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Molavynejad S, Miladinia M, Jahangiri M. A randomized trial of comparing video telecare education vs. in-person education on dietary regimen compliance in patients with type 2 diabetes mellitus: a support for clinical telehealth Providers. BMC Endocr Disord 2022; 22:116. [PMID: 35501846 PMCID: PMC9063130 DOI: 10.1186/s12902-022-01032-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Compliance to dietary recommendations by patients is the most difficult part of diabetes management. The nature of any educational method is to increase patients' awareness. But the question is, what is the effect of each method and for this purpose a comparative method should be considered. Therefore, this study was conducted to compare the effects of in-person education versus video tele-education on dietary regimen compliance in patients with T2DM. METHODS In this trial, 378 patients with type 2 diabetes mellitus (T2DM) were random allocated into video tele-education, in-person education and control groups. The patients' weight and biochemical parameters were measured before educational programs and three-month later. RESULTS The mean changes of patients' weight, glycemic parameters, and Lipid profiles decreased more in the two educational groups than the control group in a three-month period. There were no significant differences in the all study variables between the in-person and video education groups in post interventions except Total Cholesterol (TC). The pre- and post-intervention changes in the weight, TC, hemoglobin A1c, Triglyceride, and Very Low-density Lipoprotein Cholesterol were significant in both in-person group and video group. None of the educational programs had a significant impact on the Fasting blood sugar, Low-Density Lipoprotein Cholesterol, and High-Density Lipoprotein Cholesterol. DISCUSSION Video tele-education was just as effective as in-person educational method on dietary regimen compliance among patients with T2DM in a three-month period. Therefore, it is recommended to use video tele-education in combination with or as an alternative to the in-person education method. This study provides support for diabetes educator. TRIAL REGISTRATION This investigation was registered in the Iranian Registry of Clinical Trials Center ( IRCT20150302021307N4 ).
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Affiliation(s)
- Shahram Molavynejad
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mojtaba Miladinia
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Mina Jahangiri
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Chaet AV, Morshedi B, Wells KJ, Barnes LE, Valdez R. Spanish-Language Consumer Health Information Technology Interventions: A Systematic Review. J Med Internet Res 2016; 18:e214. [PMID: 27511437 PMCID: PMC4997005 DOI: 10.2196/jmir.5794] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 06/22/2016] [Accepted: 07/08/2016] [Indexed: 11/15/2022] Open
Abstract
Background As consumer health information technology (IT) becomes more thoroughly integrated into patient care, it is critical that these tools are appropriate for the diverse patient populations whom they are intended to serve. Cultural differences associated with ethnicity are one aspect of diversity that may play a role in user-technology interactions. Objective Our aim was to evaluate the current scope of consumer health IT interventions targeted to the US Spanish-speaking Latino population and to characterize these interventions in terms of technological attributes, health domains, cultural tailoring, and evaluation metrics. Methods A narrative synthesis was conducted of existing Spanish-language consumer health IT interventions indexed within health and computer science databases. Database searches were limited to English-language articles published between January 1990 and September 2015. Studies were included if they detailed an assessment of a patient-centered electronic technology intervention targeting health within the US Spanish-speaking Latino population. Included studies were required to have a majority Latino population sample. The following were extracted from articles: first author’s last name, publication year, population characteristics, journal domain, health domain, technology platform and functionality, available languages of intervention, US region, cultural tailoring, intervention delivery location, study design, and evaluation metrics. Results We included 42 studies in the review. Most of the studies were published between 2009 and 2015 and had a majority percentage of female study participants. The mean age of participants ranged from 15 to 68. Interventions most commonly focused on urban population centers and within the western region of the United States. Of articles specifying a technology domain, computer was found to be most common; however, a fairly even distribution across all technologies was noted. Cancer, diabetes, and child, infant, or maternal health were the most common health domains targeted by consumer health IT interventions. More than half of the interventions were culturally tailored. The most frequently used evaluation metric was behavior/attitude change, followed by usability and knowledge retention. Conclusions This study characterizes the existing body of research exploring consumer health IT interventions for the US Spanish-speaking Latino population. In doing so, it reveals three primary needs within the field. First, while the increase in studies targeting the Latino population in the last decade is a promising advancement, future research is needed that focuses on Latino subpopulations previously overlooked. Second, preliminary steps have been taken to culturally tailor consumer health IT interventions for the US Spanish-speaking Latino population; however, focus must expand beyond intervention content. Finally, the field should work to promote long-term evaluation of technology efficacy, moving beyond intermediary measures toward measures of health outcomes.
