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Arcos D, Russo LN, Kazmierski KFM, Zhou E, Montiel GI, Bracho A, Mejia N, Borelli JL. A Relationship-Based Resilience Program for Promotores: Protocol for a Randomized Controlled Waitlist Trial. JMIR Res Protoc 2023; 12:e51427. [PMID: 38113093 PMCID: PMC10762607 DOI: 10.2196/51427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/16/2023] [Accepted: 10/19/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Community service providers (CSPs) play an integral role in the health care of low-income Hispanic or Latinx (HL) communities. CSPs have high-stress frontline jobs and share the high-risk demographics of their communities. Relational savoring (RS) has been associated with lower cardiovascular reactivity and psychosocial benefits, with particular promise among HL participants. In this study, we aim to identify RS's potential in promoting CSPs' cardiometabolic health and, in so doing, having broader impacts on the community they serve. OBJECTIVE This randomized controlled waitlist study aims to examine the effect of an RS intervention on (1) CSPs' cardiometabolic health (cardiometabolic risk factors and outcomes) and (2) CSPs' threats to leaving the workforce. METHODS We will recruit a sample of 80 CSPs from community health agencies serving low-income HL populations. Participating CSPs will be randomized into an experimental or a waitlist control. Participants will complete 1 or 2 baseline assessment batteries (before the intervention), depending on the assigned group, and then complete 2 more assessment batteries following the 4-week RS intervention (after the intervention and at a 3-mo follow-up). The RS intervention consists of guided reflections on positive moments of connection with others. Electrocardiogram data will be obtained from a wearable device (Polar Verity Sense or Movisens) to measure heart rate variability. The primary outcome is cardiometabolic health, consisting of cardiometabolic risk (obtained from heart rate variability) and cardiometabolic health behaviors. The secondary outcomes include CSPs' threats to leaving the workforce (assessed via psychological well-being), intervention acceptability, and CSPs' delivery of cardiometabolic health programming to the community (exploratory). Analyses of covariance will be used to examine the effects of RS on cardiometabolic health and on CSPs' threats to leaving the workforce, comparing outcomes at baseline, postintervention, and at follow-up across participants in the experimental versus waitlist group. RESULTS The study has been approved by the University of California, Irvine, Institutional Review Board and is currently in the data collection phase. By May 2023, 37 HL CSPs have been recruited: 34 have completed the baseline assessment, 28 have completed the 4 intervention sessions, 27 have completed the posttreatment assessment, and 10 have completed all assessments (including the 3-mo follow-up). CONCLUSIONS This study will provide valuable information on the potential of RS to support cardiometabolic health in HL CSPs and, indirectly, in the communities they serve. TRIAL REGISTRATION ClinicalTrials.gov NCT05560893; https://clinicaltrials.gov/study/NCT05560893. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/51427.
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Affiliation(s)
- Daniela Arcos
- Department of Psychological Science, University of California Irvine, Irvine, CA, United States
| | - Lyric N Russo
- Department of Psychological Science, University of California Irvine, Irvine, CA, United States
| | - Kelly F M Kazmierski
- Department of Psychological Science, University of California Irvine, Irvine, CA, United States
| | - Elayne Zhou
- Department of Psychology, University of Southern California, Los Angeles, CA, United States
| | | | | | - Nancy Mejia
- Latino Health Access, Santa Ana, CA, United States
| | - Jessica L Borelli
- Department of Psychological Science, University of California Irvine, Irvine, CA, United States
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Moore A. From education to empowerment: Redesigning the role of students in college health promotion. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:984-987. [PMID: 34197276 DOI: 10.1080/07448481.2021.1920603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/05/2021] [Accepted: 04/18/2021] [Indexed: 05/31/2023]
Abstract
College health promotion departments frequently employ peer health educators to disseminate relevant education and conduct outreach to their student body. While there are certainly benefits to these programs, this approach is outdated and does little to empower students or engage them in the process of health promotion. In this viewpoint article, I describe the Community Health Organizer model, which expands students' role in peer engagement and advocacy beyond the traditional peer educator or peer counseling programs. Finally, I provide recommendations for college health practitioners interested in implementing a similar model on their campuses.
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Affiliation(s)
- Andrea Moore
- Office for Health Promotion Strategy, Student Health, University of Southern California, Los Angeles, California, USA
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3
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Shaw AR, Perales-Puchalt J, Johnson E, Espinoza-Kissell P, Acosta-Rullan M, Frederick S, Lewis A, Chang H, Mahnken J, Vidoni ED. Representation of Racial and Ethnic Minority Populations in Dementia Prevention Trials: A Systematic Review. J Prev Alzheimers Dis 2022; 9:113-118. [PMID: 35098981 DOI: 10.14283/jpad.2021.49] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Despite older racial and ethnic minorities (REMs) being more likely to develop dementia they are underrepresented in clinical trials focused on neurological disorders. Inclusion of REMs in dementia prevention studies is vital to reducing the impact of disparities in dementia risk. We conducted a systematic review to characterize the number of REM enrolled in brain health and prevention randomized controlled trials (RCTs). RTCs published from January 1, 2004 to April 21, 2020 were included. Participants were normal cognitive adults aged 45 years and older who participated in a Phase II or Phase III U.S. based preventative trial. Analyses were performed to examine differences in trial characteristics between RCTs that did and those that did not report race/ethnicity and to calculate the pooled proportion of each racial/ethnic group in randomized brain healthy prevention trials. A total of 42 studies consisting of 100,748 participants were included in the final analyses. A total of 26 (62%) reported some racial/ethnic identity data. The pooled proportion of REM participants was 0.256 (95% CI, 0.191, 0.326). There is a lack of racial/ethnic reporting of participants and REMs remain underrepresented in brain health prevention RCTs.
