework.
Collapse
|
25
|
Sun A, Cheng J, Bui Q, Liang Y, Ng T, Chen JL. Home-Based and Technology-Centered Childhood Obesity Prevention for Chinese Mothers With Preschool-Aged Children. J Transcult Nurs 2017; 28:616-624. [DOI: 10.1177/1043659617719139] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Angela Sun
- Chinese Community Health Resource Center, San Francisco, CA, USA
| | - Joyce Cheng
- Chinese Community Health Resource Center, San Francisco, CA, USA
| | | | - Yvonne Liang
- Chinese Community Health Resource Center, San Francisco, CA, USA
| | - Terence Ng
- Chinese Community Health Resource Center, San Francisco, CA, USA
| | - Jyu-Lin Chen
- University of California, San Francisco, CA, USA
| |
Collapse
|
26
|
Chesla CA, Chun KM, Kwong Y, Gay CL, Chi HL, Gu Y, Hernandez L, Huang P, Strycker LA, Ma J. Cultural Adaptation of the Group Lifestyle Balance Program for Chinese Americans. DIABETES EDUCATOR 2016; 42:686-696. [PMID: 27624905 DOI: 10.1177/0145721716666679] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this pilot study was to develop and evaluate a culturally adapted, language-translated diabetes prevention program for Chinese Americans. METHODS This pilot study had a single-group repeated-measures design. Participants were 25 first-generation (n = 20) or second-generation (n = 5) Chinese Americans at risk for diabetes because of overweight (using the Asian-specific criterion of body mass index ≥ 23) and either prediabetes or metabolic syndrome. The 16-session program was administered over 6 months in separate Mandarin (n = 9) and English (n = 16) groups. Outcomes were assessed at baseline and at 3 and 6 months. Four participants dropped out. Multilevel regression models were used to examine change in study outcomes over time. RESULTS Participants lost an average of 5.4% of their body weight across the 6 months of the study. Self-report questionnaires suggested improved dietary intake and increased physical activity. Both total and low-density lipoprotein cholesterol levels improved. There were no statistically significant changes in fasting plasma glucose or A1C levels. Participants reported high satisfaction with and acceptance of the program. CONCLUSION Results suggest that the culturally adapted Group Lifestyle Balance program for Chinese Americans was both acceptable and effective. The culturally adapted program warrants further examination using scientific approaches for dissemination and implementation.
Collapse
Affiliation(s)
- Catherine A Chesla
- Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, California (Dr Chesla, Dr Gay, Dr Hernandez)
| | - Kevin M Chun
- University of San Francisco, San Francisco, California (Dr Chun)
| | - Yulanda Kwong
- Donaldina Cameron House, San Francisco, California (Ms Kwong)
| | - Caryl L Gay
- Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, California (Dr Chesla, Dr Gay, Dr Hernandez)
| | - Han-Lin Chi
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, California (Dr Chi)
| | - Yunzi Gu
- San Francisco Veterans Affairs Health Care System, San Francisco, California (Ms Gu)
| | - Lenore Hernandez
- Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, California (Dr Chesla, Dr Gay, Dr Hernandez)
| | - Peggy Huang
- Diabetes Teaching Center, University of California, San Francisco, San Francisco, California (Ms Huang)
| | | | - Jun Ma
- University of Illinois at Chicago, Chicago, Illinois (Dr Ma)
| |
Collapse
|
27
|
|
28
|
Bertran EA, Fritz H, Abbas M, Tarakji S, DiZazzo-Miller R, Pociask FD, Lysack CL, Arnetz J, Jaber LA. The Impact of Arab American Culture on Diabetes Self-management Education. DIABETES EDUCATOR 2015; 41:748-54. [DOI: 10.1177/0145721715607356] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose The purpose of this study was to better understand barriers and facilitators of diabetes self-management education (DSME) among Arab American patients with diabetes. Little is known about the impact of Arab culture on DSME. Methods Arab American adults (N = 23) with medically managed diabetes participated in 1 of 3 focus groups. An Arabic-speaking, trained moderator conducted video-recorded sessions. Verbatim Arabic transcripts were translated into English. Transcripts underwent a qualitative content analysis approach. Results Arab American cultural traditions such as food sharing, religious beliefs, and gender roles both facilitated and at times impeded DSME. Patients also held conflicting views about their interactions with their providers; some participants praised the authoritative patient-physician relationship style while others perceived the gaps in communication to be a product of Arab culture. Participants expressed that lack of available educational and supportive resources are key barriers to DSME. Conclusion Arab American culture affects DSM activities, and culturally sensitive educational resources are lacking. Development of DSME programs tailored to address relevant aspects of Arab culture might improve DSME outcomes in Arab American population.