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Affiliation(s)
- Alexis V Chaet
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
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Brown SA, Kouzekanani K, García AA, Orlander PR, Hanis CL. Diabetes self-management and leptin in Mexican Americans with type 2 diabetes: the Starr County border health initiative. THE DIABETES EDUCATOR 2013; 39:820-7. [PMID: 24047926 PMCID: PMC8359772 DOI: 10.1177/0145721713505153] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE The purpose of the study was to (1) characterize leptin in Mexican Americans with poorly controlled type 2 diabetes, (2) examine relationships among leptin and indicators of diabetes status (body mass index and A1C), and (3) explore the effects of a culturally tailored diabetes self-management education intervention on leptin. METHODS In Starr County, an impoverished Texas-Mexico border community, 252 Mexican Americans with type 2 diabetes were recruited to test a diabetes self-management education intervention culturally tailored in terms of language, dietary recommendations, social emphasis, family participation, and incorporation of cultural health beliefs. Groups of 8 participants were randomized to experimental or wait-listed control conditions. Outcomes were measured at 3, 6, and 12 months; by 12 months, 109 had complete leptin data. RESULTS Most participants were women and, on average, 55 years of age, diagnosed with diabetes for 8 years, obese, and in poor glycemic control. Three variables-body mass index, sex, A1C-explained 36% of the variance in baseline leptin; there were no intervention effects on leptin. Sex, time, and gender × time interaction effects on leptin were statistically significant; greater increases in leptin over time occurred in women compared to men. In women, fasting blood glucose changes from baseline to 12 months significantly predicted leptin changes from baseline to 12 months; in men, body mass index changes predicted leptin change. CONCLUSIONS With increasing obesity rates, further research is warranted to determine if leptin is a useful intervention target in type 2 diabetes.
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Affiliation(s)
- Sharon A Brown
- School of Nursing, The University of Texas at Austin, TX, USA (Dr Brown, Prof García)
| | | | - Alexandra A García
- School of Nursing, The University of Texas at Austin, TX, USA (Dr Brown, Prof García)
| | - Philip R Orlander
- The University of Texas Medical School at Houston, TX, USA (Dr Orlander)
| | - Craig L Hanis
- The University of Texas Health Science Center at Houston, TX, USA (Prof Hanis)
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Hawthorne K, Robles Y, Cannings-John R, Edwards AG. Culturally appropriate health education for type 2 diabetes mellitus in ethnic minority groups. Cochrane Database Syst Rev 2008:CD006424. [PMID: 18646153 DOI: 10.1002/14651858.cd006424.pub2] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Ethnic minority groups in upper-middle and high income countries tend to be socio-economically disadvantaged and to have higher prevalence of type 2 diabetes than the majority population. OBJECTIVES To assess the effectiveness of culturally appropriate diabetes health education on important outcome measures in type 2 diabetes. SEARCH STRATEGY We searched the The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, ERIC, SIGLE and reference lists of articles. We also contacted authors in the field and handsearched commonly encountered journals. SELECTION CRITERIA RCTs of culturally appropriate diabetes health education for people over 16 years with type 2 diabetes mellitus from named ethnic minority groups resident in upper-middle or high income countries. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial quality and extracted data. Where there were disagreements in selection of papers for inclusion, all four authors discussed the studies. We contacted study authors for additional information when data appeared to be missing or needed clarification. MAIN RESULTS Eleven trials involving 1603 people were included, with ten trials providing suitable data for entry into meta-analysis. Glycaemic control (HbA1c), showed an improvement following culturally appropriate health education at three months (weight mean difference (WMD) - 0.3%, 95% CI -0.6 to -0.01), and at six months (WMD -0.6%, 95% CI -0.9 to -0.4), compared with control groups who received 'usual care'. This effect was not significant at 12 months post intervention (WMD -0.1%, 95% CI -0.4 to 0.2). Knowledge scores also improved in the intervention groups at three months (standardised mean difference (SMD) 0.6, 95% CI 0.4 to 0.7), six months (SMD 0.5, 95% CI 0.3 to 0.7) and twelve months (SMD 0.4, 95% CI 0.1 to 0.6) post intervention. Other outcome measures both clinical (such as lipid levels, and blood pressure) and patient centred (quality of life measures, attitude scores and measures of patient empowerment and self-efficacy) showed no significant improvement compared with control groups. AUTHORS' CONCLUSIONS Culturally appropriate diabetes health education appears to have short term effects on glycaemic control and knowledge of diabetes and healthy lifestyles. None of the studies were long-term, and so clinically important long-term outcomes could not be studied. No studies included an economic analysis. The heterogeneity of studies made subgroup comparisons difficult to interpret with confidence. There is a need for long-term, standardised multi-centre RCTs that compare different types and intensities of culturally appropriate health education within defined ethnic minority groups.
