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Grant V, Litchfield I. Acceptability of community health worker and peer supported interventions for ethnic minorities with type 2 diabetes: a qualitative systematic review. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2024; 5:1306199. [PMID: 38836261 PMCID: PMC11148349 DOI: 10.3389/fcdhc.2024.1306199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/26/2024] [Indexed: 06/06/2024]
Abstract
Objective Ethnic minority groups in high income countries in North America, Europe, and elsewhere are disproportionately affected by T2DM with a higher risk of mortality and morbidity. The use of community health workers and peer supporters offer a way of ensuring the benefits of self-management support observed in the general population are shared by those in minoritized communities. Materials and methods The major databases were searched for existing qualitative evidence of participants' experiences and perspectives of self-management support for type 2 diabetes delivered by community health workers and peer supporters (CHWPs) in ethnically minoritized populations. The data were analysed using Sekhon's Theoretical Framework of Acceptability. Results The results are described within five domains of the framework of acceptability collapsed from seven for reasons of clarity and concision: Affective attitude described participants' satisfaction with CHWPs delivering the intervention including the open, trusting relationships that developed in contrast to those with clinical providers. In considering Burden and Opportunity Costs, participants reflected on the impact of health, transport, and the responsibilities of work and childcare on their attendance, alongside a lack of resources necessary to maintain healthy diets and active lifestyles. In relation to Cultural Sensitivity participants appreciated the greater understanding of the specific cultural needs and challenges exhibited by CHWPs. The evidence related to Intervention Coherence indicated that participants responded positively to the practical and applied content, the range of teaching materials, and interactive practical sessions. Finally, in examining the impact of Effectiveness and Self-efficacy participants described how they changed a range of health-related behaviours, had more confidence in dealing with their condition and interacting with senior clinicians and benefitted from the social support of fellow participants and CHWPs. Conclusion Many of the same barriers around attendance and engagement with usual self-management support interventions delivered to general populations were observed, including lack of time and resource. However, the insight of CHWPs, their culturally-sensitive and specific strategies for self-management and their development of trusting relationships presented considerable advantages.
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Affiliation(s)
- Vivene Grant
- Birmingham Medical School, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Ian Litchfield
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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Kumar P, Puri O, Unnithan VB, Reddy AP, Aswath S, Pathania M. Preparedness of diabetic patients for receiving telemedical health care: A cross-sectional study. J Family Med Prim Care 2024; 13:1004-1011. [PMID: 38736819 PMCID: PMC11086785 DOI: 10.4103/jfmpc.jfmpc_1024_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/09/2023] [Indexed: 05/14/2024] Open
Abstract
Introduction This study evaluates feasibility of telemedicine to deliver diabetic care among different regions of the country. Materials and Methods Medical interns affiliated with Rotaract Club of Medicrew (RCM) organized a Free Diabetes Screening Camp called "Diab-at-ease" at multiple sites across the country. Of all beneficiaries of the camp >18 years of age, patients previously diagnosed with diabetes and undiagnosed patients with a random blood sugar level of more than 200 mg/dL were interviewed regarding their knowledge, attitude, and practice regarding diabetes care and preparedness and vigilance to receiving care through telemedicine. Random blood sugar, height, weight, and waist circumference were also documented. Results About 51.1% (N = 223) of female patients aged 57.57 ± 13.84 years (>18 years) with body mass index (BMI) =26.11 ± 4.63 were the beneficiaries of the health camps. About 75.3% (n = 168) of them were on oral hypoglycemic agents (OHAs), 15.7% (n = 35) were on insulin preparations, and 59.6% (n = 156) and 88.5% (n = 31) of which were highly compliant with treatment, respectively. About 35% (n = 78) and 43.9% (n = 98) of them were unaware of their frequency of hypoglycemic and hyperglycemic episodes, respectively. About 64.6% (n = 144) of the patients were equipped for receiving teleconsultation. Glucometer was only possessed by 51.6% (115) of which only 46.95% (n = 54) can operate it independently. Only 80 patients (35.9%) were aware of the correct value of blood glucose levels. Conclusion While a majority of the population is compliant with treatment and aware about diabetes self-care, they lack adequate knowledge and resource equipment for the same leading to very limited utilization.
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Affiliation(s)
- Pratyush Kumar
- Intern, Dr. Baba Saheb Ambedkar Medical College and Hospital, Rohini, Delhi, India
| | - Oshin Puri
- Intern, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Vishnu B. Unnithan
- Department of Nuclear Medicine, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Asmitha P. Reddy
- Intern, Father Muller Medical College, Mangalore, Karnataka, India
| | - Shravya Aswath
- Intern, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India
| | - Monika Pathania
- Department of Medicine, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
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Li WW, Tong J. Family-Based, Culturally Responsive Intervention for Chinese Americans With Diabetes: Lessons Learned From a Literature Review to Inform Study Design and Implementation. Asian Pac Isl Nurs J 2023; 7:e48746. [PMID: 37983073 PMCID: PMC10696500 DOI: 10.2196/48746] [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: 05/04/2023] [Revised: 09/15/2023] [Accepted: 10/17/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND The prevalence of diabetes in the United States is very high, and Chinese peoples with diabetes are estimated to comprise 50% of the total cases. Rates of diabetes continue to rise among Chinese and Chinese American people; however, research regarding effective diabetes interventions for this minority group is sparse. OBJECTIVE A literature review was conducted to determine a study design and interventions for future studies investigating the efficacy of a family-based intervention to improve diabetes care for Chinese Americans. METHODS The review was conducted from January 2023 to April 2023. The PubMed, CINAHL, ScienceDirect, ProQuest, Google Scholar, Scopus, and Cochrane Central Register of Controlled Trials databases were searched. The key search terms were "diabetes type 2," "Chinese patients," "minority patients," "interventions for diabetes," "diabetes and family," "culturally responsive interventions for diabetic patients," "family education for diabetes," and "diabetes in China." RESULTS The initial search retrieved 2335 articles, and 10 articles met the selection criteria to examine the efficacy of family-based interventions for Chinese American people. The review showed that providing multiple sessions of education and counseling for both patients and family members is promising for improving diabetes care. Recruitment of 20 to 60 dyads consisting of a patient and a family member can help assess family dynamics in the process of diabetes care, such as food shopping and preparation, and of diabetes management to further evaluate the efficacy of an intervention. Glycated hemoglobin (HbA1c) was the most often used primary outcome. Other secondary outcomes included knowledge and efficacy in diabetes management and self-care activities related to diabetes care. CONCLUSIONS A family-based intervention is essential for optimizing diabetes care for Chinese Americans. Thus, recruitment of a dyad consisting of a patient and a family member is important to investigate the efficacy of a family-based intervention for improving diabetes care in this population. Strategies for improving recruitment and retention of dyads were identified. In addition, technology can be used to promote the delivery of interventions to patients, which in turn increases efficacy. This review can help researchers investigate the efficacy of family-based interventions for promoting diabetes management by designing culturally appropriate study protocols and interventions.
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Affiliation(s)
- Wen-Wen Li
- San Francisco State University, San Francisco, CA, United States
| | - Jacqueline Tong
- San Francisco State University, San Francisco, CA, United States
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Titus SK, Quiles–Pollard G. A Study of Immigrant Latinas Perspectives of Caring for their Diabetes. J Racial Ethn Health Disparities 2023; 10:2252-2260. [PMID: 36068479 PMCID: PMC10482789 DOI: 10.1007/s40615-022-01404-5] [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] [Received: 03/18/2022] [Revised: 08/11/2022] [Accepted: 08/23/2022] [Indexed: 11/25/2022]
Abstract
Hispanic-Americans are disproportionately affected by type 2 diabetes compared to non-Hispanic Whites. Five million adult Hispanic Americans are estimated to have been diagnosed with T2D. Among US Hispanics, Mexicans have the highest rate (14.4%) of diabetes. Further, Hispanics are also twice as likely as non-Hispanics Whites to die from diabetes, making it the fifth leading cause of their death and a serious health problem in Hispanic communities. Yet, little is understood of what rural immigrant Latinas do to care for their diabetes health. In-depth interviews (3 focus groups) and thematic analysis found 16 Latinas had T2D on average for 9 years; all emigrated to the USA from Mexico, lived in the USA for an average of 27 years, and worked (60%). Within the domain of "What do you do to take care of your health?" Latinas desired to adhere to exercise, controlled diet, and medications, but perceived a powerful barrier to a healthy life was the American lifestyle that included long work days, more money to purchase unhealthy foods and a desire for them, and a lack of time for other forms of exercise. Despite the Latina participants' years of experience about living with T2D in the US, they still struggled to adhere to healthy behaviors. Future research should address the longer time Hispanic immigrants live in the US with the more at-risk they become for diminished health.
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Affiliation(s)
- Sharon K. Titus
- School of Nursing, Azusa Pacific University, 701 E. Foothill Blvd, Azusa, CA 91702-7000 USA
- Tuscaloosa, USA
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Roddy MK, Spieker AJ, Nelson LA, Greevy RA, LeStourgeon LM, Bergner EM, El-Rifai M, Elasy TA, Aikens JE, Wolever RQ, Mayberry LS. Well-being outcomes of a family-focused intervention for persons with type 2 diabetes and support persons: Main, mediated, and subgroup effects from the FAMS 2.0 RCT. Diabetes Res Clin Pract 2023; 204:110921. [PMID: 37742801 PMCID: PMC10617415 DOI: 10.1016/j.diabres.2023.110921] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/12/2023] [Accepted: 09/20/2023] [Indexed: 09/26/2023]
Abstract
AIMS Type 2 diabetes self-management occurs within social contexts. We sought to test the effects of Family/friend Activation to Motivate Self-care (FAMS), a self-care support intervention delivered via mobile phones, on psychosocial outcomes for persons with diabetes (PWDs) and their support persons. METHODS PWDs had the option to enroll with a friend/family member as a support person in a 15-month RCT to evaluate FAMS versus enhanced usual care. FAMS included 9 months of monthly phone coaching and text message support for PWDs, and text message support for enrolled support persons. RESULTS PWDs (N = 329) were 52% male and 39% reported minoritized race or ethnicity ; 50% enrolled with elevated diabetes distress. Support persons (N = 294) were 26% male and 33% reported minoritized race or ethnicity. FAMS improved PWDs' diabetes distress (d = -0.19) and global well-being (d = 0.21) during the intervention, with patterns of larger effects among minoritized groups. Post-intervention (9-month) and sustained (15-month) improvements were driven by changes in PWDs' self-efficacy, self-care behaviors, and autonomy support. Among support persons, FAMS improved helpful involvement without increasing burden or harmful involvement. CONCLUSIONS FAMS improved PWDs' psychosocial well-being, with post-intervention and sustained improvements driven by improved self-efficacy, self-care, and autonomy support. Support persons increased helpful involvement without adverse effects.
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Affiliation(s)
- McKenzie K Roddy
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Andrew J Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Lyndsay A Nelson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Robert A Greevy
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Lauren M LeStourgeon
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Erin M Bergner
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Merna El-Rifai
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Tom A Elasy
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, United States
| | - James E Aikens
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Ruth Q Wolever
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, United States; Osher Center for Integrative Health at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Lindsay S Mayberry
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, United States; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States.
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Roddy MK, Spieker AJ, Nelson LA, Greevy RA, LeStourgeon LM, Bergner EM, El-Rifai M, Elasy TA, Aikens JE, Wolever RQ, Mayberry LS. Well-being outcomes of a family-focused intervention for persons with type 2 diabetes and support persons: Main, mediated, and subgroup effects from the FAMS 2.0 RCT. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.11.23295375. [PMID: 37745314 PMCID: PMC10516078 DOI: 10.1101/2023.09.11.23295375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Aims Type 2 diabetes self-management occurs within social contexts. We sought to test the effects of Family/friends Activation to Motivate Self-care (FAMS), a self-care support intervention delivered via mobile phones, on psychosocial outcomes for persons with diabetes (PWDs) and their support persons. Methods PWDs had the option to enroll with a friend/family member as a support person in a 15-month RCT to evaluate FAMS versus enhanced usual care. FAMS included 9-months of monthly phone coaching and text message support for PWDs, and text message support for enrolled support persons. Results PWDs (N=329) were 52% male and 39% from minoritized racial or ethnic groups; 50% enrolled with elevated diabetes distress. Support persons (N=294) were 26% male and 33% minoritized racial or ethnic groups. FAMS improved PWDs' diabetes distress ( d =-0.19) and global well-being ( d =0.21) during the intervention, with patterns of larger effects among minoritized groups. Post-intervention and sustained (15-month) improvements were driven by changes in PWDs' self-efficacy, self-care behaviors, and autonomy support. Among support persons, FAMS improved helpful involvement without increasing burden or harmful involvement. Conclusions FAMS improved PWDs' psychosocial well-being, with post-intervention and sustained improvements driven by improved self-efficacy, self-care, and autonomy support. Support persons increased helpful involvement without adverse effects.