Collapse
Affiliation(s)
- Elizabeth A. Bertran
- Eugene Applebaum College of Pharmacy and Health Sciences, Department of Pharmacy Practice, Wayne State University, Detroit, Michigan (Dr Bertran, Miss Abbas, Dr DiZazzo-Miller, Dr Pociask, Dr Lysack, Dr Jaber)
- Institute of Gerontology, Wayne State University, Detroit, Michigan (Dr Fritz)
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI (Dr Tarakji, Dr Arnetz)
| | - Heather Fritz
- Eugene Applebaum College of Pharmacy and Health Sciences, Department of Pharmacy Practice, Wayne State University, Detroit, Michigan (Dr Bertran, Miss Abbas, Dr DiZazzo-Miller, Dr Pociask, Dr Lysack, Dr Jaber)
- Institute of Gerontology, Wayne State University, Detroit, Michigan (Dr Fritz)
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI (Dr Tarakji, Dr Arnetz)
| | - Malak Abbas
- Eugene Applebaum College of Pharmacy and Health Sciences, Department of Pharmacy Practice, Wayne State University, Detroit, Michigan (Dr Bertran, Miss Abbas, Dr DiZazzo-Miller, Dr Pociask, Dr Lysack, Dr Jaber)
- Institute of Gerontology, Wayne State University, Detroit, Michigan (Dr Fritz)
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI (Dr Tarakji, Dr Arnetz)
| | - Sandra Tarakji
- Eugene Applebaum College of Pharmacy and Health Sciences, Department of Pharmacy Practice, Wayne State University, Detroit, Michigan (Dr Bertran, Miss Abbas, Dr DiZazzo-Miller, Dr Pociask, Dr Lysack, Dr Jaber)
- Institute of Gerontology, Wayne State University, Detroit, Michigan (Dr Fritz)
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI (Dr Tarakji, Dr Arnetz)
| | - Rosanne DiZazzo-Miller
- Eugene Applebaum College of Pharmacy and Health Sciences, Department of Pharmacy Practice, Wayne State University, Detroit, Michigan (Dr Bertran, Miss Abbas, Dr DiZazzo-Miller, Dr Pociask, Dr Lysack, Dr Jaber)
- Institute of Gerontology, Wayne State University, Detroit, Michigan (Dr Fritz)
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI (Dr Tarakji, Dr Arnetz)
| | - Fredrick D. Pociask
- Eugene Applebaum College of Pharmacy and Health Sciences, Department of Pharmacy Practice, Wayne State University, Detroit, Michigan (Dr Bertran, Miss Abbas, Dr DiZazzo-Miller, Dr Pociask, Dr Lysack, Dr Jaber)
- Institute of Gerontology, Wayne State University, Detroit, Michigan (Dr Fritz)
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI (Dr Tarakji, Dr Arnetz)
| | - Catherine L. Lysack
- Eugene Applebaum College of Pharmacy and Health Sciences, Department of Pharmacy Practice, Wayne State University, Detroit, Michigan (Dr Bertran, Miss Abbas, Dr DiZazzo-Miller, Dr Pociask, Dr Lysack, Dr Jaber)
- Institute of Gerontology, Wayne State University, Detroit, Michigan (Dr Fritz)
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI (Dr Tarakji, Dr Arnetz)
| | - Judith Arnetz
- Eugene Applebaum College of Pharmacy and Health Sciences, Department of Pharmacy Practice, Wayne State University, Detroit, Michigan (Dr Bertran, Miss Abbas, Dr DiZazzo-Miller, Dr Pociask, Dr Lysack, Dr Jaber)
- Institute of Gerontology, Wayne State University, Detroit, Michigan (Dr Fritz)
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI (Dr Tarakji, Dr Arnetz)
| | - Linda A. Jaber
- Eugene Applebaum College of Pharmacy and Health Sciences, Department of Pharmacy Practice, Wayne State University, Detroit, Michigan (Dr Bertran, Miss Abbas, Dr DiZazzo-Miller, Dr Pociask, Dr Lysack, Dr Jaber)
- Institute of Gerontology, Wayne State University, Detroit, Michigan (Dr Fritz)
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI (Dr Tarakji, Dr Arnetz)
| |
Collapse
|
29
|
Shiue I. Urinary parabens and polyaromatic hydrocarbons independent of health conditions are associated with adult emotional support needs: USA NHANES, 2005-2008. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2015; 22:12951-12959. [PMID: 25916474 DOI: 10.1007/s11356-015-4561-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 04/16/2015] [Indexed: 06/04/2023]
Abstract
Everyone needs emotional support at some point in life, but the needs might not always be met. The present study was aimed to investigate the prevalence of unmet needs of emotional support in adults and to identify social, environmental and health attributes in a national and population-based setting in recent years. Data was retrieved from the US National Health and Nutrition Examination Surveys, 2005-2008, including demographics, blood pressure readings, self-reported emotional support needs in the last 12 months, self-reported ever health conditions and urinary environmental chemical concentrations. Statistical analyses included chi-square test, t test, survey-weighted logistic regression modeling and population attributable risk (PAR) estimation. Of 6733 American adults aged 40-80, 1273 (21.0 %) needed more emotional support in the past year. They tended to be aged 40-60, female, Mexican American, other Hispanic, education less