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Affiliation(s)
- Kamila Hawthorne
- Department of Primary Care and Public Health, Cardiff University, 3rd Floor, Neuadd Meirionnydd Building. School of Medicine, Heath Park, Cardiff, UK, CF14 4XN
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Metghalchi S, Rivera M, Beeson L, Firek A, De Leon M, Balcazar H, Cordero-MacIntyre ZR. Improved clinical outcomes using a culturally sensitive diabetes education program in a Hispanic population. THE DIABETES EDUCATOR 2008; 34:698-706. [PMID: 18669812 PMCID: PMC2779017 DOI: 10.1177/0145721708320913] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the effects of a culturally sensitive diabetes education program for Hispanics with type 2 diabetes. METHODS This study is a prospective cohort study to test the impact of a comprehensive diabetes education program on blood glucose control on Hispanics with type 2 diabetes. The educational program focused on maintaining glycemic control and general aspects of managing diabetes and complications. The study participants were recruited by flyers placed in Hispanic markets and in ambulatory care clinics. A total of 34 Hispanic male and female subjects with type 2 diabetes participated in the study. The concentrations of glucose, insulin, hemoglobin A1c (HbA1c), total cholesterol, triglycerides, low-density lipoprotein and high-density lipoprotein (HDL) cholesterol were analyzed at baseline and at 3 months. RESULTS A significant mean change was observed for HbA1c, fasting plasma glucose, cholesterol/HDL ratio, and HDL after 3 months of education compared with baseline. There were significant reductions in weight, total fat, percent fat, trunk fat, and waist-to-hip ratio compared with baseline. After 3 months, subjects showed a significant positive correlation between changes in body mass index and insulin and weight, total fat, trunk fat, and fat free mass and insulin. CONCLUSIONS A culturally sensitive program conducted in Spanish had a significant impact on important clinical parameters in Hispanic subjects with diabetes in a relatively short time period. The study demonstrates the importance of designing education intervention studies that are sensitive to cultural diversity, particularly in at-risk diabetic subjects.