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Affiliation(s)
- McKenzie K. Roddy
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN
| | - Andrew J. Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Lyndsay A Nelson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN
| | - Robert A. Greevy
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Lauren M. LeStourgeon
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN
| | - Erin M. Bergner
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN
| | - Merna El-Rifai
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN
| | - Tom A. Elasy
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - James E. Aikens
- Department of Family Medicine, University of Michigan, Ann Arbor, MI
| | - Ruth Q. Wolever
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN
- Osher Center for Integrative Health at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN
| | - Lindsay S. Mayberry
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
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Alolod GP, Gardiner HM, Blunt R, Yucel RM, Siminoff LA. Organ Donation Willingness Among Asian Americans: Results from a National Study. J Racial Ethn Health Disparities 2023; 10:1478-1491. [PMID: 35595917 PMCID: PMC9675880 DOI: 10.1007/s40615-022-01333-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/05/2022] [Accepted: 05/13/2022] [Indexed: 10/18/2022]
Abstract
Asian Americans are the fastest growing racial group in the USA, but their health disparities are often overlooked. Although their needs for transplantable organs are substantial, they have the lowest rates of organ donation per million compared to other Americans by race. To better understand Asian Americans' disposition toward organ donation, a self-administered survey was developed based on formative data collection and guidance from a Community Advisory Board composed of Asian American stakeholders. The instrument was deployed online, and quota sampling based on the 2017 American Community Survey was used to achieve a sample representative (N = 899) of the Asian American population. Bivariate tests using logistic regression and the chi-square test of independence were performed. Over half (58.1%) of respondents were willing to be organ donors. A majority (81.8%) expressed a willingness to donate a family member's organs, but enthusiasm depended on the family member's donor wishes. Only 9.5% of respondents indicated that the decision to donate their organs was theirs alone to make; the remainder would involve at least one other family member. Other key sociodemographic associations were found. This study demonstrates both the diversity of Asian Americans but also the centrality of the family's role in making decisions about organ donation. Practice and research considerations for the field are also presented.
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Affiliation(s)
- Gerard P Alolod
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA.
| | - Heather M Gardiner
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Ryan Blunt
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Recai M Yucel
- Department of Biostatistics and Epidemiology, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Laura A Siminoff
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
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Zeren FG, Canbolat O. The relationship between family support and the level of self care in type 2 diabetes patients. Prim Care Diabetes 2023:S1751-9918(23)00091-8. [PMID: 37149410 DOI: 10.1016/j.pcd.2023.04.008] [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: 10/31/2022] [Revised: 04/10/2023] [Accepted: 04/28/2023] [Indexed: 05/08/2023]
Abstract
AIMS The purpose of the study was to determine the relationship between family support and self-care in patients with type 2 diabetes in Middle Anatolia Region of Turkey. METHODS This descriptive relation-seeker-type study conducted with 284 patients who met inclusion criteria between February and May 2020 in the internal medicine and endocrinology clinics and polyclinics of a university hospital. Data were collected using, a demographic questionnaire, Hensarling's Diabetes Family Support Scale (HDFSS), and Diabetes Self-Care Scale (DSCS). RESULTS Participants had a mean DSCS and HDFSS score of 83.20 ± 18.63 and 82.44 ± 28.04, respectively. There was a strong correlation between DSCS and HDFSS scores (r:.621) (p < 0.001). Participants' DSCS totals score was strongly correlated with their HDFSS "empathetic support" (p = 0.001, r = 0.625), "encouragement" (p = 0.001, r = 0.558), "facilitative support" (p = 0.001, r = 0.558), and "participative support" scores (p = 0.001, r = 0.555). CONCLUSIONS Patients with more family support have higher levels of self-care. The results underline the significance of focusing on the relationship between self-care and family support in patients with type 2 diabetes.
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Affiliation(s)
- Fatma Gul Zeren
- Emergency Unit, Kadinhani Refik Saime Koyuncu Public Hospital, Konya, Turkey
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Mokhtari Z, Mokhtari S, Afrasiabifar A, Hosseini N. The Effect of Family-Centered Intervention on Key Indicators of Diabetes Management and Control in Patients with Type-2 Diabetes. Int J Prev Med 2023; 14:54. [PMID: 37351055 PMCID: PMC10284200 DOI: 10.4103/ijpvm.ijpvm_150_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 10/27/2022] [Indexed: 06/24/2023] Open
Abstract
Background This study is to determine the effect of the family-centered intervention (FCIS) on the key indicators of diabetes management and Control control in patients with type-2 diabetes. Method The present study is a quiz- experimental study with a randomized control group. Participants were 64 patients with type-2 diabetes visiting Ali Asghar Hospital of Isfahan in 2018. The eligible patients were assigned to either the intervention group or the control group (i.e., patient-center care) through block randomization. FCIS were implemented in 4 two-hour sessions as home visits while the patients and their caregivers were present. Data were collected twice-i.e. before the intervention and 12 weeks after it- and were analyzed, by running a t-test (α = 0.05), using SPSS-21. Results The mean ± SD age of participants was 50.4 ± 8.5. There was no significant difference between the two groups in the mean weight, serum levels of FBS and A1C, physical activity, energy intake, and BMI before intervention. But, a significant improvement in the mean values of these variables in the intervention group after the intervention, compared with the control group was indicated (P < 0.05). Conclusions This study suggests that FCIS are more effective than patient-center care in the management and control of type-2 diabetes. Therefore, it is recommended that the family be considered in educational interventions.
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Affiliation(s)
- Zeinab Mokhtari
- Nutrition and Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Somayeh Mokhtari
- MSc in Nursing, Department of Human Resources Management, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Nazafarin Hosseini
- Department of Nursing, Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
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Brennan MB, Tan TW, Schechter MC, Fayfman M. Using the National Institute on Minority Health and Health Disparities framework to better understand disparities in major amputations. Semin Vasc Surg 2023; 36:19-32. [PMID: 36958894 PMCID: PMC10039286 DOI: 10.1053/j.semvascsurg.2023.01.002] [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: 11/14/2022] [Revised: 01/10/2023] [Accepted: 01/16/2023] [Indexed: 01/22/2023]
Abstract
Recently, the United States experienced its first resurgence of major amputations in more than 20 years. Compounding this rise is a longstanding history of disparities. Patients identifying as non-Hispanic Black are twice as likely to lose a limb as those identifying as non-Hispanic White. Those identifying as Latino face a 30% increase. Rural patients are also more likely to undergo major amputations, and the rural-urban disparity is widening. We used the National Institute on Minority Health and Health Disparities framework to better understand these disparities and identify common factors contributing to them. Common factors were abundant and included increased prevalence of diabetes, possible lower rates of foot self-care, transportation barriers to medical appointments, living in disadvantaged neighborhoods, and lack of insurance. Solutions within and outside the health care realm are needed. Health care-specific interventions that embed preventative and ambulatory care services within communities may be particularly high yield.
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Affiliation(s)
- Meghan B Brennan
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI, 53583.
| | - Tze-Woei Tan
- Department of Surgery, Keck School of Medicine University of Southern California, Los Angeles, CA
| | - Marcos C Schechter
- Department of Medicine, Emory University School of Medicine, Atlanta, GA; Grady Health System, Atlanta, GA
| | - Maya Fayfman
- Department of Medicine, Emory University School of Medicine, Atlanta, GA; Grady Health System, Atlanta, GA
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Leung T, Nandy K, Ruiz ME, Polzin R, Kurator K, Wali S. Improving Self-management of Type 2 Diabetes in Latinx Patients: Protocol for a Sequential Multiple Assignment Randomized Trial Involving Community Health Workers, Registered Nurses, and Family Members. JMIR Res Protoc 2023; 12:e44793. [PMID: 36645708 PMCID: PMC9887518 DOI: 10.2196/44793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 12/24/2022] [Accepted: 12/25/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The rate of Type 2 diabetes mellitus (T2DM) among Mexican American individuals is 16.3%, about twice that of non-Hispanic White individuals. While a number of education approaches have been developed and shown to improve diabetes self-management behaviors and glycemic control for Spanish-speaking Latinx patients with T2DM, there is little research to guide health practitioners regarding which interventions to apply and when so that resources are used efficiently, and treatment outcomes are maximized. OBJECTIVE This study aimed to describe an adaptive intervention that integrates community mental health workers, diabetes nurse educators, family members, and patients as partners in care while promoting diabetes self-management for Mexican American individuals with T2DM. The project incorporates four evidence-based, culturally tailored treatments to determine what sequence of intervention strategies work most efficiently and for whom. Given the increasing prevalence of T2DM, achieving better control of diabetes and lowering the associated medical complications experienced disproportionally by Mexican American individuals is a public health priority. METHODS Funded by the National Institute of Nursing Research (National Institutes of Health grant R01 NR015809), this project used a sequential multiple assignment randomized trial and included 330 Spanish-speaking Latinx patients with T2DM. In the first phase of the study, subjects were randomly assigned to an evidence-based diabetes self-management educational program called Tomando Control delivered in a group format for 6, biweekly 1.5-hour sessions, led either by a community health worker or a diabetes nurse educator. In the second phase of the study, those subjects who did not improve their diabetes self-management behaviors were rerandomized to receive either an augmented version of Tomando Control or a multifamily group treatment focused on problem-solving. The primary outcome measure was the "Summary of Diabetes Self-Care Activities." Evaluations were made at baseline and at 3, 6, and 12 months. RESULTS This study was funded in June 2016 for a period of 5 years. Institutional review board approval was obtained in November 2016. Between March 2017 and September 2020, a total of 330 patients were recruited from the outpatient primary care clinics of Olive View-UCLA Medical Center, with a brief hiatus between May 2020 and July 2020 due to COVID-19 restrictions. The study interventions were completed in December 2020. Data collection began in March 2017 and was completed in December 2021. Data analysis is expected to be completed in Spring 2023, and results will be published in Fall 2023. CONCLUSIONS The results of this trial should help practitioners in selecting the optimal approach for improving diabetes self-management in Spanish-speaking, Latinx patients with T2DM. TRIAL REGISTRATION ClinicalTrials.gov NCT03092063; https://clinicaltrials.gov/ct2/show/NCT03092063. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/44793.
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Affiliation(s)
| | - Karabi Nandy
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Maria Elena Ruiz
- University of California, Los Angeles School of Nursing, Los Angeles, CA, United States
| | - Rhonda Polzin
- Department of Nursing, Olive View-UCLA Medical Center, Sylmar, CA, United States
| | - Kevin Kurator
- Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA, United States
| | - Soma Wali
- Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA, United States
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12
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Hawley NL, Rivara AC, Naseri J, Faumuina K, Potoa’e-Solaita N, Iopu F, Faiai M, Naveno E, Tasele S, Lefale T, Lantini R, Carlson JC, Rabin TL, Semaia P, Mugadza P, Rosen RK. Protocol: Implementation and evaluation of an adolescent-mediated intervention to improve glycemic control and diabetes self-management among Samoan adults. PLoS One 2023; 18:e0279084. [PMID: 36795707 PMCID: PMC9934313 DOI: 10.1371/journal.pone.0279084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 11/25/2022] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Diagnoses of Type 2 Diabetes in the United States have more than doubled in the last two decades. One minority group at disproportionate risk are Pacific Islanders who face numerous barriers to prevention and self-care. To address the need for prevention and treatment in this group, and building on the family-centered culture, we will pilot test an adolescent-mediated intervention designed to improve the glycemic control and self-care practices of a paired adult family member with diagnosed diabetes. METHODS We will conduct a randomized controlled trial in American Samoa among n = 160 dyads (adolescent without diabetes, adult with diabetes). Adolescents will receive either a six-month diabetes intervention or a leadership and life skills-focused control curriculum. Aside from research assessments we will have no contact with the adults in the dyad who will proceed with their usual care. To test our hypothesis that adolescents will be effective conduits of diabetes knowledge and will support their paired adult in the adoption of self-care strategies, our primary efficacy outcomes will be adult glycemic control and cardiovascular risk factors (BMI, blood pressure, waist circumference). Secondarily, since we believe exposure to the intervention may encourage positive behavior change in the adolescent themselves, we will measure the same outcomes in adolescents. Outcomes will be measured at baseline, after active intervention (six months post-randomization) and at 12-months post-randomization to examine maintenance effects. To determine potential for sustainability and scale up, we will examine intervention acceptability, feasibility, fidelity, reach, and cost. DISCUSSION This study will explore Samoan adolescents' ability to act as agents of familial health behavior change. Intervention success would produce a scalable program with potential for replication in other family-centered ethnic minority groups across the US who are the ideal beneficiaries of innovations to reduce chronic disease risk and eliminate health disparities.
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Affiliation(s)
- Nicola L. Hawley
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America
- * E-mail:
| | - Anna C. Rivara
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America
| | - Joshua Naseri
- Obesity, Lifestyle and Genetic Adaptations Study Group, Pago Pago, American Samoa
| | - Kitiona Faumuina
- Obesity, Lifestyle and Genetic Adaptations Study Group, Pago Pago, American Samoa
| | | | - Francine Iopu
- Department of Public Health, Portland State University, Portland, OR, United States of America
| | - Mata’uitafa Faiai
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America
| | | | - Susie Tasele
- Obesity, Lifestyle and Genetic Adaptations Study Group, Pago Pago, American Samoa
| | - Temukisa Lefale
- Obesity, Lifestyle and Genetic Adaptations Study Group, Pago Pago, American Samoa
| | - Ryan Lantini
- Center for Behavioral and Preventative Medicine, The Miriam Hospital, Providence, RI, United States of America
| | - Jenna C. Carlson
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
- Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Tracy L. Rabin
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States of America
| | - Penny Semaia
- Athletic Department, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Phyllis Mugadza
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America
| | - Rochelle K. Rosen
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States of America
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Jarvandi S, Roberson P, Greig J, Upendram S, Grion J. Effectiveness of diabetes education interventions in rural America: a systematic review. HEALTH EDUCATION RESEARCH 2022:cyac039. [PMID: 36583394 DOI: 10.1093/her/cyac039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/23/2022] [Accepted: 12/06/2022] [Indexed: 06/17/2023]
Abstract
The purpose of this systematic review is to summarize the characteristics of recent studies on diabetes education interventions in rural areas and identify the relative proportion of studies with characteristics of interest that showed a reduction in glycated hemoglobin (A1C). A systematic literature search was performed in Web of Science, PubMed and PsychInfo, using keywords and Medical Subject Heading terms. Articles conducted in rural areas of the United States tested an educational intervention for people with type 2 diabetes, and reported outcomes were identified. A total of 2762 articles were identified, of which 27 were included. Of the 27 articles, most were implemented in the Southeast (n = 13). Of the 21 interventions that measured A1C, 10 reported a statistically significant decrease in A1C. The proportion of studies with a significant A1C reduction was higher for the studies that used telehealth/online, delivered by a collaboration between health-care professionals and lay educators or included family or group components. Only three studies included their criteria in determining rurality. Future diabetes education interventions may consider including family members or group sessions, holding online sessions and partnering with local resources. Additionally, stronger research methods are needed to test practical and effective interventions to improve diabetes education in rural areas.