than high school, or poverty income ratio 5+. People with higher levels of butyl paraben, ethyl paraben, methyl paraben, 1-hydroxynaphthalene, 2-hydroxynaphthalene, or 9-hydroxyfluorene (but not heavy metals, arsenic, phenols, phthalates, pesticides, or phytoestrogens) or historical diabetes, asthma, arthritis, stroke, thyroid disorder, chronic bronchitis, sleep complaint/disorder, or trouble seeing needed more emotional support. Significant risk associations from environmental chemicals mentioned above have remained after adjusting for historical health conditions as potential mediators. This is the first time examining prevalence of the unmet emotional support in adults and identifying the social, environmental and health attributes. Removal of parabens and polyaromatic hydrocarbons and increasing healthcare for people with health conditions to accommodate emotional support should be considered.
Collapse
Affiliation(s)
- Ivy Shiue
- School of Energy, Geoscience, Infrastructure & Society, Heriot-Watt University, Riccarton, Edinburgh, Scotland, EH14 4AS, UK,
| |
Collapse
|
30
|
Park C, Nam S, Whittemore R. Incorporating Cultural Perspectives into Diabetes Self-Management Programs for East Asian Immigrants: A Mixed-Study Review. J Immigr Minor Health 2015; 18:454-67. [DOI: 10.1007/s10903-015-0181-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
31
|
Leung AYM, Bo A, Hsiao HY, Wang SS, Chi I. Health literacy issues in the care of Chinese American immigrants with diabetes: a qualitative study. BMJ Open 2014; 4:e005294. [PMID: 25406155 PMCID: PMC4244415 DOI: 10.1136/bmjopen-2014-005294] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To investigate why first-generation Chinese immigrants with diabetes have difficulty obtaining, processing and understanding diabetes related information despite the existence of translated materials and translators. DESIGN This qualitative study employed purposive sampling. Six focus groups and two individual interviews were conducted. Each group discussion lasted approximately 90 min and was guided by semistructured and open-ended questions. SETTING Data were collected in two community health centres and one elderly retirement village in Los Angeles, California. PARTICIPANTS 29 Chinese immigrants aged ≥45 years and diagnosed with type 2 diabetes for at least 1 year. RESULTS Eight key themes were found to potentially affect Chinese immigrants' capacity to obtain, communicate, process and understand diabetes related health information and consequently alter their decision making in self-care. Among the themes, three major categories emerged: cultural factors, structural barriers, and personal barriers. CONCLUSIONS Findings highlight the importance of cultural sensitivity when working with first-generation Chinese immigrants with diabetes. Implications for health professionals, local community centres and other potential service providers are discussed.
Collapse
Affiliation(s)
- Angela Yee Man Leung
- Li Ka Shing Faculty of Medicine, School of Nursing, University of Hong Kong, Hong Kong, Hong Kong
- Li Ka Shing Faculty of Medicine, Research Centre on Heart, Brain, Hormone and Healthy Aging, University of Hong Kong, Hong Kong, Hong Kong
| | - Ai Bo
- School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Hsin-Yi Hsiao
- School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Song Song Wang
- School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Iris Chi
- School of Social Work, University of Southern California, Los Angeles, California, USA
| |
Collapse
|
32
|
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.
Collapse
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
| | | |
Collapse
|
33
|
Grady PA, Gough LL. Self-management: a comprehensive approach to management of chronic conditions. Am J Public Health 2014; 104:e25-31. [PMID: 24922170 PMCID: PMC4103232 DOI: 10.2105/ajph.2014.302041] [Citation(s) in RCA: 447] [Impact Index Per Article: 44.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2014] [Indexed: 11/04/2022]
Abstract
For both clinical and economic reasons, the increasing number of persons living with chronic conditions represents a public health issue of growing importance. Emphasizing patient responsibility, and acting in concert with the provider community, self-management represents a promising strategy for treating chronic conditions-moving beyond education to teaching individuals to actively identify challenges and solve problems associated with their illness. Self-management also shows potential as an effective paradigm across the prevention spectrum (primary, secondary, and tertiary) by establishing a pattern for health early in life and providing strategies for mitigating illness and managing it in later life. We suggest ways to advance research methods and practical applications of self-management as steps in its future development and implementation.