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Affiliation(s)
- A R Shaw
- Eric Vidoni, 4350 Shawnee Mission Parkway, Fairway, KS, 66205, USA, ; Phone: 913-588-5312; Fax: 913-945-5035
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4
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Clarke M, Onyeachu P. An investigation on the level of acceptance and use of communication technology by the elderly: cross sectional study (Preprint). JMIR Form Res 2021. [DOI: 10.2196/35995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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5
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Weight Loss Interventions for Hispanic Women in the United States: A Systematic Review. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2021; 2021:8714873. [PMID: 34457010 PMCID: PMC8397533 DOI: 10.1155/2021/8714873] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/30/2021] [Indexed: 12/17/2022]
Abstract
Background Obesity rates in Hispanic women residing in the United States (U.S.) are disproportionately high, increasing the risk of obesity-related disease and mortality. The effectiveness of interventions targeting weight loss in this population remains largely unknown. Purpose The purpose of this review was to systematically evaluate the evidence related to the effectiveness of weight loss interventions conducted among U.S. Hispanic women and provide guidance for future research. Methods Bibliographic databases (n = 10, from each database's inception to July 2, 2019) were searched using the PRISMA guidelines for systematic reviews. Randomized controlled trials (RCTs) and quasi-experimental studies with weight change outcomes were included. Results were described in a narrative synthesis. Results 5,423 articles were assessed for eligibility based on inclusion criteria; 15 studies were included in the final review. Nine trials were RCTs and six were quasi-experimental studies; all but six were pilot studies. Most studies recruited overweight or obese women with no existing medical conditions and did not follow participants beyond the intervention. All trials were delivered in-person. Intervention strategies and content and weight change outcomes were highly variable. Conclusions RCTs with statistically powered sample sizes are needed to robustly test the effects of weight loss interventions in this population.
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DeFosset AR, Sivashanmugam M, Mosst J, Kuo T. Clinic- and Community-Based National Diabetes Prevention Programs in Los Angeles. HEALTH EDUCATION & BEHAVIOR 2021; 49:647-657. [PMID: 34053326 DOI: 10.1177/10901981211016759] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Clinics and community-based organizations (CBOs) are priority settings for implementing the evidence-based National Diabetes Prevention Program (DPP). Both program settings present theoretical advantages and disadvantages for engaging and helping populations most at risk for diabetes achieve lifestyle change goals. To date, few studies have compared implementation across them. The present study describes participant characteristics and lifestyle change outcomes across a sample of clinic- and community-based National DPPs which delivered services in Los Angeles during 2015 to 2018 (two clinics, two CBOs, combined n = 265 participants). Analyses examined participant gender, age, race/ethnicity, baseline body mass index, and program attributes such as screening method and language of instruction. Negative binomial regression models tested for differences in program attendance, mean weekly physical activity, and percent change in body weight by setting. Overall, participants were largely Hispanic/Latinx (81.51%) and female (90.19%). Programs operated by CBOs engaged other race/ethnic groups including Black participants more frequently than those operated by clinics (20.56% vs. 0%); the latter engaged more men (15.29% vs. 7.22%). Few participants in any setting met the National DPP's weight loss goal (clinic: 15.29%, CBO: 20.00%). Participating in a community-based program was initially associated with higher attendance and mean weekly physical activity, but associations were not significant after adjusting for covariates. Study results have practice implications for National DPP implementation and can help inform future efforts to scale and spread the program in Los Angeles and nationally.
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Affiliation(s)
- Amelia R DeFosset
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Megala Sivashanmugam
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Jennifer Mosst
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Tony Kuo
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, CA, USA.,University of California, Los Angeles, CA, USA
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Molina K, Baskin ML, Long D, Carson TL. Psychological and behavioral pathways between perceived stress and weight change in a behavioral weight loss intervention. J Behav Med 2021; 44:822-832. [PMID: 34003418 DOI: 10.1007/s10865-021-00231-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 05/07/2021] [Indexed: 11/30/2022]
Abstract
Black women have a higher prevalence of obesity and tend to have suboptimal outcomes in behavioral weight loss programs for reasons that are not fully understood. Studies have shown a potential relationship between perceived psychological stress and weight loss in behavioral interventions. This study sought to assess whether baseline stress was directly or indirectly associated with 6-month weight change among Black women participating in a behavioral weight loss study. Indirect pathways of interest included depressive symptoms and dietary intake. A secondary analysis of data (n = 409) collected from a cluster, randomized behavioral weight loss trial was conducted. Demographics, anthropometry, surveys, and dietary data were collected at baseline and 6 months. Path analysis was used to test for direct and indirect effects of baseline stress on 6-month weight change while controlling for sociodemographic factors and intervention group. Baseline stress was not directly associated with 6-month weight change nor was it indirectly associated via depressive symptoms in the adjusted model. However, each of the direct paths linking baseline stress to weight loss were statistically significant. Stress was not associated with 6-month weight change via dietary intake. Baseline stress was positively associated with 6-month depressive symptoms which in turn was associated with less weight change. Depressive symptoms may offer an additional psychosocial target to consider when designing behavioral weight loss interventions for Black women.
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Affiliation(s)
- Kristine Molina
- Department of Psychological Sciences, University of California Irvine, Irvine, CA, USA
| | - Monica L Baskin
- School of Medicine, Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Dustin Long
- School of Public Health, Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tiffany L Carson
- Department of Health Outcomes and Behavior, Division of Population Sciences, H. Lee Moffitt Cancer Center & Research Institute, MFC-EDU, 12902 Magnolia Drive, Tampa, FL, 33612, USA.
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
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Talk to PAPA: A Systematic Review of Patient/Participant (PAPA) Feedback on Interactions With Community Health Workers Using a Depth Analysis Approach. J Ambul Care Manage 2020; 43:55-70. [PMID: 31770186 DOI: 10.1097/jac.0000000000000309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Because of their shared backgrounds, community health workers' (CHWs) care of patients/program participants (PAPAs) is assumed to be acceptable, and often not evaluated empirically. Using PRISMA guidelines, we reviewed 9560 articles from 5 databases, selected 37 articles for full-text review, and developed a 5-dimensional depth analysis (focus, context, meaning, range, and voices) to characterize quality/quantity of PAPA feedback. Depth analyses clarified a spectrum of PAPA responses from extremely positive to ambivalence to outright distrust and frustration with perceived CHW limitations. Designing evaluations with 5-dimensional depth analysis can enhance PAPA feedback quality and improve evidence-based, patient-centered, CHW care delivery.