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Affiliation(s)
- Soghra Jarvandi
- Department of Family and Consumer Sciences, University of Tennessee, 2621 Morgan Circle, 119 Morgan Hall, Knoxville, TN 37996-4501, USA
| | - Patricia Roberson
- College of Nursing, University of Tennessee, 1200 Volunteer Blvd., Knoxville, TN 37996, USA
| | - Jamie Greig
- Department of Agricultural Leadership, Education and Communications, University of Tennessee, 320 Morgan Hall, 2621 Morgan Circle Drive, Knoxville, TN 37996, USA
| | - Sreedhar Upendram
- Department of Agricultural and Resource Economics, University of Tennessee, 227C Morgan Hall, 2621 Morgan Circle, Knoxville, TN 37996-4518, USA
| | - Joelle Grion
- College of Nursing, University of Tennessee, 1200 Volunteer Blvd., Knoxville, TN 37996, USA
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Garcia-Ulloa AC, Díaz-Pineda M, Ramírez-García A, Antonio-Villa NE, Almeda-Valdes P, Kaufer-Horwitz M, Torres-Mejía G, Aguilar-Salinas CA, Hernández-Jiménez SC. The beneficial effect of a comprehensive diabetes care model on high-risk relatives accompanying patients with type 2 diabetes. Prim Care Diabetes 2022; 16:791-796. [PMID: 36182627 DOI: 10.1016/j.pcd.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 08/25/2022] [Accepted: 09/19/2022] [Indexed: 11/18/2022]
Abstract
AIMS Assess the effect of a diabetes program on lifestyle, metabolic, and mental health parameters in relatives of patients with T2D, and correlate changes between relatives and patients. METHODS Relatives were included in a structured program for patients with T2D. They received individualized interventions or were asked to follow lifestyle modifications indicated to their patient with diabetes. Outcomes were change in BMI, fat loss, patients achieving LDL-c and triglycerides goals, exercise, and mental health indicators at three and twelve months. RESULTS We included 200 relatives. Obesity was present in 42 %, hypertension in 8.5 %, hypercholesterolemia in 29.5 %, and hypertriglyceridemia in 46 % of relatives. Relatives lost - 3.7 kg and - 3.0 kg of body fat at three months and one-year evaluations. At least 60 % achieved normal triglycerides and LDL-c, and 40 % exercised at least 150 min/week. Anxiety symptoms dropped from 37 % to 22 % (p = 0.001), and depressive symptoms from 22 % to 12.9 % (p = 0.01) at three months. Correlations were found between the changes in relatives and patients in weight at three months (r = 0.22, p = 0.001), one year (r = 0.3, p < 0.001), and the number of goals achieved at one year. CONCLUSION Relatives of patients with diabetes attending a multidisciplinary program for T2D benefit in metabolic, lifestyle, and mental health indicators.
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Affiliation(s)
- Ana C Garcia-Ulloa
- Center of Comprehensive Care of the Patient with Diabetes (CAIPaDi), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Vasco de Quiroga No. 15, Colonia Belisario Dominguez Sección XVI, Tlalpan, Mexico City 14080, Mexico; Endocrinology and Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Vasco de Quiroga No. 15, Colonia Belisario Dominguez Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - Michelle Díaz-Pineda
- Center of Comprehensive Care of the Patient with Diabetes (CAIPaDi), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Vasco de Quiroga No. 15, Colonia Belisario Dominguez Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - Alberto Ramírez-García
- Center of Comprehensive Care of the Patient with Diabetes (CAIPaDi), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Vasco de Quiroga No. 15, Colonia Belisario Dominguez Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - Neftali Eduardo Antonio-Villa
- Faculty of Medicine, Universidad Nacional Autónoma de México, Circuito Escolar 411 A, Copilco Universidad, Coyoacán, 04360 Mexico CIty, Mexico
| | - Paloma Almeda-Valdes
- Endocrinology and Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Vasco de Quiroga No. 15, Colonia Belisario Dominguez Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - Martha Kaufer-Horwitz
- Obesity and Eating Disorders Clinic, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Vasco de Quiroga No. 15, Colonia Belisario Dominguez Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - Gabriela Torres-Mejía
- Instituto Nacional de Salud Pública, Avenida Universidad 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos, Mexico
| | - Carlos A Aguilar-Salinas
- Direction of Nutrition, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Vasco de Quiroga No. 15, Colonia Belisario Dominguez Sección XVI, Tlalpan, Mexico City 14080, Mexico.
| | - Sergio C Hernández-Jiménez
- Center of Comprehensive Care of the Patient with Diabetes (CAIPaDi), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Vasco de Quiroga No. 15, Colonia Belisario Dominguez Sección XVI, Tlalpan, Mexico City 14080, Mexico; Endocrinology and Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Vasco de Quiroga No. 15, Colonia Belisario Dominguez Sección XVI, Tlalpan, Mexico City 14080, Mexico
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Ali SH, Rouf R, Mohsin FM, Meltzer G, Sharma P, DiClemente RJ. The influence of routine and leisure family activities on the ability of young Asian Americans to maintain a healthy lifestyle: findings from a nationwide survey. J Behav Med 2022; 45:962-974. [PMID: 35948698 PMCID: PMC9365227 DOI: 10.1007/s10865-022-00352-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 07/18/2022] [Indexed: 11/08/2022]
Abstract
Family is uniquely influential in the health of young Asian Americans (AAs), yet little is known on the impact of specific shared family activities. This study explores different types and frequencies of AA young adult shared family activities on perceived familial influence on the ability to maintain a healthy lifestyle (diet, physical activity, sleep, social relationships, stress, and risky substances). A nationwide sample of 18-35-year-old AAs was surveyed in March 2021 on a list of 30 shared family activities with mothers, fathers, siblings, or extended family. Overall, 984 unique family relationships reported by 616 young AAs were analyzed. Confirmatory factor analysis synthesized a reliable two-factor (routine, leisure activities) 10-item Shared Activities with Family (SAF) scale. Mothers were most influential (mean 3.25, SD = 1.14), although shared activities among South Asians or with extended family were most associated with changes in perceived influence. Routine shared activities were more strongly associated with perceived influence on sleep, diet, and risky substances, while leisure shared activities were more associated with influence on developing healthy social relationships. Family-based, dyadic interventions for young AAs may incorporate shared activities (both routine and leisure) to promote healthy behaviors, although further research to explore mechanisms and directionality of influence is needed to inform action.
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Affiliation(s)
- Shahmir H Ali
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, 708 Broadway, New York, NY, 10003, USA.
| | - Rejowana Rouf
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Farhan M Mohsin
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, USA
| | - Gabriella Meltzer
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, 708 Broadway, New York, NY, 10003, USA
| | - Priyanshi Sharma
- College of Letters and Sciences, University of California, Berkeley, CA, USA
| | - Ralph J DiClemente
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, 708 Broadway, New York, NY, 10003, USA
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16
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Ojewale LY, Oluwatosin OA. Family-integrated diabetes education for individuals with diabetes in South-west Nigeria. Ghana Med J 2022; 56:276-284. [PMID: 37575630 PMCID: PMC10416295 DOI: 10.4314/gmj.v56i4.6] [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: 08/15/2023] Open
Abstract
Objectives This study aimed to determine the effects of family-integrated diabetes education on diabetes knowthe ledge of patients and family members, as well as its impact on patients' glycosylated haemoglobin (A1C). Design The design was a two-group Pretest Posttest quasi-experimental. Setting The study took place at the diabetes clinics of two tertiary hospitals in southwestern Nigeria. Participants People Living with Diabetes (PLWD) and family members aged 18 years and over and without cognitive impairment were placed, as clusters, into either a control group (CG) or an intervention group (IG) The CG comprised 88 patients and 88 family members while IG comprised 82 patients and 82 family members. Of these, 78 and 74 patients completed the study in CG and IG, respectively. Interventions PLWD in IG along with their family members were given an educational intervention on diabetes management and collaborative support with an information booklet provided. This was followed by three (3) complimentary Short Messaging Service (SMS). Main outcome measures A1C and diabetes knowledge. Results Over half (52.4%) and about a fifth (18.2%) of family members and patients, respectively, had never had diabetes education. There was a statistically significant increase in the knowledge of patients and family members in IG. Unlike CG, the A1C of patients in IG improved significantly at three and six-month post-intervention, (p<0.01). Regression showed an independent effect of family members' knowledge on IG's A1C. Conclusions Improved family members' diabetes knowledge positively impacted patients' glucose level. There is a need to integrate family members into diabetes care better. Funding African Doctoral Dissertation Research Fellowship (ADDRF) award offered by the Africa Population and Health Research Center (APHRC) in partnership with the International Development Research Centre.
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Affiliation(s)
- Lucia Y Ojewale
- Department of Nursing, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Oyeninhun A Oluwatosin
- Department of Nursing, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
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17
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Rondhianto R, Nursalam N, Kusnanto K, Melaniani S. [The effect of family caregiver empowerment interventions on family caregiver capabilities in self-management of type 2 diabetes mellitus in Indonesia]. ENFERMERIA CLINICA (ENGLISH EDITION) 2022; 32:385-395. [PMID: 36509468 DOI: 10.1016/j.enfcle.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 01/03/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Empowering family caregivers is one of the strategies to increase the family caregiver's capability in T2DM self-management. The adequate capability of family caregivers in T2DM self-management can improve T2DM management, impacting people's health status with T2DM. This study aimed to examine the effect of family caregiver empowerment intervention on the family caregiver's T2DM self-management capability. METHODS This study is an experimental study with a randomized control group pre-test post-test design. The sample size is 60 respondents by simple random sampling, which is divided into two groups randomly. The treatment group (n=30) received 10-session intervention in 10 weeks (six education and training sessions and four mentoring sessions), and the control group (n=30) received standard care. Data were collected using a questionnaire, twice, before and after the intervention (12 weeks after the last intervention session) and analysed descriptively and statistically (One way-ANOVA test, dependent t-test, and independent t-test). RESULTS The empowerment intervention significantly increased the family caregiver's T2DM self-management capability, including diet management (t=4.070; p<.001), physical activity management (t=9.493; p<.001), medication management (t=4.021; p<.001), self-monitoring blood glucose levels (t=2.789; p<.001), and foot care skills (t=6.835; p<.001). CONCLUSION Family caregiver empowerment interventions can improve the capability of family caregivers in self-management of T2DM, including increasing the capability to manage diet, physical activity, medication, self-monitoring blood glucose levels, and foot care. Nurses can empower family members as family caregivers to improve self-management of T2DM.
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Comparing the effectiveness of Family Support for Health Action (FAM-ACT) with traditional community health worker-led interventions to improve adult diabetes management and outcomes: study protocol for a randomized controlled trial. Trials 2022; 23:841. [PMID: 36192769 PMCID: PMC9527393 DOI: 10.1186/s13063-022-06764-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 09/17/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Diabetes self-management education and support (DSMES) programs have struggled to deliver sustainable, effective support for adults with diabetes (AWDs) to improve self-management behaviors, achieve glycemic goals, and reduce risk for complications. One largely untapped resource for this support is AWDs' social networks. Fifty to 75% of AWDs have an unpaid family member or friend ("support person") who provides ongoing help with diabetes management. However, DSMES interventions to date lack structured and effective approaches to directly engage support persons in AWDs' diabetes management. METHODS This parallel arm randomized trial is designed to determine the effectiveness of Family Support for Health Action (FAM-ACT), a novel community health worker (CHW)-delivered program focused on educating and supporting patients with type 2 diabetes (T2D) and their support persons (SPs), relative to an established, CHW-delivered, individual patient-focused DSMES and care management (I-DSMES) intervention. Both interventions were developed using a community-based participatory research (CBPR) approach. The study will be conducted in partnership with an urban Federally Qualified Health Center (FQHC) serving a low-income, Latino/a community, with target enrollment of 268 dyads consisting of an FQHC patient with T2D with high HbA1c and an SP. Patient-SP dyads will be randomized to receive FAM-ACT or I-DSMES over 6 months. The primary outcome is change in patient HbA1c from baseline to 6 months. Secondary patient outcomes include 12-month change in HbA1c, changes in patient blood pressure, diabetes self-management behaviors, diabetes distress, patient activation, diabetes self-efficacy, and perceptions of and satisfaction with SP support for diabetes. Secondary SP outcomes include self-efficacy for helping the patient with diabetes management and SP distress about the patient's diabetes. We also will assess the effect of the COVID-19 pandemic on patient's ability to manage diabetes. DISCUSSION This study will inform scalable, evidence-based approaches that leverage family support to help AWDs improve and sustain self-management strategies that underpin optimal management of multiple diabetes complication risk factors. The protocol is designed for and evaluated with a low-income and predominantly Latino/a community, which may increase applicability to other similar communities. The COVID-19 pandemic presented several challenges to study protocol and intervention delivery; modifications made to address these challenges are described. TRIAL REGISTRATION ClinicalTrials.gov NCT03812614. Registered on 18 January 2019.