Collapse
Affiliation(s)
- Patricia A Grady
- The authors are with the National Institute of Nursing Research, National Institutes of Health, Bethesda, MD
| | | |
Collapse
|
34
|
Towards a conceptual model of diabetes self-management among Chinese immigrants in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:6727-42. [PMID: 24978878 PMCID: PMC4113840 DOI: 10.3390/ijerph110706727] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 06/06/2014] [Accepted: 06/06/2014] [Indexed: 11/29/2022]
Abstract
Background: Chinese immigrants have been disproportionally affected by type 2 diabetes. This paper presents the state of science regarding the factors that may influence diabetes self-management among Chinese immigrants in the US and the potential health outcomes. Design: Using Walker and Avant’s techniques, a search of the literature was conducted from CINAHL, PubMed, OVID, and Web of Science. Findings: Factors most relevant to diabetes self-management were grouped under five categories: socio-demographic characteristics, behavioral and psychological characteristics, social support, linguistic barriers, and cultural characteristics. Potential outcomes derived from improved diabetes self-management include quality of life, glycosylated hemoglobin, and blood pressure and other cardiovascular risk factors. Discussion: A conceptual model was provided to guide future research. Based on the review of the literature, specific research topics that need to fill the gaps in the literature were provided, including family-focused interventions for Chinese immigrant patients with diabetes and the effectiveness of these interventions to improve family functioning.
Collapse
|
35
|
Joo JY. Effectiveness of culturally tailored diabetes interventions for Asian immigrants to the United States: a systematic review. DIABETES EDUCATOR 2014; 40:605-15. [PMID: 24829268 DOI: 10.1177/0145721714534994] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE The purpose of this systematic review is to evaluate the effectiveness of tailoring community-based diabetes intervention to Asian immigrant cultures. METHODS The Cochrane processes and Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations guided this systematic review. PubMed, the Cumulative Index to Nursing and Allied Health Literature, Ovid, and PsycINFO were searched for analyses and syntheses of primary research published since 2000 that described interventions tailored for the cultures of Asian immigrants with diabetes. This search yielded a total of 9 articles published from 2005 to 2013. The Amsterdam-Maastricht Consensus List for Quality Assessment was used to assess the quality of the studies. RESULTS Retrieved studies' populations were foreign-born adults >50 years of age with type 2 diabetes. The review revealed that culturally tailored diabetes programs are effective at improving patients' objectively measured clinical outcomes, in particular A1C levels, and psychobehavioral outcomes. Patients were also highly satisfied with bilingual health care providers and bilingual educational programs. CONCLUSIONS There is strong evidence of the effectiveness of tailoring diabetes interventions to Asian immigrant populations' cultures. Further studies, including longitudinal studies and studies with rigorous research designs that subclassify Asian immigrants, are needed to encourage the implementation of culturally tailored diabetes intervention for this ethnic minority.
Collapse
Affiliation(s)
- Jee Young Joo
- College of Nursing, University of Missouri-St. Louis, St. Louis, Missouri (Dr Joo)
| |
Collapse
|
36
|
Ho EY, Tran H, Chesla CA. Assessing the cultural in culturally sensitive printed patient-education materials for Chinese Americans with type 2 diabetes. HEALTH COMMUNICATION 2014; 30:39-49. [PMID: 24446839 PMCID: PMC4105327 DOI: 10.1080/10410236.2013.835216] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Type 2 diabetes affects Chinese Americans at an alarming rate. To address this health disparity, research in the area of cultural sensitivity and health literacy provides useful guidelines for creating culturally appropriate health education. In this article, we use discourse analysis to examine a group of locally available, Chinese- and English-language diabetes print documents from a surface level and deep structure level of culture. First, we compared these documents to research findings about printed health information to determine whether and how these documents apply current best practices for health literacy and culturally appropriate health communication. Second, we examined how diabetes as a disease and diabetes management is being constructed. The printed materials addressed surface level culture through the use of Chinese language, pictures, foods, and exercises. From a deeper cultural level, the materials constructed diabetes management as a matter of measurement and control that contrasted with previous research suggesting an alternative construction of balance. A nuanced assessment of both surface and deeper levels of culture is essential for creating health education materials that are more culturally appropriate and can lead to increased health literacy and improved health outcomes.
Collapse
Affiliation(s)
- Evelyn Y Ho
- a Department of Communication Studies , University of San Francisco
| | | | | |
Collapse
|