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Heisler M, Kullgren J, Richardson C, Stoll S, Alvarado Nieves C, Wiley D, Sedgwick T, Adams A, Hedderson M, Kim E, Rao M, Schmittdiel JA. Study protocol: Using peer support to aid in prevention and treatment in prediabetes (UPSTART). Contemp Clin Trials 2020; 95:106048. [PMID: 32497783 PMCID: PMC8059966 DOI: 10.1016/j.cct.2020.106048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/20/2020] [Accepted: 05/25/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND There is an urgent need to develop and evaluate effective and scalable interventions to prevent or delay the onset of type 2 diabetes mellitus (T2DM). METHODS In this randomized controlled pragmatic trial, 296 adults with prediabetes will be randomized to either a peer support arm or enhanced usual care. Participants in the peer support arm meet face-to-face initially with a trained peer coach who also is a patient at the same health center to receive information on locally available wellness and diabetes prevention programs, discuss behavioral goals related to diabetes prevention, and develop an action plan for the next week to meet their goals. Over six months, peer coaches call their assigned participants weekly to provide support for weekly action steps. In the final 6 months, coaches call participants at least once monthly. Participants in the enhanced usual care arm receive information on local resources and periodic updates on available diabetes prevention programs and resources. Changes in A1c, weight, waist circumference and other patient-centered outcomes and mediators and moderators of intervention effects will be assessed. RESULTS At least 296 participants and approximately 75 peer supporters will be enrolled. DISCUSSION Despite evidence that healthy lifestyle interventions can improve health behaviors and reduce risk for T2DM, engagement in recommended behavior change is low. This is especially true among racial and ethnic minority and low-income adults. Regular outreach and ongoing support from a peer coach may help participants to initiate and sustain healthy behavior changes to reduce their risk of diabetes. TRIAL REGISTRATION The ClinicalTrials.gov registration number is NCT03689530.
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Affiliation(s)
- Michele Heisler
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States of America; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States of America.
| | - Jeffrey Kullgren
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States of America; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States of America; Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, United States of America; University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, United States of America.
| | - Caroline Richardson
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, United States of America.
| | - Shelley Stoll
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States of America.
| | - Cristina Alvarado Nieves
- University of Michigan, Department of Internal Medicine- Metabolism, Endocrinology and Diabetes, United States of America.
| | - Deanne Wiley
- Kaiser Permanente Northern California, United States of America.
| | - Tali Sedgwick
- Kaiser Permanente Northern California Division of Research, United States of America.
| | - Alyce Adams
- Kaiser Permanente Northern California, United States of America.
| | | | - Eileen Kim
- The Permanente Medical Group (Kaiser Permanente, Northern California), United States of America.
| | - Megan Rao
- The Permanente Medical Group (Kaiser Permanente, Northern California), United States of America.
| | - Julie A Schmittdiel
- Kaiser Permanente Northern California Division of Research, United States of America.
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Conte KP, Held F, Pipitone O, Bowman S. The Feasibility of Recruiting and Training Lay Leaders During Real-World Program Delivery and Scale-up: The Case of Walk With Ease. Health Promot Pract 2019; 22:91-101. [PMID: 30971154 DOI: 10.1177/1524839919840004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction. To maximize limited resources, many health promotion programs are designed to be delivered by volunteer lay leaders. But this model poses challenges to implementation in real-world settings and barriers to successfully scaling-up programs. This study examines the current lay leader training model for Walk With Ease, a Centers for Disease Control and Prevention-funded evidence-based arthritis program delivered at-scale. Method. Recruited volunteers (n = 106) opted into free online or in-person training and agreed to deliver one Walk With Ease program within the following year-only 49%, however, did. Using logistic regression models and qualitative interviews, we explored predictors of volunteer delivery. Results. Volunteers had higher odds of delivering programs if they trained online (odds ratio [OR] = 9.04, 95% confidence interval [CI: 2.30, 48.36]), previously taught health programs (OR = 15.52, 95% CI [3.51, 103.55]) or trained in the second year of implementation (OR = 27.08, 95% CI [2.63, 415.78]). Qualitative findings underscored that successful volunteers were readied by their previous health education experience. Conclusions. While online training modes appear effective to prepare experienced volunteers, lay leaders required additional support. This calls into question whether lay-led delivery models are suitable for scaling-up programs with limited resources. Given the many lay-led health interventions for chronic disease self-management, investing in common training and infrastructures for lay leader development could advance the quality and sustainability of real-world program delivery.
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Affiliation(s)
| | - Fabian Held
- University of Sydney, Sydney, New South Wales, Australia
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Ralston AL, Andrews AR, Hope DA. Fulfilling the promise of mental health technology to reduce public health disparities: Review and research agenda. ACTA ACUST UNITED AC 2019. [DOI: 10.1111/cpsp.12277] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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12
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Banna J. Considerations for Evaluation of Diabetes Prevention Programs in Hispanic Adults in the United States. Am J Lifestyle Med 2018; 12:21-24. [PMID: 30202379 DOI: 10.1177/1559827617726503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Hispanics are at high risk for diabetes. While there have been a number of diabetes prevention programs targeting Hispanics in the United States, not all recent studies focused on evaluating such programs have made use of validated tools to examine behavior change or examined acceptability and feasibility of the intervention. Tools used to assess behavioral outcomes such as diet should be tested to ensure validity and reliability. Acceptability may be examined using qualitative and quantitative measures to obtain feedback on the content of the intervention. Feasibility of the intervention may be evidenced by the enrollment, attendance, and attrition rates, as well as barriers or facilitators to participating in the program. Appropriate and comprehensive evaluation of such programs will allow for continued improvement of prevention efforts to address high rates of diabetes in this at-risk population.