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19
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Hawkins J, Kieffer EC, Sinco B, Piatt G, Jones L, Mitchell J, Espitia N, LeBron A, Kloss KA, Kurnick K, Palmsiano G, Spencer MS. Using Path Analysis and Linear Regression to Test for Gender and Participation: Effects in a Culturally Tailored Diabetes Intervention for Latino Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11982. [PMID: 36231282 PMCID: PMC9565909 DOI: 10.3390/ijerph191911982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/17/2022] [Accepted: 09/17/2022] [Indexed: 06/16/2023]
Abstract
While the incidence and prevalence of type 2 diabetes is higher among Latino/as, Latino men are disproportionately affected and have poorer outcomes. We aimed to determine whether gender impacted any outcomes in a culturally tailored type 2 diabetes (T2D) intervention and to evaluate the effects of gender and intervention participation intensity on outcomes at 6-month follow-up. Nested path and regression models were compared with the likelihood ratio test and information criteria in a sample of Latino/a adults with T2D (n = 222) participating in a T2D community health worker (CHW)-led intervention. Path analysis showed that the effect of the intervention did not vary by gender. The intervention was associated with significant improvements in knowledge of T2D management 0.24 (0.10); p = 0.014, diabetes distress, -0.26 (0.12); p = 0.023, and self-efficacy, 0.61 (0.21); p = 0.005. At 6-month follow-up, improved self-management was associated with greater self-efficacy and Hemoglobin A1c (HbA1c) was lower by -0.18 (0.08); p = 0.021 for each unit of self-management behavior. Linear regressions showed that class attendance and home visits contributed to positive intervention results, while gender was non-significant. Pathways of change in a CHW-led culturally tailored T2D intervention can have a significant effect on participant behaviors and health status outcomes, regardless of gender.
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Affiliation(s)
- Jaclynn Hawkins
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI 48109, USA
| | - Edith C. Kieffer
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI 48109, USA
| | - Brandy Sinco
- Center for Healthcare Outcomes & Policy, University of Michigan, 2800 Plymouth Road, North Campus Research Complex, Bldg. 16, Ann Arbor, MI 48109, USA
| | - Gretchen Piatt
- Department of Learning Health Sciences, School of Medicine, University of Michigan, 1111 E. Catherine Street, Ann Arbor, MI 48109, USA
| | - Lenette Jones
- School of Nursing, University of Michigan, 400 North Ingalls Building, Ann Arbor, MI 48109, USA
| | - Jamie Mitchell
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI 48109, USA
| | - Nicolaus Espitia
- Department of Sociology, Anthropology, Social Work and Criminal Justice Oakland University, 614 Pioneer Dr, Rochester, MI 48309, USA
| | - Alana LeBron
- School of Public Health, University of California, Irvine, 3151 Social Science Plaza, SST 369 (Chicano/Latino Studies) OR 653 E Peltason Drive, AIRB 2026 (Public Health), Irvine, CA 92697, USA
| | - Katherine A. Kloss
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI 48109, USA
| | - Katie Kurnick
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI 48109, USA
| | - Gloria Palmsiano
- Community Health and Social Services Center, 5635 West Fort Street, Detroit, MI 48209, USA
| | - Michael S. Spencer
- School of Social Work, University of Washington, 4101 15th Avenue NE, Seattle, WA 98105, USA
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Lutala P, Nyasulu P, Muula A. Salient beliefs about modifiable risk behaviours among patients living with diabetes, hypertension or both: A qualitative formative study. Afr J Prim Health Care Fam Med 2022; 14:e1-e12. [PMID: 36226929 PMCID: PMC9558168 DOI: 10.4102/phcfm.v14i1.3327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background Although there is evidence of the key role played by focusing on local knowledge in designing appropriate interventions regarding modifiable risk behaviours among patients living with diabetes and hypertension in Mangochi (and Malawi), little is known about local salient beliefs. Aim With a focus on the theory of planned behaviour as a theoretical lens, this study aimed to identify salient beliefs about modifiable risk behaviours among patients with diabetes, hypertension or both in Mangochi, south-eastern Malawi. Specifically, the objectives were to identify advantages and disadvantages (behavioural salient beliefs), people who approve or disapprove (normative salient beliefs) and enablers and barriers (control salient beliefs) for measures to change modifiable risk behaviours among patients with diabetes, hypertension or both in Mangochi, Malawi. Setting A hypertension diabetes clinic at Mangochi District Hospital, south-eastern Malawi. Methods A formative qualitative study of a quasi-experimental trial was conducted among 25 patients, purposefully sampled, who were living with diabetes, hypertension or both at Mangochi District Hospital in February 2019. Researchers conducted in-depth interviews with patients using an interview guide informed by the theory of planned behaviour’s elicitation interview guide. Thematic content analysis was used to identify emerging themes. Results A total of 25 participants were recruited, of which 12 (48%) were living with diabetes. Five thematic areas emerged from this analysis: physical and psychological fitness, social disconnection, perceived support systems, perceived enablers and perceived barriers to change. Conclusion Appropriate words for each salient belief were identified. Future researchers should use the identified salient beliefs when designing interventions based on the theory of planned behaviour in diabetes and hypertension. Contribution The paper adds to the body of knowledge informing the use of theory of planned behavior in addressing modifiable risk factors among practitioners, specialists and academics in primary care and Family Medicine in the field of noncommunicable diseases in Mangochi Malawi and beyond.
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Affiliation(s)
- Prosper Lutala
- Department of Family Medicine, Faculty of Medicine and Oral Health, Kamuzu University of Health Sciences, Blantyre; and NCD-BRITE Consortium, Faculty of Public and Global Health, Kamuzu University of Health Sciences, Blantyre.
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Fields B, Makaroun L, Rodriguez KL, Robinson C, Forman J, Rosland AM. Caregiver role development in chronic disease: A qualitative study of informal caregiving for veterans with diabetes. Chronic Illn 2022; 18:193-205. [PMID: 35253472 DOI: 10.1177/1742395320949633] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Support for chronic conditions such as diabetes from friends and family positively influences health management and outcomes, but limited data exist on how and why caregivers assume specific support roles for otherwise independent aging adults. We conducted a qualitative study to examine the nature of caregivers' roles in supporting Veterans' management of a chronic condition and caregivers' reasons for assuming those roles, using Type 2 diabetes as an example. METHODS Thirty-two interviews were conducted with Veterans with Type 2 diabetes (n = 20) and their caregivers (n = 12). Two coders independently analyzed interview transcripts using a thematic analysis approach. RESULTS Three central roles of caregivers in diabetes management were described: direct care support, memory support/care organizer, and advocate. Three explanations for assuming caregiving roles emerged: changes in patient health, natural evolution of family roles, and caregivers' health care experience or training. DISCUSSION Understanding what roles caregivers fill and why is critical to designing services to support caregivers in helping improve chronic health condition management for aging adults.
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Affiliation(s)
- Beth Fields
- VA Pittsburgh Healthcare System and University of Wisconsin-Madison, Madison, USA
| | - Lena Makaroun
- VA Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, USA
| | - Keri L Rodriguez
- VA Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, USA
| | | | - Jane Forman
- VA Ann Arbor Healthcare System, Ann Arbor, USA
| | - Ann-Marie Rosland
- VA Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, USA
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22
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The effect of family caregiver empowerment interventions on family caregiver capabilities in self-management of type 2 diabetes mellitus in Indonesia. ENFERMERIA CLINICA 2022. [DOI: 10.1016/j.enfcli.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Suglo JN, Winkley K, Sturt J. Prevention and Management of Diabetes-Related Foot Ulcers through Informal Caregiver Involvement: A Systematic Review. J Diabetes Res 2022; 2022:9007813. [PMID: 35462785 PMCID: PMC9021995 DOI: 10.1155/2022/9007813] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 02/28/2022] [Accepted: 03/22/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The literature remains unclear whether involving informal caregivers in diabetes self-care could lead to improved diabetic foot outcomes for persons at risk and/or with foot ulcer. In this review, we synthesized evidence of the impact of interventions involving informal caregivers in the prevention and/or management of diabetes-related foot ulcers. METHODS A systematic review based on PRISMA, and Synthesis Without Meta-analysis (SWiM) guidelines was conducted. MEDLINE (Ovid), Embase (Ovid), PsycINFO, CINAHL, and Cochrane Central Register of Controlled Trial of the Cochrane Library databases were searched from inception to February 2021. The following MESH terms were used: diabetic foot, foot ulcer, foot disease, diabetes mellitus, caregiver, family caregiver ,and family. Experimental studies involving persons with diabetes, with or at risk of foot ulcers and their caregivers were included. Data were extracted from included studies and narrative synthesis of findings undertaken. RESULTS Following the search of databases, 9275 articles were screened and 10 met the inclusion criteria. Studies were RCTs (n = 5), non-RCTs (n = 1), and prepoststudies (n = 4). Informal caregivers through the intervention programmes were engaged in diverse roles that resulted in improved foot ulcer prevention and/or management outcomes such as improved foot care behaviors, increased diabetes knowledge, decreased HbA1c (mmol/mol or %), improved wound healing, and decreased limb amputations rates. Engaging both caregivers and the person with diabetes in education and hands-on skills training on wound care and foot checks were distinctive characteristics of interventions that consistently produced improved foot self-care behavior and clinically significant improvement in wound healing. CONCLUSION Informal caregivers play diverse and significant roles that seem to strengthen interventions and resulted in improved diabetes-related foot ulcer prevention and/or management outcomes. However, there are multiple intervention types and delivery strategies, and these may need to be considered by researchers and practitioners when planning programs for diabetes-related foot ulcers.
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Affiliation(s)
- Joseph Ngmenesegre Suglo
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings College London, UK
- Department of Nursing, Presbyterian University College Ghana, Ghana
| | - Kirsty Winkley
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings College London, UK
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings College London, UK
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Lamson AL, Hodgson JL, Pratt KJ, Mendenhall TJ, Wong AG, Sesemann EM, Brown BJ, Taylor ES, Williams-Reade JM, Blocker DJ, Harsh Caspari J, Zubatsky M, Martin MP. Couple and family interventions for high mortality health conditions: A strategic review (2010-2019). JOURNAL OF MARITAL AND FAMILY THERAPY 2022; 48:307-345. [PMID: 34741539 DOI: 10.1111/jmft.12564] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/12/2021] [Indexed: 06/13/2023]
Abstract
The earliest publications in the field of marriage and family therapy introduced interventions conducted with families experiencing complex health conditions. This strategic review captures an evaluation of efficacy for 87 couple and family interventions published between 2010 and 2019 with a focus on the leading causes of mortality in the United States. These health conditions include chromosomal anomalies and accidents with infants aged 0-4 years; accidents and cancer among children aged 5-14; accidents among adolescents aged 15-24; and heart disease, cancer, accidents, chronic lower respiratory diseases, stroke, Alzheimer's disease, diabetes, influenza/pneumonia, and nephritis/nephrosis among adults 25 and older. Results support the need for greater inclusion of couples and families in assessments and interventions. The greatest chasm in efficacy research was with minoritized couples and families. Implications include ways to initiate couple and family interventions in the context of health conditions with attention given to accessibility, recruitment, retention, and evaluation.
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Affiliation(s)
- Angela L Lamson
- Department of Human Development & Family Science, College of Health and Human Performance, Greenville, North Carolina, USA
| | - Jennifer L Hodgson
- Department of Human Development & Family Science, College of Health and Human Performance, Greenville, North Carolina, USA
| | - Keeley J Pratt
- Department of Human Services, Human Development and Family Science Program, Couple and Family Therapy Specialization, College of Education & Human Ecology, Columbus, Ohio, USA
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Tai J Mendenhall
- Department of Family Social Science, University of Minnesota, Saint Paul, Minnesota, USA
| | - Alison G Wong
- Department of Marriage and Family Therapy, Fuller School of Psychology and Marriage and Family Therapy, Pasadena, California, USA
| | | | - Braden J Brown
- Department of Family Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Athletics Department, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Erika S Taylor
- Department of Family Medicine, Behavioral Medicine Section, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | | | - Daniel J Blocker
- Pomona Valley Family Medicine Residency, Pomona Valley Hospital Medical Center, Pomona, California, USA
| | - Jennifer Harsh Caspari
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Max Zubatsky
- Department of Family and Community Medicine, Saint Louis University, St. Louis, Missouri, USA
| | - Matthew P Martin
- Doctor of Behavioral Health Program, College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
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Adi Pamungkas R, Chamroonsawasdi K, Usman AM. Unmet basic needs and family functions gaps in diabetes management practice among Indonesian communities with uncontrolled type 2 diabetes: A qualitative study. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2021; 16:23-35. [PMID: 34938390 PMCID: PMC8680942 DOI: 10.51866/oa1123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Family members play a vital role in both helping and undermining diabetes mellitus selfmanagement practices. This qualitative study aimed to explore the potentially unmet needs of family function to support diabetes self-management (DSM) practices. In-depth interviews and focus group discussions (FGDs) were conducted among different key informants, including uncontrolled T2DM patients, caretakers and healthcare providers (HCPs) at community health centres. An open-ended approach was applied to elicit responses from the key informants. A total of 22 participants were involved in this study. All interview and FGD processes were audiorecorded and transcribed verbatim. The results found that all key informants addressed six core themes, with sub-themes to describe the unmet needs of family function to support DSM practice. The critical unmet needs of family function include: 1) Lack of problem-solving skills to deal with poor diabetes management; 2) Ineffective communication and refusal to share the burden of diabetes management; 3) Lack of affective responsiveness to encourage patients' compliance; 4) Lack of affective involvement in DSM; 5) Insufficient family roles in supporting patients; 6) Poor behaviour control of T2DM. Our findings provide insights into how family function may influence the adoption and maintenance of healthy behaviours among diabetic patients. Since health providers seek new approaches to improve DSM practices, this valuable finding was essential to understand how family function can improve and empower patients in DSM practice.