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Affiliation(s)
- Shiva Metghalchi
- The Department of Epidemiology and Biostatistics in the School of Public Health (Mr Metghalchi, Ms Rivera, Dr Beeson)
| | - Maribet Rivera
- The Department of Epidemiology and Biostatistics in the School of Public Health (Mr Metghalchi, Ms Rivera, Dr Beeson)
| | - Larry Beeson
- The Department of Epidemiology and Biostatistics in the School of Public Health (Mr Metghalchi, Ms Rivera, Dr Beeson)
| | | | - Marino De Leon
- Center for Health Disparities and Molecular Medicine (Dr De Leon, Dr Cordero- MacIntyre)
- Nutrition Department in the School of Public Health (Dr De Leon, Dr Cordero-MacIntyre)
| | - Hector Balcazar
- Loma Linda University, Loma Linda, California, and Department of Social and Behavioral Sciences, School of Public Health, University of North Texas, Fort Worth, Texas (Dr Balcazar)
| | - Zaida R Cordero-MacIntyre
- Center for Health Disparities and Molecular Medicine (Dr De Leon, Dr Cordero- MacIntyre)
- Nutrition Department in the School of Public Health (Dr De Leon, Dr Cordero-MacIntyre)
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Fain JA. Psychometric properties of the Spanish Version of the Diabetes Self-management Assessment Report Tool. DIABETES EDUCATOR 2008; 33:827-32. [PMID: 17925586 DOI: 10.1177/0145721707308355] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study is to evaluate the psychometric properties of a Spanish-language version of the Diabetes Self-management Assessment Report Tool (D-SMART) for Hispanics with type 2 diabetes. METHODS Participants were 174 Hispanics from the Worcester Family Health Center diagnosed with type 2 diabetes. Reliability testing was conducted to determine the internal consistency and stability of the newly revised Spanish-language version of the D-SMART. RESULTS Psychometric findings support the reliability of the newly translated Spanish-language version of the D-SMART. CONCLUSIONS The newly revised Spanish-language version of the D-SMART provides educators with a culturally relevant measure of diabetes self-management along with a better understanding about how Hispanics perceive their diabetes and self-management practices.
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Affiliation(s)
- James A Fain
- University of Massachusetts Dartmouth, College of Nursing, 285 Old Westport Road, North Dartmouth, MA 02747, USA.
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Lorig K, Ritter PL, Villa F, Piette JD. Spanish diabetes self-management with and without automated telephone reinforcement: two randomized trials. Diabetes Care 2008; 31:408-14. [PMID: 18096810 DOI: 10.2337/dc07-1313] [Citation(s) in RCA: 175] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine 1) whether participants in the Spanish Diabetes Self-Management Program (SDSMP), when compared at 6 months to randomized control subjects, would demonstrate improvements in health status, health behaviors, and self-efficacy; and 2) whether SDSMP participants receiving monthly automated telephone reinforcement would maintain improvements at 18 months better than those not receiving reinforcement. RESEARCH DESIGN AND METHODS A total of 567 Spanish-speaking adults with type 2 diabetes were randomized to a usual-care control group or 6-week community-based, peer-led SDSMP. SDSMP participants were re-randomized to receive 15 months of automated telephone messages or no reinforcement. A1C was measured at baseline and 6 and 18 months. All other data were collected by self-administered questionnaires. RESULTS At 6 months SDSMP participants compared with control subjects demonstrated improvements in A1C (-0.4%), health distress, symptoms of hypo- and hyperglycemia, and self-efficacy (P < 0.05). At 18 months all improvements persisted (P < 0.05). SDSMP participants also demonstrated improvements in self-rated health and communication with physicians, had fewer emergency room visits (-0.18 visits in 6 months, P < 0.05), and trended toward fewer visits to physicians. At 18 months the only difference between reinforced and nonreinforced participants was increased glucose monitoring for the reinforcement group. CONCLUSIONS The SDSMP demonstrated effectiveness in lowering A1C and improving health status. Reinforcement did not add to its effectiveness. Given the high needs of the Spanish-speaking population, the SDSMP deserves consideration for implementation.
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Affiliation(s)
- Kate Lorig
- Stanford University School of Medicine, 2000 Welch Rd., Ste. 204, Palo Alto, California 40304, USA
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Rosal MC, Goins KV, Carbone ET, Cortes DE. Views and preferences of low-literate Hispanics regarding diabetes education: results of formative research. HEALTH EDUCATION & BEHAVIOR 2004; 31:388-405. [PMID: 15155047 DOI: 10.1177/1090198104263360] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hispanics are twice as likely as non-Hispanic Whites to have diabetes and are also at higher risk for diabetes-related complications and poorer outcomes. The prevalence of diabetes is inversely related to educational status. Low literacy is common, especially among older Hispanics. Little literature exists on formative research to create diabetes education materials for this audience. Two focus groups assessed views and preferences for diabetes education of low-literate, low-income, non-English-speaking urban Caribbean and Central American Hispanics with diabetes, as well as utility of materials developed specifically for this population, as part of the preliminary work for a pilot study of a diabetes intervention. Implications for practitioners and researchers are discussed.