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Affiliation(s)
- Jinan Banna
- Department of Human Nutrition, Food and Animal Sciences, University of Hawaii at Manoa, Honolulu, Hawaii
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Cheun ASA, Loomis J. A Culturally Sensitive Approach to Cervical Cancer Prevention in the Latina Population Using the Promotora Model. Nurs Womens Health 2018; 22:338-345. [PMID: 30077240 DOI: 10.1016/j.nwh.2018.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 02/01/2018] [Accepted: 02/01/2018] [Indexed: 06/08/2023]
Abstract
Latina women of low socioeconomic status are particularly vulnerable to morbidity and mortality from cervical cancer. Lower rates of screening are associated with increased mortality rates in this population. Community health workers known as promotoras de salud can be an effective part of the health care team to help improve health care access in this population. Promotoras using a cervical cancer education curriculum known as AMIGAS can help promote access to services, provide education, and possibly save lives in an underserved population. Nurses and advanced practice nurses who care for underserved Latina women can collaborate with promotoras to increase women's knowledge of cervical cancer screening and of community-based resources available to increase their access to Pap testing and human papillomavirus vaccination.
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Gilmer T, O'Connor PJ, Schiff JS, Taylor G, Vazquez-Benitez G, Garrett JE, Vue-Her H, Rinn S, Anderson J, Desai J. Cost-Effectiveness of a Community-Based Diabetes Prevention Program with Participation Incentives for Medicaid Beneficiaries. Health Serv Res 2018; 53:4704-4724. [PMID: 29770445 DOI: 10.1111/1475-6773.12973] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To examine the cost-effectiveness of a community-based Diabetes Prevention Program (DPP) for Medicaid beneficiaries from the perspective of the health care sector. DATA SOURCES/STUDY SETTING A total of 847 Medicaid enrollees at high risk for type 2 diabetes participating in a community-based DPP. STUDY DESIGN Pre- and post clinical outcome and cost data were used as inputs into a validated diabetes simulation model. The model was used to evaluate quality-adjusted life years (QALYs) and health care costs over a 40-year time horizon from the perspective of the health care sector. DATA COLLECTION/EXTRACTION METHODS Clinical outcome and cost data were derived from a study examining the effect of financial incentives on weight loss. PRINCIPAL FINDINGS Study participants lost an average of 4.2 lb (p < .001) and increased high-density lipoprotein cholesterol by 1.75 mg/dl (p = .002). Intervention costs, which included financial incentives for participation and weight loss, were $915 per participant. The incremental cost-effectiveness ratio was estimated to be $14,011 per QALY but was sensitive to the time horizon studied. CONCLUSIONS Widespread adoption of community-based DPP has the potential to reduce diabetes and cardiovascular-related morbidity and mortality for low-income persons at high risk for diabetes and may be a cost-effective investment for Medicaid programs.
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Affiliation(s)
- Todd Gilmer
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
| | | | - Jeffrey S Schiff
- Minnesota Health Care Programs, Minnesota Department of Human Services, Saint Paul, MN
| | - Gretchen Taylor
- Minnesota Diabetes Program, Minnesota Department of Health, Saint Paul, MN
| | | | - Joyce E Garrett
- Minnesota Health Care Programs, Minnesota Department of Human Services, Saint Paul, MN
| | - Houa Vue-Her
- Minnesota Diabetes Program, Minnesota Department of Health, Saint Paul, MN
| | - Sarah Rinn
- Minnesota Health Care Programs, Minnesota Department of Human Services, Saint Paul, MN
| | | | - Jay Desai
- HealthPartners Institute, Bloomington, MN
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Evaluation of ¡Vivir Mi Vida! to improve health and wellness of rural-dwelling, late middle-aged Latino adults: results of a feasibility and pilot study of a lifestyle intervention. Prim Health Care Res Dev 2018; 19:448-463. [PMID: 29729677 DOI: 10.1017/s1463423617000901] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
AimThe aim of this study was to determine the feasibility and efficacy of a culturally tailored lifestyle intervention, ¡Vivir Mi Vida! (Live My Life!). This intervention was designed to improve the health and well-being of high risk late middle-aged Latino adults and to be implemented in a rural primary care system. BACKGROUND Rural-dwelling Latino adults experience higher rates of chronic disease compared with their urban counterparts, a disparity exacerbated by limited access to healthcare services. Very few lifestyle interventions exist that are both culturally sensitive and compatible for delivery within a non-metropolitan primary care context. METHODS Participants were 37 Latino, Spanish-speaking adults aged 50-64-years-old, recruited from a rural health clinic in the Antelope Valley of California. ¡Vivir Mi Vida! was delivered by a community health worker-occupational therapy team over a 16-week period. Subjective health, lifestyle factors, and cardiometabolic measures were collected pre- and post-intervention. Follow-up interviews and focus groups were held to collect information related to the subjective experiences of key stakeholders and participants.FindingsParticipants demonstrated improvements in systolic blood pressure, sodium and saturated fat intake, and numerous patient-centered outcomes ranging from increased well-being to reduced stress. Although participants were extremely satisfied with the program, stakeholders identified a number of implementation challenges. The findings suggest that a tailored lifestyle intervention led by community health workers and occupational therapists is feasible to implement in a primary care setting and can improve health outcomes in rural-dwelling, late middle-aged Latinos.
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Hill J, Peer N, Oldenburg B, Kengne AP. Roles, responsibilities and characteristics of lay community health workers involved in diabetes prevention programmes: A systematic review. PLoS One 2017; 12:e0189069. [PMID: 29216263 PMCID: PMC5720739 DOI: 10.1371/journal.pone.0189069] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 11/17/2017] [Indexed: 01/16/2023] Open
Abstract
AIM To examine the characteristics of community health workers (CHWs) involved in diabetes prevention programmes (DPPs) and their contributions to expected outcomes. METHODS Electronic databases including PubMed-MEDLINE, EBSCOHost, and SCOPUS/EMBASE were searched for studies published between January 2000 and March 2016. All studies that used CHWs to implement DPP in ≥18-year-old participants without diabetes but at high risk for developing the condition, irrespective of the study design, setting or outcomes measured, were included. Results were synthesized narratively. RESULTS Forty papers of 30 studies were identified. Studies were mainly community-based and conducted in minority populations in USA. Sample sizes ranged from 20 participants in a single community to 2369 participants in 46 communities. Although CHWs were generally from the local community, their qualifications, work experience and training received differed across studies. Overall the training was culturally sensitive and/or appropriate, covering topics such as the importance of good nutrition and the benefits of increased physical activity, communication and leadership. CHWs delivered a variety of interventions and also screened or recruited participants. The shared culture and language between CHWs and participants likely contributed to better programme implementation and successful outcomes. CONCLUSIONS The complexity of DPPs and the diverse CHW roles preclude attributing specific outcomes to CHW involvement. Nevertheless, documenting potential CHW roles and the relevant training required may optimise CHW contributions and facilitate their involvement in DPPs in the future.