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Affiliation(s)
- Rian Adi Pamungkas
- Dr.P.H., Ns, Department of Nursing, Faculty of Health Sciences, Esa Unggul University, Jakarta, Indonesia,
| | - Kanittha Chamroonsawasdi
- Ph.D., RN, Department of Family Health, Faculty of Public Health, Mahidol University Bangkok, Thailand,
| | - Andi Mayasari Usman
- M.Kep., Ns, Department of Nursing, Faculty of Health Science, Nasional University Jakarta, Indonesia
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Vieira ER, Cavalcanti FADC, Civitella F, Hollifield M, Caceres S, Carreno J, Gaillard T, Huffman FG, Mora JC, Queiroga MR. Effects of Exercise and Diet on Body Composition and Physical Function in Older Hispanics with Type 2 Diabetes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158019. [PMID: 34360312 PMCID: PMC8345658 DOI: 10.3390/ijerph18158019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/25/2021] [Accepted: 07/27/2021] [Indexed: 12/20/2022]
Abstract
Type 2 Diabetes mellitus (DM2) affects 9.3% of the U.S. population. Health disparities are evident in DM2; twice as many Hispanics as non-Hispanic Whites have DM2. The objective of this study was to pilot test the feasibility of implementing and evaluating trends of nutrition and exercise interventions to improve diabetes management and physical function in 29 disadvantaged older Hispanics with DM2. We delivered combined diet and exercise (n = 8) and diet-only (n = 6) interventions and compared the results to a control/no intervention group (n = 15). We cluster-randomized the participants into the three arms based on the senior center they attended. The interventions were delivered twice a week for 3 months (24 sessions) and assessments were conducted pre and post intervention. The results indicate the feasibility of implementing the interventions and slight improvements in both intervention groups compared to the control group. The diet-only group tended to have larger improvements on body composition measures (especially in muscle mass), while the diet + exercise group tended to have larger improvements on physical function (especially in chair stands). There was a high rate of attrition, especially in the diet + exercise group, but those who completed the intervention tended to have improvements in body composition and physical function.
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Affiliation(s)
- Edgar Ramos Vieira
- Department of Physical Therapy, Florida International University, Miami, FL 33179, USA; (F.C.); (S.C.); (J.C.)
- Correspondence:
| | | | - Fernanda Civitella
- Department of Physical Therapy, Florida International University, Miami, FL 33179, USA; (F.C.); (S.C.); (J.C.)
| | - Monica Hollifield
- Department of Dietetics and Nutrition, Florida International University, Miami, FL 33179, USA; (M.H.); (F.G.H.)
| | - Stephanie Caceres
- Department of Physical Therapy, Florida International University, Miami, FL 33179, USA; (F.C.); (S.C.); (J.C.)
| | - Jorge Carreno
- Department of Physical Therapy, Florida International University, Miami, FL 33179, USA; (F.C.); (S.C.); (J.C.)
| | - Trudy Gaillard
- Department of Undergraduate Nursing, Florida International University, Miami, FL 33179, USA;
| | - Fatma G. Huffman
- Department of Dietetics and Nutrition, Florida International University, Miami, FL 33179, USA; (M.H.); (F.G.H.)
| | - Jorge Camilo Mora
- Department of Humanities, Health and Society, Florida International University, Miami, FL 33179, USA;
| | - Marcos Roberto Queiroga
- Department of Physical Education, Midwestern Parana State University, Guarapuava 85040-167, PR, Brazil;
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Taumoepeau J, Knight-Agarwal CR, Tu'i 'EAP, Jani R, Osuagwu UL, Simmons D. Living with type 2 diabetes mellitus in the Kingdom of Tonga: a qualitative investigation of the barriers and enablers to lifestyle management. BMC Public Health 2021; 21:1307. [PMID: 34217248 PMCID: PMC8254930 DOI: 10.1186/s12889-021-11391-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the increasing prevalence of Type 2 Diabetes Mellitus (T2DM) in the Kingdom of Tonga, little is known of non-communicable disease experiences among adults living in this location. This investigation aimed to explore the barriers and enablers to healthy lifestyle in a group of men and women living with T2DM residing in this Pacific Island nation. METHODS This qualitative study consisted of three semi-structured focus groups (n = 16), conducted at the only Tongan Public Hospital located at Nuku'alofa, capital of Tonga (north coast of the island of Tongatapu). Discussions were audio-recorded, transcribed, cross-checked for consistency, and entered into a word processing document for analysis. Thematic analysis was employed to synthesise results. RESULTS Four main themes were identified: (1) Knowledge and Support; (2) Fear and Motivation; 3) Physical and Psychological Environment; and (4) Faith and Culture. CONCLUSIONS The qualitative findings from this study will assist the future development and information dissemination of culturally appropriate lifestyle-related for men and women living with T2DM in the Kingdom of Tonga. The need for collaboration between practitioners at the hospital, the church, family members, and local traditional healers is important if the lifestyle-related needs and wants of this group of people are to be met.
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Affiliation(s)
| | | | | | - Rati Jani
- School of Clinical Sciences, Faculty of Health, University of Canberra, Canberra, Australia
| | - Uchechukwu Levi Osuagwu
- Diabetes, Obesity and Metabolism Translational Research Unit (DOMTRU), School of Medicine, University of Western Sydney, Campbelltown, Australia
| | - David Simmons
- Diabetes, Obesity and Metabolism Translational Research Unit (DOMTRU), School of Medicine, University of Western Sydney, Campbelltown, Australia
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Rouch SA, Fields BE, Alibrahim HA, Rodakowski J, Leland NE. Evidence for the Effectiveness of Interventions for Caregivers of People With Chronic Conditions: A Systematic Review. Am J Occup Ther 2021; 75:12528. [PMID: 34780615 DOI: 10.5014/ajot.2021.042838] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Caregivers are pivotal in supporting the growing population of people with chronic conditions. Yet, engaging in the caregiver role involves the risk of poor outcomes. Caregiver interventions are needed that address poor outcomes while fostering engagement in role-related activities. OBJECTIVE To evaluate the evidence for interventions to support caregivers of adults with chronic conditions. DATA SOURCES Five databases were searched for studies of interventions for caregivers and patient-caregiver dyads published between 1995 and 2019. Study Selection and Data Collection: We reviewed the titles, abstracts, and full-text articles of the initial search results (N = 12,216 studies) according to a predetermined protocol. FINDINGS Forty-eight studies met the inclusion criteria. Psychoeducation and education with skills training were the two caregiver intervention themes. Studies evaluating psychoeducation (n = 28) provided low strength of evidence for improved psychosocial outcomes. Within this theme, problem-solving and coping skills training were common intervention components associated with significant improvements in depression and quality of life. Studies evaluating education with skills training (n = 20) provided moderate strength of evidence for improved knowledge and low strength of evidence for improved psychosocial outcomes. Dyadic self-management education and hands-on training were common components associated with significant improvements in knowledge, quality of life, and burden or strain. CONCLUSIONS AND RELEVANCE We found low strength of evidence to support the use of psychoeducation and education with skills training. Within these approaches, problem-solving and coping skills training, dyadic self-management education, and hands-on training show promise for improving caregiver outcomes. What This Article Adds: Findings of this systematic review are inconclusive with respect to psychoeducation and education with skills training leading to improved caregiver well-being. Within these broad approaches, the findings support the use of problem-solving and coping skills training, dyadic self-management education, and hands-on training to improve knowledge and well-being among caregivers of people with chronic conditions.
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Affiliation(s)
- Stephanie A Rouch
- Stephanie A. Rouch, MOT, OTR/L, is Graduate Student Researcher, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA;
| | - Beth E Fields
- Beth E. Fields, PhD, OTR/L, is Assistant Professor, Department of Kinesiology, University of Wisconsin-Madison
| | - Hussain A Alibrahim
- Hussain A. Alibrahim, MsOT, OTR/L, is Occupational Therapist, Saudi Ministry of Higher Education, Riyadh, Saudi Arabia
| | - Juleen Rodakowski
- Juleen Rodakowski, OTD, MS, OTR/L, is Assistant Professor, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Natalie E Leland
- Natalie E. Leland, PhD, OTR/L, BCG, FAOTA, FGSA, is Associate Professor and Vice Chair for Research, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA
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Hu J, Mion LC, Tan A, Du Y, Chang MW, Miller C, Joseph JJ. Perceptions of African American Adults With Type 2 Diabetes on Family Support: Type, Quality, and Recommendations. Sci Diabetes Self Manag Care 2021; 47:302-311. [PMID: 34075831 DOI: 10.1177/26350106211018994] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE The overall purpose of the study was to explore perceptions of family support in diabetes self-management among African American adults with type 2 diabetes. METHODS A qualitative study using focus group methodology and individual interviews was conducted. Thirty-seven African American adults with type 2 diabetes were recruited in the Midwest, United States. Data were analyzed using qualitative content analysis. RESULTS Themes emerged from the perspectives of the social interdependence theory. Positive family support included emotional support, instrumental support, and specific information or advice on diabetes management strategies. Positivity, family communication, and healthy eating/meal planning were perceived as helpful family behaviors. Negative support was perceived as intentional or unintentional behaviors. Family members' help in decision-making included goal setting with family member(s) and help in making decisions on diet and exercise. Recommendations included exercise and nutritional programs, support groups, family involvement, and materials and resources. Motivations for attending diabetes programs included involving family members, sharing success stories, seeing positive results, encouraging and caring, and providing incentives. CONCLUSIONS Intervention programs for African Americans should specifically target challenges in family support, healthy eating, and physical activity at an interpersonal level. Health care providers should assess family roles and family support to facilitate diabetes self-management for African Americans.
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Affiliation(s)
- Jie Hu
- The Ohio State University, College of Nursing, Columbus, Ohio
| | - Lorraine C Mion
- The Ohio State University, College of Nursing, Columbus, Ohio
| | - Alai Tan
- The Ohio State University, College of Nursing, Columbus, Ohio
| | - Yang Du
- The Ohio State University, College of Nursing, Columbus, Ohio
| | - Mei-Wei Chang
- The Ohio State University, College of Nursing, Columbus, Ohio
| | - Carla Miller
- The Ohio State University, Department of Human Sciences, Human Nutrition, Ohio
| | - Joshua J Joseph
- The Ohio State University, College of Medicine, Columbus, OH
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Heidari T, Mousavi SM, Mousavinasab SN, AzimiLolaty H. Effect of Family and Patient Centered Empowerment Program on Depression, Anxiety and Stress in Patients with Obsessive-Compulsive Disorder and Their Caregivers' Burden. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2021; 25:482-489. [PMID: 33747837 PMCID: PMC7968591 DOI: 10.4103/ijnmr.ijnmr_161_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 08/18/2019] [Accepted: 06/27/2020] [Indexed: 12/04/2022]
Abstract
Background: Considering the importance of family participation in patients' treatment and the positive effects of simultaneous patient and family education, this study was conducted to determine the effect of a family and patient-oriented empowerment program on depression, anxiety, and stress in patients with Obsessive-Compulsive Disorder (OCD) and their caregivers' burden. Materials and Methods: This quasi-experimental study was conducted on 50 OCD patients along with their primary caregivers. The intervention group participated in eight sessions of training, each lasting from 60 to 90 min (twice a week), and the control group received the usual treatment. The Depression, Anxiety and Stress Scale, Maudsley's Obsessive-Compulsive Inventory, Goldberg's General Health Questionnaire, and Zarit's Burden Inventory were used to collect the data before, immediately after and 1 month after the intervention, and then the gathered data were analyzed with t-test and analysis of variance using the Statistical Package for the Social Sciences software, version 21. Results: The changes in the mean scores of depression (F2,48= 21.02, p < 0.001), anxiety (F2,48= 29.72, p < 0.001), and stress (F2,48= 16.52, p < 0.001) of the patients in the intervention group showed significant decrease over time; however, in the control group, there was no significant decrease in the mean scores of depression (F2,48= 1.69, p = 0.19), anxiety (F2,48= 0.47, p = 0.62), and stress (F2,48= 1.09, p = 0.34) over time. The changes in the caregiver's burden score in both groups indicated a significant decrease over time in the intervention group (F2,48= 24.70, p < 0.001) and the control group (F2,48= 33. 30, p < 0.001). Conclusions: The findings of this study revealed that concurrently training the patients and caregivers could reduce the negative emotions of the patients and their caregivers' burden.
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Affiliation(s)
- Tahereh Heidari
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | | | | | - Hamideh AzimiLolaty
- Associate Professor, Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Department of Psychiatric Nursing, Mazandaran University of Medical Sciences, Sari, Iran
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Hu X, Zhang Y, Lin S, Guo X, Yang D, Cai M, Gao L. Dietary Knowledge, Attitude and Practice (KAP) Among the Family Members of Patients with Type 2 Diabetes Mellitus (T2DM) and Its Influence on the KAP of T2DM Patients. Diabetes Metab Syndr Obes 2021; 14:205-213. [PMID: 33488108 PMCID: PMC7815068 DOI: 10.2147/dmso.s290639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 12/30/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To investigate the dietary knowledge, attitude and practice (KAP) among the family members (FMs) of Chinese type 2 diabetes mellitus (T2DM) patients and its influence on the KAP of T2DM patients. PATIENTS AND METHODS Two hundred thirty-six pairs of hospitalized T2DM patients and their FMs (472 in total) in our hospital were enrolled. A pair of self-designed questionnaires on dietary KAP (Cronbach's α ≥ 0.763, I-CVI ≥ 0.857, S-CVI = 0.964, 0.958) were used to collect data and assess the KAP towards diabetes diets. RESULTS The mean score for dietary KAP of T2DM patients was 2.33 ± 0.60, 3.03 ± 0.44 and 2.77 ± 0.38, whereas that of their FMs was 2.37 ± 0.55, 3.08 ± 0.48 and 2.82 ± 0.61, respectively. Pearson's correlation analysis showed that the glycosylated hemoglobin (HbA1c) of T2DM patients was negatively correlated to their dietary practice (r = -0.218, P < 0.01). There was a positive correlation between T2DM patients and their FMs for dietary KAP (r = 0.306, P < 0.05). The dietary practice of T2DM patients was positively correlated with the dietary KAP of their FMs (r = 0.305, 0.252 and 0.136, respectively, P < 0.01). Logistic regression analysis revealed that the score for dietary knowledge and attitude, occupation, residence, family history, complications of the T2DM patient, and the sex and dietary knowledge score of the FM were significantly associated with dietary practice for T2DM patients. CONCLUSION The dietary attitude of FMs was moderate but dietary knowledge and practice were poor. Dietary KAP was positively correlated with T2DM patients and their FMs.
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Affiliation(s)
- Xiling Hu
- Department of Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Yao Zhang
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Shuo Lin
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Xiaodi Guo
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Dan Yang
- School of Nursing, Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Mengyin Cai
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of China
- Correspondence: Mengyin Cai Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, Guangdong510630, People’s Republic of ChinaTel +86 13922131451 Email
| | - Lingling Gao
- School of Nursing, Sun Yat-Sen University, Guangzhou, People’s Republic of China
- Lingling Gao School of Nursing, Sun Yat-Sen University, No. 74, Zhongshan Er Road, Guangzhou, Guangdong510085, People’s Republic of ChinaTel +86 13539965693 Email
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Ligita T, Harvey N, Wicking K, Francis K, Nurjannah I. Diabetes self-management: what role does the family play? HEALTH EDUCATION 2020. [DOI: 10.1108/he-12-2019-0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThis paper aims to explicate one of the major findings of a research study seeking to understand how Indonesian people with diabetes learn about their disease. The one key finding discussed in this paper is how families influence the learning and self-management processes adopted by Indonesian people with diabetes.Design/methodology/approachA grounded theory methodology was adopted to investigate how Indonesian people with diabetes learn about their disease. Twenty-eight semi-structured interviews were undertaken with Indonesian people living with diabetes, families of people living with diabetes, healthcare professionals and other healthcare providers. Data was analysed by using constant comparative analysis during three coding stages.FindingsThe study explicated the basic social process of how people with diabetes in Indonesia learn about their disease through a generated theory “Learning, choosing, and acting: self-management of diabetes in Indonesia”. This study found family engagement was integral to Indonesian people living with diabetes who were self-managing their disease. Families assisted with seeking information, providing recommendations, selecting and implementing actions, appraising implemented actions, and informing others about their experiences. By acknowledging that family is involved in this process, the healthcare professional can adequately provide health education to both the person with diabetes and their families. Involving families in health education is crucial as family can influence decision making made by people with diabetes in a proper or improper way. Thus, clinicians need to also skilfully recognise difficulties these people encounter by monitoring their self-management progress and by working closely with them and their family members.Originality/valueThis is the first study conducted in Indonesia that specifically investigates the process of how people with diabetes learn about their disease. The involvement of families in this process is a central finding of the study. Families can enhance the overall health and well-being of the person with diabetes, aid in early recognition of aberration to health status and trigger the initiation of interventions to re-establish homeostasis if they are actively engaged and supported by health professionals.
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Rondhianto R, Nursalam N, Kusnanto K, Melaniani S, Ahsan A. Analysis of the Sociodemographic and Psychological Factors of the Family Caregivers’ Self-Management Capabilities for Type 2 Diabetes Mellitus. JURNAL NERS 2020. [DOI: 10.20473/jn.v14i2.16592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: The successful management of Type 2 diabetes mellitus is determined by the role of the family in self-management as a family caregiver. Many factors influence the capability of the family caregivers to carry out diabetes self-management. The purpose of this study was to analyze the factors that influence the family caregiver capability of performing diabetes self-management in people with Type 2 diabetes mellitus.Methods: The study design was an analytical observation using a cross-sectional approach. The sample was 220 family caregivers of people with Type 2 diabetes mellitus in Jember Regency, East Java Province, Indonesia. The multistage random sampling technique was used as the sampling technique. The research instrument was a questionnaire. The questionnaires used in this study were the Diabetes Management Self Efficacy Scale, the Spoken Knowledge in Low Literacy Patients with Diabetes Questionnaire, the Motives for Caregiving Scale, the Spirituality Index of Well-Being, the Sense of Coherence Scale, the Coping Scale, the Hensarling Diabetes Family Support Scale, and the Family Caregiver's Perception of the Role of the Nurse Questionnaire. The data analysis was performed using the Pearson correlation test, the Spearman rank test, and the multiple linear regression test.Results: The results of the Pearson correlation test and Spearman rank test showed that the sociodemographic factors associated with diabetes self management were age (p=0.000), gender (p=0.016), education (p=0.000), income (p=0.000), and kinship (p=0.000). The psychosocial factors associated with diabetes self management were diabetes knowledge (p=0.000), motivation (p=0.000), coping skills (p=0.000), spirituality (p=0.000), family coherence (p=0.000), family support (p=0.000) and the role of the nurses (p=0.000). The multiple linear regression test showed that the factors associated with diabetes self management were diabetes knowledge (β=0.047), motivation (β=0.094), coping (β=0.188), spirituality (β= -0.082), family coherence (β= −0.043), family support (β= 0.296) and the role of the nurses (β= 0.512).Conclusion: Efforts to increase the family caregiver’s capabilities in terms of diabetes self-management should pay attention to the socio-demographic and psychosocial factors to prevent complications and to improve the health status, and quality of life of people with Type 2 diabetes mellitus.
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Flores-Luevano S, Pacheco M, Shokar GS, Dwivedi AK, Shokar NK. Impact of a Culturally Tailored Diabetes Education and Empowerment Program in a Mexican American Population Along the US/Mexico Border: A Pragmatic Study. J Clin Med Res 2020; 12:517-529. [PMID: 32849940 PMCID: PMC7430876 DOI: 10.14740/jocmr4273] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 07/07/2020] [Indexed: 01/30/2023] Open
Abstract
Background The study purpose was to deliver a diabetes education program under real world conditions and evaluate its effect on diabetes-related clinical, self-management and psychosocial outcomes among Mexican Americans residing along the US/Mexico border. Methods A pragmatic study was conducted among adult patients with diabetes in three primary care clinics located along the US/Mexico border. A bilingual culturally tailored diabetes education program incorporating hands-on participatory techniques was delivered in 4 - 8 weekly group sessions. Clinical, self-management and psychosocial outcomes were evaluated pre- and post-intervention with surveys and medical record review. Results A total of 209 participants were enrolled; mean age was 58.9 years (range 23 - 94, standard deviation: 11.2); 68.4% were female; 91.1% were Hispanic. Significant improvements were observed in glycated hemoglobin (-1.1%, P < 0.001, n = 79), total cholesterol (-17.2 mg/dL, P = 0.041, n = 63), glucose self-monitoring (+1.3 times a week, P = 0.021, n = 115), exercise less than once a week (-18.2%, P < 0.001, n = 129), nutritional behavior (+2.23, P < 0.001, n = 115), knowledge (+1. 83, P < 0.001, n = 141) and diabetes-related emotional distress (-7.32, P = 0.002, n = 111). Benefits were observed with attendance rates as low as 50%. Conclusion A clinic-based culturally competent diabetes education/self-management program resulted in significant improvements in outcomes among Hispanic participants. Experimentally tested culturally appropriate interventions adapted for real world situations can benefit Mexican American diabetic patients even when attendance is imperfect.
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Affiliation(s)
- Silvia Flores-Luevano
- Department of Molecular and Translational Medicine and Family and Community Medicine, Texas Tech University Health Sciences Center, El Paso, TX 79924, USA
| | - Maricela Pacheco
- Christus Health TX A&M College of Medicine Spohn Hospital, Family Medicine Residency, 600 Elizabeth Street, Corpus Christi, TX 78404, USA
| | - Gurjeet S Shokar
- Department of Family and Community Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX 79924, USA
| | - Alok Kumar Dwivedi
- Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Biostatistics and Epidemiology Consulting Lab (BECL), Texas Tech University Health Sciences Center El Paso (TTUHSC EP), El Paso, TX 79905, USA
| | - Navkiran K Shokar
- Family & Community Medicine & Department of Molecular and Translational Medicine, Center of Emphasis for Cancer, El Paso, TX 79924, USA
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Silva-Tinoco R, Cuatecontzi-Xochitiotzi T, De la Torre-Saldaña V, León-García E, Serna-Alvarado J, Orea-Tejeda A, Castillo-Martínez L, Gay JG, Cantú-de-León D, Prada D. Influence of social determinants, diabetes knowledge, health behaviors, and glycemic control in type 2 diabetes: an analysis from real-world evidence. BMC Endocr Disord 2020; 20:130. [PMID: 32843004 PMCID: PMC7449009 DOI: 10.1186/s12902-020-00604-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 07/30/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Although important achievements have been done in type 2 diabetes mellitus (T2D) treatment and glycemic control, new strategies may take advantage of non-pharmacological approaches and of other potential determinants of health (e.g., socioeconomic status, education, diabetes knowledge, physical activity, and self-care behavior). However, the relationships between these factors are not totally clear and have not been studied in the context of large urban settings. This study aimed to explore the relationship between these determinants of glycemic control (GC) in a low-income urban population from Mexico City, focused in exploring potential the mediation of self-care behaviors in the association between diabetes knowledge and GC. METHODS A multicenter cross-sectional study was conducted in patients with type 2 diabetes (T2D) from 28 primary care outpatient centers located in Mexico City. Using multivariable-adjusted models, we determined the associations between diabetes knowledge, self-care behaviors, and GC. The mediation analyses to determine the pathways on glycemic control were done using linear regression models, where the significance of indirect effects was calculated with bootstrapping. RESULTS The population (N = 513) had a mean age of 53.8 years (standard deviation: 11.3 yrs.), and 65.9% were women. Both socioeconomic status and level of education were directly associated with diabetes knowledge. Using multivariable-adjusted linear models, we found that diabetes knowledge was associated with GC (β: -0.102, 95% Confidence Interval [95% CI] -0.189, - 0.014). Diabetes knowledge was also independently associated with self-care behavior (for physical activity: β: 0.181, 95% CI 0.088, 0.273), and self-care behavior was associated with GC (for physical activity: β: -0.112, 95% CI -0.194, - 0.029). The association between diabetes knowledge and GC was not observed after adjustment for self-care behaviors, especially physical activity (β: -0.084, 95% CI -0.182, 0.014, p-value: 0.062). Finally, the mediation models showed that the effect of diabetes knowledge on GC was 17% independently mediated by physical activity (p-value: 0.049). CONCLUSIONS Socioeconomic and educational gradients influence diabetes knowledge among primary care patients with type 2 diabetes. Self-care activities, particularly physical activity, mediated the effect of diabetes knowledge on GC. Our results indicate that diabetes knowledge should be reinforced in low-income T2D patients, with an emphasis on the benefits physical activity has on improving GC.
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Affiliation(s)
- Rubén Silva-Tinoco
- Clínica Especializada en el Manejo de la Diabetes en la Ciudad de México, Servicios de Salud Pública de la Ciudad de México, Alfonso Toro s/n, Col. Escuadrón 201, Iztapalapa, 09060, Mexico City, Mexico.
| | - Teresa Cuatecontzi-Xochitiotzi
- Clínica Especializada en el Manejo de la Diabetes en la Ciudad de México, Servicios de Salud Pública de la Ciudad de México, Alfonso Toro s/n, Col. Escuadrón 201, Iztapalapa, 09060, Mexico City, Mexico
| | - Viridiana De la Torre-Saldaña
- Clínica Especializada en el Manejo de la Diabetes en la Ciudad de México, Servicios de Salud Pública de la Ciudad de México, Alfonso Toro s/n, Col. Escuadrón 201, Iztapalapa, 09060, Mexico City, Mexico
| | - Enrique León-García
- Servicios de Salud Pública del Gobierno de la Ciudad de México, Mexico City, Mexico
| | | | - Arturo Orea-Tejeda
- Heart Failure and Respiratory Distress Clinic at Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico
| | - Lilia Castillo-Martínez
- Departamento de Nutriología Clínica, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Juan G Gay
- Tecnología e Información para la Salud, TIS, Mexico City, Mexico
| | - David Cantú-de-León
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología - Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Diddier Prada
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología - Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
- Support and Research Promotion Program (AFINES), Faculty of Medicine, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
- Department of Biomedical Informatics, Faculty of Medicine, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
- Department of Environmental Health Science, Mailman School of Public Health, Columbia University, New York City, USA
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Subrata SA. Implementation of spiritual care in patients with diabetic foot ulcers: a literature review. ACTA ACUST UNITED AC 2020; 29:S24-S32. [PMID: 32790549 DOI: 10.12968/bjon.2020.29.15.s24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Lower extremity amputation is a complication of diabetic foot ulcers that can cause spiritual crisis. Integrating spiritual care into nursing practice is important to overcome this. However, studies articulating the role of nurses in spiritual care when caring for patients with diabetic foot ulcers is limited. This article aims to describe the importance of providing spiritual care for this group of patients. The interpretation of spiritual care with respect to the relationship between the patient and the family, and the role of the nurse are discussed. The findings offer a theoretical perspective on spiritual care that can be used to develop spiritual interventions, as well as prevent spiritual crises in patients with diabetic foot ulcers.
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Affiliation(s)
- Sumarno Adi Subrata
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand, Nursing Lecturer at the Department of Nursing and Wound Research Centre, Faculty of Health Sciences, Universitas Muhammadiyah Magelang, Indonesia
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Singh PN, Steinbach J, Nelson A, Shih W, D’Avila M, Castilla S, Jordan M, McCarthy WJ, Hayes-Bautista D, Flores H. Incorporating an Increase in Plant-Based Food Choices into a Model of Culturally Responsive Care for Hispanic/Latino Children and Adults Who Are Overweight/Obese. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134849. [PMID: 32640565 PMCID: PMC7370208 DOI: 10.3390/ijerph17134849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 11/17/2022]
Abstract
Introduction: The national rate of obesity in US Hispanic/Latinos exceeds all other major ethnic subgroups and represents an important health disparity. Plant-based diet interventions that emphasize whole plant foods with minimal processing and less refined grains and sugar have shown great promise in control of obesity, but there is a paucity of data translating this treatment effect to disparate populations. The objective of our study was to evaluate the efficacy of the Healthy Eating Lifestyle Program (HELP) for accomplishing weight management in a hospital-based, family centered, culturally tailored, plant-based diet intervention for Hispanic/Latino children who were overweight or obese. Methods: Our mixed methods evaluation included: (1) A one arm study to measure changes in body mass index (BMI) from pre- to post-intervention, and (2) A stakeholder analysis of the program staff. Results: For children ages 5–12 years who were overweight/obese, we found no evidence of excess weight gain evidenced by BMI Z scores (Zpost-pre = −0.02, p = 0.11). Among the parent/guardians who were overweight or obese, we found a decrease in BMI that was stronger in men (BMI post-pre = −0.75 kg/m2, p = 0.01) than in women (BMI post-pre = −0.12 kg/m2, p = 0.30). A program strength was the cultural tailoring of the plant-based diet choices. Conclusions: The evaluation raises the possibility that incorporating intervention components of HELP (plant-based food choices, family-based, cultural tailoring) into pediatric weight management can improve the standard of care.