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Affiliation(s)
- Jillian Hill
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- * E-mail:
| | - Nasheeta Peer
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Brian Oldenburg
- Melbourne School of Public Health and Global Health, University of Melbourne, Melbourne, Australia
| | - Andre Pascale Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
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Avilés-Santa ML, Colón-Ramos U, Lindberg NM, Mattei J, Pasquel FJ, Pérez CM. From Sea to Shining Sea and the Great Plains to Patagonia: A Review on Current Knowledge of Diabetes Mellitus in Hispanics/Latinos in the US and Latin America. Front Endocrinol (Lausanne) 2017; 8:298. [PMID: 29176960 PMCID: PMC5687125 DOI: 10.3389/fendo.2017.00298] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 10/16/2017] [Indexed: 12/13/2022] Open
Abstract
The past two decades have witnessed many advances in the prevention, treatment, and control of diabetes mellitus (DM) and its complications. Increased screening has led to a greater recognition of type 2 diabetes mellitus (type 2 DM) and prediabetes; however, Hispanics/Latinos, the largest minority group in the US, have not fully benefited from these advances. The Hispanic/Latino population is highly diverse in ancestries, birth places, cultures, languages, and socioeconomic backgrounds, and it populates most of the Western Hemisphere. In the US, the prevalence of DM varies among Hispanic/Latino heritage groups, being higher among Mexicans, Puerto Ricans, and Dominicans, and lower among South Americans. The risk and prevalence of diabetes among Hispanics/Latinos are significantly higher than in non-Hispanic Whites, and nearly 40% of Hispanics/Latinos with diabetes have not been formally diagnosed. Despite these striking facts, the representation of Hispanics/Latinos in pharmacological and non-pharmacological clinical trials has been suboptimal, while the prevalence of diabetes in these populations continues to rise. This review will focus on the epidemiology, etiology and prevention of type 2 DM in populations of Latin American origin. We will set the stage by defining the terms Hispanic, Latino, and Latin American, explaining the challenges identifying Hispanics/Latinos in the scientific literature and databases, describing the epidemiology of diabetes-including type 2 DM and gestational diabetes mellitus (GDM)-and cardiovascular risk factors in Hispanics/Latinos in the US and Latin America, and discussing trends, and commonalities and differences across studies and populations, including methodology to ascertain diabetes. We will discuss studies on mechanisms of disease, and research on prevention of type 2 DM in Hispanics/Latinos, including women with GDM, youth and adults; and finalize with a discussion on lessons learned and opportunities to enhance research, and, consequently, clinical care oriented toward preventing type 2 DM in Hispanics/Latinos in the US and Latin America.
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Affiliation(s)
- M. Larissa Avilés-Santa
- National Heart, Lung, and Blood Institute at the National Institutes of Health, Bethesda, MD, United States
| | - Uriyoán Colón-Ramos
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Nangel M. Lindberg
- Kaiser Permanente Center for Health Research, Portland, OR, United States
| | - Josiemer Mattei
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, United States
| | - Francisco J. Pasquel
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Cynthia M. Pérez
- University of Puerto Rico Graduate School of Public Health, San Juan, Puerto Rico
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Venditti EM. Behavioral lifestyle interventions for the primary prevention of type 2 diabetes and translation to Hispanic/Latino communities in the United States and Mexico. Nutr Rev 2017; 75:85-93. [PMID: 28049753 DOI: 10.1093/nutrit/nuw041] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Lifestyle behaviors in overweight and obese individuals are closely linked to the development, course, and outcomes of type 2 diabetes and multiple comorbid health conditions. Behavior change theory and many randomized controlled studies offer strong support for screening and identifying adults at increased cardiometabolic risk and for providing early intervention to mitigate risk factors to prevent or delay the onset of disease. The current article reviews key lifestyle intervention efficacy and dissemination trials conducted with individuals deemed to be at increased risk for diabetes and describes the rationale for training teams of professionals and community health workers (e.g., promotores [in Spanish]) to implement comprehensive programs, with fidelity, in a variety of medical care and community settings. This evidence-based road map may be used to facilitate the design and implementation of strategies for structured behavioral diabetes risk reduction programs in the public and private healthcare sectors and other relevant community-based platforms serving individuals of Hispanic/Latino origin in the United States and Mexico.
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Affiliation(s)
- Elizabeth M Venditti
- E.M. Venditti is with the Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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Abstract
PURPOSE OF REVIEW Multi-sector partnerships are broadly considered to be of value for diabetes prevention and management. The purpose of this article is to summarize academic and government collaborations focused on diabetes prevention and management. RECENT FINDINGS Using a narrative review approach, we identified 17 articles describing 10 academic and government partnerships for diabetes management and surveillance. Challenges and gaps in the literature include complexity of diabetes management vis a vis current healthcare infrastructure; a paucity of racial/ethnic diversity in translational efforts; and the time/effort needed to maintain strong relationships across partner institutions. Academic and government partnerships are of value for diabetes prevention and management activities. Acknowledgment that the key priorities of government programming are often costs and feasibility is critical for collaborations to be successful. Future translational efforts of diabetes prevention and management programs should focus on the following: (1) expansion of partnerships between academia and local health departments; (2) increased utilization of implementation science for enhanced and efficient implementation and dissemination; and (3) harnessing of technological advances for data analysis, patient communication, and report generation.