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Affiliation(s)
- Pramil N. Singh
- Center for Health Research, Loma Linda University, Loma Linda, CA 92350, USA;
- School of Public Health, Loma Linda University, Loma Linda, CA 92350, USA; (A.N.); (W.S.)
- Correspondence: ; Tel.: +1-(909)-651-5732; Fax: +1-(909)-558-0306
| | - Jessica Steinbach
- Center for Health Research, Loma Linda University, Loma Linda, CA 92350, USA;
- School of Public Health, Loma Linda University, Loma Linda, CA 92350, USA; (A.N.); (W.S.)
| | - Anna Nelson
- School of Public Health, Loma Linda University, Loma Linda, CA 92350, USA; (A.N.); (W.S.)
| | - Wendy Shih
- School of Public Health, Loma Linda University, Loma Linda, CA 92350, USA; (A.N.); (W.S.)
| | - Mary D’Avila
- Diabetes Education Center, Adventist Health White Memorial Medical Center, Los Angeles, CA 90033, USA; (M.D.); (S.C.)
| | - Selene Castilla
- Diabetes Education Center, Adventist Health White Memorial Medical Center, Los Angeles, CA 90033, USA; (M.D.); (S.C.)
| | - Michael Jordan
- Research and Center for Hispanic Health, Adventist Health White Memorial Medical Center, Los Angeles, CA 90033, USA;
| | - William J. McCarthy
- Department of Health Policy and Management, School of Public Health, UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA 90095, USA;
| | - David Hayes-Bautista
- Center for Study of Latino Health and Culture, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA;
| | - Hector Flores
- Department of Family Medicine, Adventist Health White Memorial Medical Center, Los Angeles, CA 90033, USA;
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Silva-Tinoco R, Cuatecontzi-Xochitiotzi T, De la Torre-Saldaña V, León-García E, Serna-Alvarado J, Guzmán-Olvera E, Cabrera D, Gay JG, Prada D. Role of social and other determinants of health in the effect of a multicomponent integrated care strategy on type 2 diabetes mellitus. Int J Equity Health 2020; 19:75. [PMID: 32448267 PMCID: PMC7245830 DOI: 10.1186/s12939-020-01188-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 05/11/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Although important advances in treatment strategies have been developed in type 2 diabetes mellitus (T2DM), large gaps exist in achieving glycemic control and preventing complications, particularly in low-and middle-income countries, which suggests a potential effect of social determinants of health (SDH, i.e., education level and socioeconomic status). However, few studies have determined the role of SDH and other determinants of health (ODH, i.e., diabetes knowledge and self-care scores) in achieving T2DM goals during effective multidisciplinary interventions. We aimed to examine a multicomponent integrated care (MIC) program on diabetes care goals and determine the effect of SDH and ODH on T2DM patients. METHODS A before-and-after design (a pretest, a 5-month intervention, and a follow-up) was used in a T2DM population from Mexico City. The SDH included education level and socioeconomic status; the ODH included diabetes knowledge, self-care scores, and deltas (i.e., differences between baseline and follow-up scores). The triple-target goal (glycated hemoglobin, blood pressure, and LDL-cholesterol) was established as a measurement of T2DM goals. RESULTS The DIABEMPIC (DIABetes EMPowerment and Improvement of Care) intervention (n = 498) reduced the glycated hemoglobin levels (mean reduction 2.65%, standard deviation [SD]: 2.02%) and cardiometabolic parameters; it also improved health-related quality of life. From 1.81% at baseline, 25.9% of participants (p-value< 0.001) achieved the triple-target goal. We found a significant association between education level (p-value = 0.010), diabetes knowledge at baseline (p-value = 0.004), and self-care scores at baseline (p-value = 0.033) in the delta (change between baseline and follow-up assessments) of HbA1c levels. Improvements (increase) in diabetes knowledge (p-value = 0.006) and self-care scores (p-value = 0.002) were also associated with greater reductions in HbA1c. CONCLUSIONS MIC strategies in urban primary care settings contribute to control of T2DM. SDH, such as education level, and ODH (diabetes knowledge and self-care scores at baseline) play a key role in improving glycemic control in these settings.
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Affiliation(s)
- Rubén Silva-Tinoco
- Clínica Especializada en el Manejo de la Diabetes de la Ciudad de México-Iztapalapa, Servicios de Salud Pública de la Ciudad de México, Iztapalapa, 09060, Mexico City, Mexico.
| | - Teresa Cuatecontzi-Xochitiotzi
- Clínica Especializada en el Manejo de la Diabetes de la Ciudad de México-Iztapalapa, Servicios de Salud Pública de la Ciudad de México, Iztapalapa, 09060, Mexico City, Mexico
| | - Viridiana De la Torre-Saldaña
- Clínica Especializada en el Manejo de la Diabetes de la Ciudad de México-Iztapalapa, Servicios de Salud Pública de la Ciudad de México, Iztapalapa, 09060, Mexico City, Mexico
| | - Enrique León-García
- Servicios de Salud Pública del Gobierno de la Ciudad de México, Mexico City, Mexico
| | | | - Eileen Guzmán-Olvera
- Servicios de Salud Pública del Gobierno de la Ciudad de México, Mexico City, Mexico
| | - Dolores Cabrera
- Servicios de Salud Pública del Gobierno de la Ciudad de México, Mexico City, Mexico
| | - Juan G Gay
- Tecnología e Información para la Salud, TIS, Mexico City, Mexico
| | - Diddier Prada
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología - Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, San Fernando 22, Colonia Sección XVI, Tlalpan, 14080, Mexico City, Mexico. .,Department of Biomedical Informatics, Faculty of Medicine, Universidad Nacional Autónoma de México, Av. Universidad 3000, Circuito Exterior S/N Delegación Coyoacán, 04510, Mexico City, Mexico. .,Department of Environmental Health Science, Mailman School of Public Health, Columbia University, New York City, 10032, USA.
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Marquez I, Calman N, Crump C. A Framework for Addressing Diabetes-Related Disparities in US Latino Populations. J Community Health 2020; 44:412-422. [PMID: 30264184 DOI: 10.1007/s10900-018-0574-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Despite national efforts to redress racial/ethnic disparities, Latino Americans continue to share a disproportionate burden of diabetes-related morbidity and mortality. A better understanding of underlying causes and influencing factors is needed to guide future efforts to eliminate racial/ethnic disparities in diabetes control. The objectives of this review are: (1) to summarize our understanding of determinants and modifiable predictors of glycemic control; (2) to provide an overview of existing strategies to reduce diabetes-related disparities; and (3) to identify gaps in the literature regarding whether these interventions effectively address disparities in US Latino populations. Key findings include evidence that diabetes care services can be designed to accommodate heterogeneity within the Latino American community by addressing key modifiable predictors of poor glycemic control, including insurance status, diabetes care utilization, patient self-management, language access, culturally appropriate care, and social support services. Future research efforts should evaluate the effect of structurally tailored interventions that address these key modifiable predictors by targeting patients, providers, and health care delivery systems.
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Affiliation(s)
- Ivan Marquez
- Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, Suite L5-40, New York, NY, 10029, USA.
| | - Neil Calman
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The Institute for Family Health, New York, NY, USA
| | - Casey Crump
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Alolod GP, Gardiner H, Agu C, Turner JL, Kelly PJ, Siminoff LA, Gordon EJ, Norden R, Daly TA, Benitez A, Hernandez I, Guinansaca N, Winther LR, Bergeron CD, Montalvo A, Gonzalez T. A Culturally Targeted eLearning Module on Organ Donation (Promotoras de Donación): Design and Development. J Med Internet Res 2020; 22:e15793. [PMID: 31929102 PMCID: PMC6996759 DOI: 10.2196/15793] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 01/20/2023] Open
Abstract
Background As an overrepresented population on the transplant waitlist, stagnated rates of organ donation registration among Latinxs must be redressed. Promotoras (community health workers), who are effective at advocating and spearheading health promotion efforts in the Latinx community, show promise in their ability to educate about organ donation and donor registration. Objective This study aimed (1) to develop an interactive, evidence-based program to educate promotoras about organ donation, the need for organ donors in the Latinx American community, and ways to register as deceased organ donors and (2) to train promotoras to lead discussions about organ donation and to promote the act of donor registration. Methods In partnership with 4 promotoras organizations, the culturally targeted Promotoras de Donación eLearning module was developed based on input from 12 focus groups conducted with Latina women (n=61) and promotoras (n=37). Formative work, existing literature, the Vested Interest Theory, and the Organ Donation Model guided curriculum development. In partnership with the Gift of Life Institute and regional promotoras, the curriculum was designed, filmed, and developed in a visually appealing module interface. The module was beta-tested with promotoras before launch. Results Promotoras de Donación, available in Spanish with English subtitling, lasts just over an hour. The module comprised 6 sections including various activities and videos, with the curriculum divided into a skills-based communication component and a didactic educational component. Pre- and posttests assessed the module’s direct effects on promotoras’ organ donation knowledge and attitudes as well as confidence promoting the act of donor registration. Conclusions This novel, theoretically and empirically based intervention leveraged the existing network of promotoras to promote the act of donor registration. Future research should assess whether the module helps increase rates of donor registration within Latinx communities and reduce disparities in access to transplantation. Trial Registration ClinicalTrials.gov NCT04007419; https://www.clinicaltrials.gov/ct2/show/NCT04007419
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Affiliation(s)
- Gerard P Alolod
- College of Public Health, Temple University, Philadelphia, PA, United States
| | - Heather Gardiner
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, United States
| | - Chidera Agu
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, United States
| | - Jennie L Turner
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, United States
| | - Patrick J Kelly
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, United States
| | - Laura A Siminoff
- College of Public Health, Temple University, Philadelphia, PA, United States
| | - Elisa J Gordon
- Division of Transplantation, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Robert Norden
- Gift of Life Institute, Philadelphia, PA, United States
| | | | | | | | | | | | | | | | - Tony Gonzalez
- Esperanza Health Center, Philadelphia, PA, United States
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Bhuiyan N, Singh P, Harden SM, Mama SK. Rural physical activity interventions in the United States: a systematic review and RE-AIM evaluation. Int J Behav Nutr Phys Act 2019; 16:140. [PMID: 31882013 PMCID: PMC6935185 DOI: 10.1186/s12966-019-0903-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 12/12/2019] [Indexed: 01/08/2023] Open
Abstract
Background Previous reviews of rural physical activity interventions were focused on intervention effectiveness and had reported overall mixed findings. The purpose of this systematic review was to apply the Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM) framework to evaluate the extent to which rural physical activity interventions in the U.S. have reported on dimensions of internal and external validity and to offer suggestions for future physical activity interventions for rural U.S. populations. Methods Pubmed, PsychINFO, CINAHL, PAIS, and Web of Science were searched through February 2019 to identify physical activity intervention studies conducted in rural regions in the U.S. with adult populations. Titles, abstracts, and full texts of articles were reviewed against inclusion and exclusion criteria. Data extraction from included articles included a summary of study details, rural classification system used, and the presence or absence of a total 61 RE-AIM indicators, including reach (n = 13), efficacy/effectiveness (n = 10), adoption (n = 21), implementation (n = 9), and maintenance (n = 8). Results A total of 40 full-text articles representing 29 unique studies were included. Classifications of rurality included self-statements by authors (n = 19, 65.5%), population/census-based definitions (n = 3, 10.3%), Rural Urban Continuum Codes (n = 3, 10.3%), Rural Urban Commuting Area codes (n = 2, 6.9%), the 2014 Alabama Rural Health Association classification system (n = 1, 3.4%) and the U.S. Office of Management and Budget classification system (n = 1, 3.4%). Individual studies reported between 14.8 to 52.5% of total RE-AIM indicators. Studies reported 15.4 to 84.6% indicators for reach; 20.0 to 70.0% indicators for efficacy/effectiveness; 4.8 to 47.6% indicators for adoption; 11.1 to 88.9% indicators for implementation; and 0 to 25.0% indicators for maintenance. Conclusions We found an overall poor reporting of components related to external validity, which hinders the generalizability of intervention findings, and a lack of consistency in the definition of rurality. Future research should focus on balancing factors of internal and external validity, and should aim to develop a greater understanding of how rurality influences health and behavior to provide contextual knowledge needed to advance the translation of physical activity interventions into practice in rural communities and reduce rural health disparities. Trial registration The review protocol was registered with PROSPERO: CRD42019116308.
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Affiliation(s)
- Nishat Bhuiyan
- Department of Kinesiology, The Pennsylvania State University, 23B Recreation Building, University Park, PA, 16802, USA.
| | - Pritika Singh
- Department of Kinesiology, The Pennsylvania State University, 23B Recreation Building, University Park, PA, 16802, USA
| | - Samantha M Harden
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, 24060, USA
| | - Scherezade K Mama
- Department of Kinesiology, The Pennsylvania State University, 268J Recreation Building, University Park, PA, 16802, USA
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Implementation of a Stress Intervention with Latino Immigrants in a Non-traditional Migration City. J Immigr Minor Health 2019; 21:372-382. [PMID: 29623527 DOI: 10.1007/s10903-018-0732-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Stress negatively impacts health outcomes across all racial and ethnic groups, but the health disparities experienced by Latino immigrants in nontraditional migration cities are exacerbated by undeveloped infrastructure and weak social support networks. Immigrants in new migration cities can be difficult to engage in health interventions and are therefore underrepresented in the very research where their inclusion is most crucial. To effectively engage Latino immigrants, a team of academic and community researchers collaborated on a community-based participatory research project to design and implement a stress and coping intervention. Top stressors reported were family, children, and work, but health was most commonly identified as the primary stressor. Participants overwhelmingly chose physical activity goals for stress reduction. Pre- to post- intervention results revealed significant improvements in social support and stress management. Results demonstrate the effectiveness of a peer-led, community-partnered approach to implementing a stress intervention with Latino immigrants in a nontraditional migration city.
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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.
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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
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Vásquez PM, Tarraf W, Doza A, Marquine MJ, Perreira KM, Schneiderman N, Zeng D, Cai J, Isasi CR, Daviglus ML, González HM. The cross-sectional association of cognitive stimulation factors and cognitive function among Latino adults in Hispanic Community Health Study/Study of Latinos (HCHS/SOL). ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2019; 5:533-541. [PMID: 31650010 PMCID: PMC6804586 DOI: 10.1016/j.trci.2019.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Higher cognitive stimulation (CS) is associated with improved cognition. Sources of CS among Hispanics/Latinos are understudied. METHODS In the Hispanic Community Health Study/Study of Latinos 2008 to 2011 (n = 9438), we used finite mixture models to generate latent CS profiles, and multivariate linear regressions to examine associations with cognition in Hispanic/Latino adults (45-74 years). CS included education, occupation, social network, and acculturation. Cognitive measures included the Six-Item Screener, Brief-Spanish English Verbal Learning Test Sum and Recall, Controlled Oral Word Association Test, Digit Symbol Substitution, and Global Cognition. RESULTS Two CS profiles emerged, and were labeled "typical" and "enhanced." The enhanced CS profile (22%) had more family connections, bicultural engagements, skilled/professional occupations, education, and higher cognitive scores. DISCUSSION An enhanced CS profile emerged from contextual and culturally relevant factors, and was associated with higher cognitive scores across all measures. This provides initial evidence on how factors coalesce to shape cognitive protection in Hispanics/Latinos.
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Affiliation(s)
- Priscilla M. Vásquez
- Department of Neuroscience, University of California San Diego, La Jolla, CA, USA
| | - Wassim Tarraf
- Department of Healthcare Sciences & Institute of Gerontology, Wayne State University, Detroit, MI, USA
| | - Adit Doza
- Department of Healthcare Sciences & Institute of Gerontology, Wayne State University, Detroit, MI, USA
| | - Maria J. Marquine
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Krista M. Perreira
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Neil Schneiderman
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Donglin Zeng
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
| | - Jianwen Cai
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
| | - Carmen R. Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Martha L. Daviglus
- College of Medicine, Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL, USA
| | - Hector M. González
- Department of Neuroscience, University of California San Diego, La Jolla, CA, USA
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Culturally Congruent Evidence-Based Practice in an International Outreach Course for Prelicensure Nursing Students. Nurs Educ Perspect 2019; 40:309-311. [PMID: 31335493 DOI: 10.1097/01.nep.0000000000000555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The PICO (Population/Problem, Intervention, Comparison, Outcome) framework is widely accepted for posing evidence-based practice questions. This framework offers prelicensure nursing students a structured process for synthesizing nursing knowledge with the best available evidence to make decisions for practice. However, students in an international outreach course may find that evidence-based practice is not available in-country; furthermore, it may not be congruent with a population's culture. Faculty guidance helps students enrolled in international outreach courses to integrate cultural competence into the PICO structure. A case study illustrates how the framework was applied during an undergraduate nursing outreach course to Nicaragua.
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Chao DY, Lin TM, Ma WY. Enhanced Self-Efficacy and Behavioral Changes Among Patients With Diabetes: Cloud-Based Mobile Health Platform and Mobile App Service. JMIR Diabetes 2019; 4:e11017. [PMID: 31094324 PMCID: PMC6534048 DOI: 10.2196/11017] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 08/04/2018] [Accepted: 04/02/2019] [Indexed: 01/19/2023] Open
Abstract
Background The prevalence of chronic disease is increasing rapidly. Health promotion models have shifted toward patient-centered care and self-efficacy. Devices and mobile app in the Internet of Things (IoT) have become critical self-management tools for collecting and analyzing personal data to improve individual health outcomes. However, the precise effects of Web-based interventions on self-efficacy and the related motivation factors behind individuals’ behavioral changes have not been determined. Objective The objective of this study was to gain insight into patients' self-efficacy with newly diagnosed diabetes (type 2 diabetes mellitus) and analyze the association of patient-centered health promotion behavior and to examine the implications of the results for IoT and mobile health mobile app features. Methods The study used data from the electronic health database (n=3128). An experimental design (n=121) and randomized controlled trials were employed to determine patient preferences in the health promotion program (n=62) and mobile self-management education (n=28). The transtheoretical model was used as a framework for observing self-management behavior for the improvement of individual health, and the theory of planned behavior was used to evaluate personal goals, execution, outcome, and personal preferences. A mobile app was used to determine individualized health promotion interventions and to apply these interventions to improve patients’ self-management and self-efficacy. Results Mobile questionnaires were administered for pre- and postintervention assessment through mobile app. A dynamic questionnaire allocation method was used to follow up and monitor patient behavioral changes in the subsequent 6 to 18 months. Participants at a high risk of problems related to blood pressure (systolic blood pressure ≥120 mm Hg) and body mass index (≥23 kg/m2) indicated high motivation to change and to achieve high scores in the self-care knowledge assessment (n=49, 95% CI −0.26% to −0.24%, P=.052). The associated clinical outcomes in the case group with the mobile-based intervention were slightly better than in the control group (glycated hemoglobin mean −1.25%, 95% CI 6.36 to 7.47, P=.002). In addition, 86% (42/49) of the participants improved their health knowledge through the mobile-based app and information and communications technology. The behavior-change compliance rate was higher among the women than among the men. In addition, the personal characteristics of steadiness and dominance corresponded with a higher compliance rate in the dietary and wellness intervention (83%, 81/98). Most participants (71%, 70/98) also increased their attention to healthy eating, being active, and monitoring their condition (30% 21/70, 21% 15/70, and 20% 14/70, respectively). Conclusions The overall compliance rate was discovered to be higher after the mobile app–based health intervention. Various intervention strategies based on patient characteristics, health care–related word-of-mouth communication, and social media may be used to increase self-efficacy and improve clinical outcomes. Additional research should be conducted to determine the most influential factors and the most effective adherence management techniques.
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Affiliation(s)
- Dyna Yp Chao
- Healthcare Solution Center, Health Inventor of Taipei, Taipei City, Taiwan
| | - Tom My Lin
- Graduate Institute of Management, National Taiwan University of Science and Technology, Taipei City, Taiwan
| | - Wen-Ya Ma
- Department of Metabolism, Cardinal Tien Hospital, New Taipei City, Taiwan
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Burner E, Mercado J, Hernandez-Saenz A, Peters A, Mack W, Baezconde-Garbanati L, Arora S, Wu S. Design and patient characteristics of the randomized controlled trial TExT-MED + FANS A test of mHealth augmented social support added to a patient-focused text-messaging intervention for emergency department patients with poorly controlled diabetes. Contemp Clin Trials 2019; 80:1-8. [PMID: 30878623 PMCID: PMC6488230 DOI: 10.1016/j.cct.2019.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 03/01/2019] [Accepted: 03/05/2019] [Indexed: 01/20/2023]
Abstract
Although diabetes is a nationwide epidemic, US Latinos are a particularly vulnerable population. Culturally appropriate interventions can combat this disparity, especially those that increase social support. However, these interventions face significant cost and time barriers, which mHealth (mobile health) may overcome. This trial examines the benefit of adding social support to an existing text-message based, patient-focused mHealth intervention for emergency department patients with poorly controlled diabetes. Family members and friends of patients were randomized to mHealth augmented social support training (daily text-messages that synchronize with the patient messages) or a pamphlet based training (the same content mailed to their house.) We hypothesize that patients who received mHealth augmented social support will have a larger improvement in diabetes management (glycosylated hemoglobin or A1C) than those receiving standard support at six-months, and that improvement will be sustained at twelve-months. Secondary patient outcomes are clinical (weight, blood pressure), behavioral (medication adherence, self-care activities) and psychosocial (general and diabetes-specific social support, self-efficacy, diabetes-related distress, depression, fatalism and quality of life). We screened 2004 patients and enrolled 166 patient/supporter dyads. 70% of patients are Spanish-speaking, 51% female, with a mean A1C of 10.8. We employed innovative measures to remotely enroll family members and support a bilingual population, which will assist other investigators in design of similar trials. The findings of our trial will have real-world applicability for clinicians, health system administrators, health educators and mHealth developers who aim to improve the health of this vulnerable population.
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Affiliation(s)
- Elizabeth Burner
- Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, United States.
| | - Janisse Mercado
- Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, United States
| | | | - Anne Peters
- Division of Endocrinology, Keck School of Medicine of the University of Southern California, United States
| | - Wendy Mack
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, United States
| | - Lourdes Baezconde-Garbanati
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, United States
| | - Sanjay Arora
- Department of Emergency Medicine, Keck School of Medicine of the University of Southern California, United States
| | - Shinyi Wu
- School of Social Work, University of Southern California, United States
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Mohd Suan MA, Asli SE, Abdullah WM, Shafie Z, Johari NH. Patient Perspective on Factors Contributing to Nonadherence to Dietary Therapy: A Qualitative Study in Multicultural Population of Kedah, Malaysia. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2018; 39:217-223. [PMID: 30587080 DOI: 10.1177/0272684x18821306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The purpose of this study is to explore diabetes patients' views on various factors contributing to nonadherence to dietary therapy. Using a qualitative approach, 17 in-depth interviews were conducted with type 2 diabetes mellitus patients at Hospital Sultanah Bahiyah, Kedah state, Malaysia. All interviews were audio recorded, transcribed verbatim, and translated before analysis. Thematic content analysis was used and three main themes emerged. The main factors that affect diabetes patients' dietary adherence were "individual preference," "family support," and "social and cultural activities." Difficulty to change the existing meals, poor family support, practice of eating out, and social and cultural gatherings were among the factors that influenced diabetes patients' adherence toward dietary therapy. Most challenges were related to the social role of food in the multicultural population. Therefore, in addition to the family and community involvement, dietary therapy should be individualized to improve patient adherence.
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Affiliation(s)
- Mohd Azri Mohd Suan
- 1 Clinical Research Centre, Sultanah Bahiyah Hospital, Alor Setar, Kedah, Malaysia
| | - Siti Ertina Asli
- 1 Clinical Research Centre, Sultanah Bahiyah Hospital, Alor Setar, Kedah, Malaysia
| | - Wan Muhana Abdullah
- 1 Clinical Research Centre, Sultanah Bahiyah Hospital, Alor Setar, Kedah, Malaysia
| | - Zainab Shafie
- 1 Clinical Research Centre, Sultanah Bahiyah Hospital, Alor Setar, Kedah, Malaysia
| | - Nor Hafiza Johari
- 1 Clinical Research Centre, Sultanah Bahiyah Hospital, Alor Setar, Kedah, Malaysia
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Family functioning integrated with diabetes self-management: a concept analysis. FRONTIERS OF NURSING 2018. [DOI: 10.1515/fon-2018-0027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Although the concept of family functioning has gained recent popularity, the terms "family functioning" and "family resilience" are sometimes confused and used interchangeably. The aim of this concept analysis was to clarify what is meant by family functioning in the context of diabetes self-management by assessing specific attributes, antecedents, and consequences. A concept analysis model by Walker and Avant was applied. The Identified attributes of family functioning in a diabetes self-management context Included problem-solving, communication, roles, affective responsiveness, affective involvement, and behavioral control. Antecedents Included family structure, socloeconomic status, family functioning relationships, family stage, and life events. Consequences Included family satisfaction, family cohesion, and family relationships. This analysis provided a deeper understanding of a family functioning concept within a diabetes self-management context. It is recommended that health care providers should be aware of antecedent factors that could inhibit outcome improvement. Further research is needed to explain family functioning attributes in relation to antecedents and potential consequences.
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Pesantes MA, Del Valle A, Diez-Canseco F, Bernabé-Ortiz A, Portocarrero J, Trujillo A, Cornejo P, Manrique K, Miranda JJ. Family Support and Diabetes: Patient's Experiences From a Public Hospital in Peru. QUALITATIVE HEALTH RESEARCH 2018; 28:1871-1882. [PMID: 30066604 PMCID: PMC6346298 DOI: 10.1177/1049732318784906] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Family support is crucial for managing chronic conditions but it is often overlooked when designing behavioral interventions in type 2 diabetes mellitus (T2DM). As part of the formative phase of a feasibility randomized control trial (RCT), we conducted 20 semistructured interviews with people with T2DM from Lima, Peru. Based on such results, we describe the support people with T2DM receive from their families and the role that such support has in their efforts to implement diabetes management practices. We learned that participants receive support from family members, but mostly from their spouses and children. Their relatives encourage them and motivate them to fight for their health, they also provide instrumental support by preparing healthy meals, reminding them to take medications, and sharing physical activity. Participants also reported controlling actions which were not always "well received." Thus, any intervention supporting self-management practices need to work with key family members. We support the literature that suggests that interventions should target family members to ensure improved T2DM self-management practices.
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Affiliation(s)
| | - Adela Del Valle
- University of North Carolina at Chapel
Hill, Chapel Hill, North Carolina, USA
| | | | - Antonio Bernabé-Ortiz
- Universidad Peruana Cayetano Heredia,
Lima, Peru
- London School of Hygiene and Tropical
Medicine, Bloomsbury, London, United Kingdom
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