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Affiliation(s)
- Stella S Yi
- Department of Population Health, NYU School of Medicine, 550 First Ave VZN Suite 844, 8th floor, New York, NY, 10016, USA.
| | - Shadi Chamany
- New York City Department of Health and Mental Hygiene, Division of Primary Care and Prevention, New York, NY, USA
| | - Lorna Thorpe
- Department of Population Health, NYU School of Medicine, 550 First Ave VZN Suite 844, 8th floor, New York, NY, 10016, USA
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Sharoni SKA, Abdul Rahman H, Minhat HS, Shariff Ghazali S, Azman Ong MH. A self-efficacy education programme on foot self-care behaviour among older patients with diabetes in a public long-term care institution, Malaysia: a Quasi-experimental Pilot Study. BMJ Open 2017; 7:e014393. [PMID: 28600363 PMCID: PMC5623401 DOI: 10.1136/bmjopen-2016-014393] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE A pilot self-efficacy education programme was conducted to assess the feasibility, acceptability and potential impact of the self-efficacy education programme on improving foot self-care behaviour among older patients with diabetes in a public long-term care institution. METHOD A prequasi-experimental and postquasi-experimental study was conducted in a public long-term care institution in Selangor, Malaysia. Patients with diabetes aged 60 years and above who fulfilled the selection criteria were invited to participate in this programme. Four self-efficacy information sources; performance accomplishments, vicarious experience, verbal persuasion and physiological information were translated into programme interventions. The programme consisted of four visits over a 12-week period. The first visit included screening and baseline assessment and the second visit involved 30 min of group seminar presentation. The third and fourth visits entailed a 20-min one-to-one follow-up discussion and evaluation. A series of visits to the respondents was conducted throughout the programme. The primary outcome was foot self-care behaviour. Foot self-efficacy (efficacy-expectation), foot care outcome expectation, knowledge of foot care, quality of life, fasting blood glucose and foot condition were secondary outcomes. Data were analysed with descriptive and inferential statistics (McNemar's test and Wilcoxon signed-rank test) using the Statistical Package for the Social Sciences V.20.0. RESULTS Fifty-two residents were recruited but only 31 met the inclusion criteria and were included in the analysis at baseline and at 12 weeks postintervention. The acceptability rate was moderately high. At postintervention, foot self-care behaviour (p<0.001), foot self-efficacy (efficacy-expectation), (p<0.001), foot care outcome expectation (p<0.001), knowledge of foot care (p<0.001), quality of life (physical symptoms) (p=0.003), fasting blood glucose (p=0.010), foot hygiene (p=0.030) and anhydrosis (p=0.020) showed significant improvements. CONCLUSION Findings from this pilot study would facilitate the planning of a larger study among the older population with diabetes living in long-term care institutions. TRIAL REGISTRATION NUMBER ACTRN12616000210471; Pre-results.
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Affiliation(s)
- Siti Khuzaimah Ahmad Sharoni
- Department of Nursing, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Hejar Abdul Rahman
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Halimatus Sakdiah Minhat
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Sazlina Shariff Ghazali
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Mohd Hanafi Azman Ong
- Department of Statistics, Faculty of Computer Science and Mathematics, Universiti Teknologi MARA, Segamat, Johor, Malaysia
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PREVENT-DM Comparative Effectiveness Trial of Lifestyle Intervention and Metformin. Am J Prev Med 2017; 52:788-797. [PMID: 28237635 PMCID: PMC5438762 DOI: 10.1016/j.amepre.2017.01.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 11/22/2016] [Accepted: 01/05/2017] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Although the Diabetes Prevention Program and other clinical trials demonstrated the efficacy of intensive lifestyle interventions (ILI) and metformin to prevent type 2 diabetes, no studies have tested their comparative effects in pragmatic settings. This study was designed to compare the real-world effectiveness of ILI, metformin, and standard care among Hispanic women (Latinas) with prediabetes. STUDY DESIGN RCT. SETTING/PARTICIPANTS Ninety-two Latinas, who had a mean hemoglobin A1c of 5.9%, BMI of 33.3 kg/m2, and waist circumference of 97.4 cm (38.3 inches), were recruited from an urban community and randomly assigned to ILI, metformin, or standard care using 1:1:1 allocation. Data were collected from 2013-2015 and analyzed in 2016. INTERVENTION The 12-month ILI was adapted from the Diabetes Prevention Program's ILI and delivered by community health workers (promotoras) over 24 sessions. Metformin participants received 850 mg twice daily. Those randomized to standard care continued their regular medical care. MAIN OUTCOME MEASURES Weight and secondary outcomes (waist circumference, blood pressure, hemoglobin A1c, fasting plasma glucose, insulin, and lipids) were assessed at baseline and 12 months. RESULTS ILI participants demonstrated significantly greater mean weight loss (-4.0 kg, 5.0%) than metformin (-0.9 kg, 1.1%) and standard care participants (+0.8 kg, 0.9%) (p<0.001). The difference in weight loss between metformin and standard care was not significant. The ILI group experienced a greater reduction in waist circumference than standard care (p=0.001), and a marginal improvement in hemoglobin A1c compared with metformin and standard care (p=0.063). CONCLUSIONS In the first comparative effectiveness trial of diabetes prevention treatments, a 12-month ILI produced significantly greater weight loss than metformin and standard care among Latinas with prediabetes. These data suggest that ILI delivered by promotoras is an effective strategy for preventing diabetes in this high-risk group, which may be superior to metformin. Future pragmatic trials involving larger samples should examine differences in diabetes incidence associated with these treatments.
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McCurley JL, Gutierrez AP, Gallo LC. Diabetes Prevention in U.S. Hispanic Adults: A Systematic Review of Culturally Tailored Interventions. Am J Prev Med 2017; 52:519-529. [PMID: 27989451 PMCID: PMC5362335 DOI: 10.1016/j.amepre.2016.10.028] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 09/29/2016] [Accepted: 10/18/2016] [Indexed: 11/21/2022]
Abstract
CONTEXT Type 2 diabetes, prediabetes, and metabolic syndrome are highly prevalent in Hispanic individuals in the U.S. Cultural adaptations of traditional lifestyle interventions have been recommended to better reach this high-risk population. This systematic review examined the effectiveness of diabetes prevention programs for Hispanics in lowering risk for Type 2 diabetes, as evidenced by a reduction in weight or improvement in glucose regulation. EVIDENCE ACQUISITION PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, and PsycINFO were searched from database inception to June 2016 for studies that evaluated diabetes prevention trials targeting U.S. Hispanic populations. Twelve publications met criteria for inclusion. EVIDENCE SYNTHESIS Interventions varied substantially in length, rigor, and tailoring strategies. Five of 12 studies were RCTs. Eight studies included entirely or largely (>70%) female samples. All studies were delivered in Spanish and took place in community settings. Nine studies reported significant reductions in weight, and two in glucose regulation, post-intervention or when compared with controls. Effect sizes were small to moderate, study quality was moderate, and attrition was high in most trials. Interventions with the largest effect sizes included one or more of the following adaptations: literacy modification, Hispanic foods/recipes, cultural diabetes beliefs, family/friend participation, structured community input, and innovative experiential learning. CONCLUSIONS Culturally tailored lifestyle interventions for diabetes prevention appear to be modestly effective in reducing risk for diabetes in Hispanics in the U.S. More studies are needed that utilize randomized controlled designs, recruit Hispanic men, report intervention content and tailoring strategies systematically, and publish participant evaluation and feedback.
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Affiliation(s)
- Jessica L McCurley
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California.
| | - Angela P Gutierrez
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, California
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Desai J, Taylor G, Vazquez-Benitez G, Vine S, Anderson J, Garrett JE, Gilmer T, Vue-Her H, Schiff J, Rinn S, Engel K, Michael A, O'Connor PJ. Financial incentives for diabetes prevention in a Medicaid population: Study design and baseline characteristics. Contemp Clin Trials 2017; 53:1-10. [DOI: 10.1016/j.cct.2016.11.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 11/15/2016] [Accepted: 11/17/2016] [Indexed: 01/02/2023]
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Lagisetty PA, Priyadarshini S, Terrell S, Hamati M, Landgraf J, Chopra V, Heisler M. Culturally Targeted Strategies for Diabetes Prevention in Minority Population. THE DIABETES EDUCATOR 2017; 43:54-77. [PMID: 28118127 PMCID: PMC5408505 DOI: 10.1177/0145721716683811] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Purpose The purpose of this study is to (a) assess the effectiveness of culturally tailored diabetes prevention interventions in minority populations and (b) develop a novel framework to characterize 4 key domains of culturally tailored interventions. Prevention strategies specifically tailored to the culture of ethnic minority patients may help reduce the incidence of diabetes. Methods We searched PubMed, EMBASE, and CINAHL for English-language, randomized controlled trials (RCTs) or quasi-experimental (QE) trials testing culturally tailored interventions to prevent diabetes in minority populations. Two reviewers independently extracted data and assessed risk of bias. Inductive thematic analysis was used to develop a framework with 4 domains (FiLLM: Facilitating [ie, delivering] Interventions Through Language, Location, and Message). The framework was used to assess the overall effectiveness of culturally tailored interventions. Results Thirty-four trials met eligibility criteria. Twelve studies were RCTs, and 22 were QE trials. Twenty-five out of 34 studies (74%) that used cultural tailoring demonstrated significantly improved A1C, fasting glucose, and/or weight loss. Of the 25 successful interventions, 21 (84%) incorporated at least 3 culturally targeted domains. Seven studies used all 4 domains and were all successful. The least utilized domain was delivery (4/34) of the intervention's key educational message. Conclusions Culturally tailoring interventions across the 4 domains of facilitators, language, location, and messaging can be effective in improving risk factors for progression to diabetes among ethnic minority groups. Future studies should evaluate how specific tailoring approaches work compared to usual care as well as comparative effectiveness of each tailoring domain.
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Affiliation(s)
- Pooja A Lagisetty
- Department of General Internal Medicine, University of Michigan, Ann Arbor, Michigan (Dr Lagisetty, Ms Priyadarshini, Ms Terrell, Ms Hamati, Ms Landgraf, Dr Chopra, Dr Heisler)
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan (Dr Lagisetty, Dr Heisler)
| | - Shubadra Priyadarshini
- Department of General Internal Medicine, University of Michigan, Ann Arbor, Michigan (Dr Lagisetty, Ms Priyadarshini, Ms Terrell, Ms Hamati, Ms Landgraf, Dr Chopra, Dr Heisler)
| | - Stephanie Terrell
- Department of General Internal Medicine, University of Michigan, Ann Arbor, Michigan (Dr Lagisetty, Ms Priyadarshini, Ms Terrell, Ms Hamati, Ms Landgraf, Dr Chopra, Dr Heisler)
| | - Mary Hamati
- Department of General Internal Medicine, University of Michigan, Ann Arbor, Michigan (Dr Lagisetty, Ms Priyadarshini, Ms Terrell, Ms Hamati, Ms Landgraf, Dr Chopra, Dr Heisler)
| | - Jessica Landgraf
- Department of General Internal Medicine, University of Michigan, Ann Arbor, Michigan (Dr Lagisetty, Ms Priyadarshini, Ms Terrell, Ms Hamati, Ms Landgraf, Dr Chopra, Dr Heisler)
| | - Vineet Chopra
- Department of General Internal Medicine, University of Michigan, Ann Arbor, Michigan (Dr Lagisetty, Ms Priyadarshini, Ms Terrell, Ms Hamati, Ms Landgraf, Dr Chopra, Dr Heisler)
| | - Michele Heisler
- Department of General Internal Medicine, University of Michigan, Ann Arbor, Michigan (Dr Lagisetty, Ms Priyadarshini, Ms Terrell, Ms Hamati, Ms Landgraf, Dr Chopra, Dr Heisler)
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan (Dr Lagisetty, Dr Heisler)
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Kangovi S, Carter T, Charles D, Smith RA, Glanz K, Long JA, Grande D. Toward A Scalable, Patient-Centered Community Health Worker Model: Adapting the IMPaCT Intervention for Use in the Outpatient Setting. Popul Health Manag 2016; 19:380-388. [PMID: 27007164 DOI: 10.1089/pop.2015.0157] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Community health worker (CHW) programs are an increasingly popular strategy for patient-centered care. Many health care organizations are building CHW programs through trial and error, rather than implementing or adapting evidence-based interventions. This study used a qualitative design-mapping process to adapt an evidence-based CHW intervention, originally developed and tested in the hospital setting, for use among outpatients with multiple chronic conditions. The study involved qualitative in-depth, semi-structured interviews with chronically ill, uninsured, or Medicaid outpatients from low-income zip codes (n = 21) and their primary care practice staff (n = 30). Three key themes informed adaptation of the original intervention for outpatients with multiple conditions. First, outpatients were overwhelmed by their multiple conditions and wished they could focus on 1 at a time. Thus, the first major revision was to design a low-literacy decision aid that patients and providers could use to select a condition to focus on during the intervention. Second, motivation for health behavior change was a more prominent theme than in the original intervention. It was decided that in addition to providing tailored social support as in the original intervention, CHWs would help patients track progress toward their chronic disease management goals to motivate health behavior change. Third, patients were already connected to primary care; yet they still needed additional support to navigate their clinic once the intervention ended. The intervention was revised to include a weekly clinic-based support group. Structured adaptation using qualitative design mapping may allow for rapid adaptation and scale-up of evidence-based CHW interventions across new settings and populations.
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Affiliation(s)
- Shreya Kangovi
- 1 Perelman School of Medicine, University of Pennsylvania , Division of General Internal Medicine, Philadelphia, Pennsylvania
| | - Tamala Carter
- 2 Perelman School of Medicine, University of Pennsylvania , Penn Center for Community Health Workers, Philadelphia, Pennsylvania
| | - Dorothy Charles
- 3 Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Robyn A Smith
- 1 Perelman School of Medicine, University of Pennsylvania , Division of General Internal Medicine, Philadelphia, Pennsylvania
| | - Karen Glanz
- 4 Perelman School of Medicine and School of Nursing, University of Pennsylvania , Department of Biostatistics and Epidemiology, Philadelphia, Pennsylvania
| | - Judith A Long
- 1 Perelman School of Medicine, University of Pennsylvania , Division of General Internal Medicine, Philadelphia, Pennsylvania.,5 Corporal Michael J. Crescenz VA Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania
| | - David Grande
- 1 Perelman School of Medicine, University of Pennsylvania , Division of General Internal Medicine, Philadelphia, Pennsylvania
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Perez A, Alos VA, Scanlan A, Maia CM, Davey A, Whitaker RC, Foster GD, Ackermann RT, O'Brien MJ. The rationale, design, and baseline characteristics of PREVENT-DM: A community-based comparative effectiveness trial of lifestyle intervention and metformin among Latinas with prediabetes. Contemp Clin Trials 2015; 45:320-327. [PMID: 26597415 PMCID: PMC4674352 DOI: 10.1016/j.cct.2015.10.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 10/19/2015] [Accepted: 10/23/2015] [Indexed: 11/18/2022]
Abstract
Promotora Effectiveness Versus Metformin Trial (PREVENT-DM) is a randomized comparative effectiveness trial of a lifestyle intervention based on the Diabetes Prevention Program delivered by community health workers (or promotoras), metformin, and standard care. Eligibility criteria are Hispanic ethnicity, female sex, age ≥ 20 years, fluent Spanish-speaking status, BMI ≥ 23 kg/m(2), and prediabetes. We enrolled 92 participants and randomized them to one of the following three groups: standard care, DPP-based lifestyle intervention, or metformin. The primary outcome of the trial is the 12-month difference in weight between groups. Secondary outcomes include the following cardiometabolic markers: BMI, waist circumference, blood pressure, and fasting plasma glucose, hemoglobin A1C (HbA1c), total cholesterol, triglycerides, LDL cholesterol, HDL cholesterol, and insulin. PREVENT-DM participants are socioeconomically disadvantaged Latinas with a mean annual household income of $15,527 ± 9922 and educational attainment of 9.7 ± 3.6 years. Eighty-six percent of participants are foreign born, 20% have a prior history of gestational diabetes, and 71% have a first-degree relative with diagnosed diabetes. At baseline, PREVENT-DM participants had a mean age of 45.1 ± 12.5 years, weight of 178.8 ± 39.3 lbs, BMI of 33.3 ± 6.5 kg/m(2), HbA1c of 5.9 ± 0.2%, and waist circumference of 97.4 ± 11.1cm. Mean baseline levels of other cardiometabolic markers were normal. The PREVENT-DM study successfully recruited and randomized an understudied population of Latinas with prediabetes. This trial will be the first U.S. study to test the comparative effectiveness of metformin and lifestyle intervention versus standard care among prediabetic adults in a "real-world" setting.
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Affiliation(s)
- Alberly Perez
- Center for Obesity Research and Education, Temple University, 3223 North Broad Street, Suite 175, Philadelphia, PA 19140, USA; Puentes de Salud Health and Wellness Center, 1700 South Street, Philadelphia, PA 19146, USA
| | - Victor A Alos
- Center for Obesity Research and Education, Temple University, 3223 North Broad Street, Suite 175, Philadelphia, PA 19140, USA; Puentes de Salud Health and Wellness Center, 1700 South Street, Philadelphia, PA 19146, USA
| | - Adam Scanlan
- Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Catarina M Maia
- Center for Obesity Research and Education, Temple University, 3223 North Broad Street, Suite 175, Philadelphia, PA 19140, USA; Puentes de Salud Health and Wellness Center, 1700 South Street, Philadelphia, PA 19146, USA
| | - Adam Davey
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, 1301 Cecil B. Moore Avenue, Ritter Annex, 9th Floor, Philadelphia, PA 19122, USA
| | - Robert C Whitaker
- Center for Obesity Research and Education, Temple University, 3223 North Broad Street, Suite 175, Philadelphia, PA 19140, USA; Department of Epidemiology and Biostatistics, College of Public Health, Temple University, 1301 Cecil B. Moore Avenue, Ritter Annex, 9th Floor, Philadelphia, PA 19122, USA
| | - Gary D Foster
- Weight Watchers International, Inc., 675 Avenue of the Americas, 6th Floor, New York, NY 10010, USA
| | - Ronald T Ackermann
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL 60611, USA; Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 6th Floor, Chicago, IL 60611, USA
| | - Matthew J O'Brien
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL 60611, USA; Center for Community Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 6th Floor, Chicago, IL 60611, USA.
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