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Affiliation(s)
- Milagros C Rosal
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA.
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Benavides-Vaello S, Garcia AA, Brown SA, Winchell M. Using focus groups to plan and evaluate diabetes self-management interventions for Mexican Americans. DIABETES EDUCATOR 2004; 30:238, 242-4, 247-50 passim. [PMID: 15095514 DOI: 10.1177/014572170403000217] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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10
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Morgan BS, Buscemi CP, Fajardo VP. Assessing instruments in a Cuban American population with type 2 diabetes mellitus. J Transcult Nurs 2004; 15:139-46. [PMID: 15070496 DOI: 10.1177/1043659603262487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The purposes of this pilot study were to identify and adapt instruments for future use in assessing diabetes self-management in a sample of Cuban Americans with Type 2 diabetes. Eight instruments were selected from the literature, translated into Spanish, and administered to a sample of 20 Cuban Americans with Type 2 diabetes. Psychometric properties were examined along with clarity of wording, cultural appropriateness, and ease of use. Reliability data were compared, when possible, with original scores generated with non-Cuban populations. Results indicated that reliability scores among populations were similar. Support for using these instruments in clinical practice to assess initial knowledge and beliefs about aspects of diabetes management and to monitor changes is provided.
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von Goeler DS, Rosal MC, Ockene JK, Scavron J, De Torrijos F. Self-management of type 2 diabetes: a survey of low-income urban Puerto Ricans. DIABETES EDUCATOR 2003; 29:663-72. [PMID: 13677177 DOI: 10.1177/014572170302900412] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE This study explored self-reported barriers to diabetes self-management in a population of urban, low-income Puerto Rican individuals. METHODS A cross-sectional exploratory survey was conducted with 30 Puerto Rican adults with type 2 diabetes. Participants were randomly selected and recruited from a health center, an elder center, and a community outreach database. A survey was used to assess participants' diabetes-related knowledge, attitudes, and patterns of and barriers to self-management. RESULTS Participants were older and had limited education and good access to health care. Although two thirds had participated in diabetes education, most demonstrated major deficits in diabetes knowledge. Negative attitudes about living with diabetes were common as was dietary knowledge and nonadherence. Most participants were overweight or obese, did regular self-monitoring of blood glucose but did not use the results to improve their diabetes control, and frequently missed doses of their diabetes medications. Self-reported barriers to self-management were financial and social obstacles and competing health and family concerns. CONCLUSIONS The knowledge and self-management behaviors in this population of Puerto Rican individuals with type 2 diabetes need to be improved.
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Affiliation(s)
- Dorothea S von Goeler
- The Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester (Dr von Goeler)
| | - Milagros C Rosal
- The Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester (Drs Rosal and Ockene and Mr De Torrijos)
| | - Judith K Ockene
- The Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester (Drs Rosal and Ockene and Mr De Torrijos)
| | - Jeffrey Scavron
- The Department of Medicine, Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts (Dr Scavron)
| | - Fernando De Torrijos
- The Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester (Drs Rosal and Ockene and Mr De Torrijos)
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Abstract
OBJECTIVE The purpose of this study was to describe the development and testing of a videotape intervention for sexual counseling after myocardial infarction (MI). INTERVENTION A videotape was developed as a research intervention for sexual counseling after MI. The concepts of sexual integrity, quality of life, and stress and coping were key concepts underpinning the intervention. This article describes the development of the videotape and its content, including considerations for planning, testing, and producing a videotape for research. The videotape intervention is currently being used in a study of patients with MI who are pretested while hospitalized and posttested at 1, 3, and 5 months after MI. Subjects in the treatment group receive the videotape to view in the privacy of their home. Control subjects receive the videotape after the 5-month follow-up period. All subjects receive the usual written and verbal instructions while hospitalized. OUTCOME MEASURES The 5 outcome variables tested in the study with the videotape are quality of life, knowledge, anxiety, sexual satisfaction, and return to sexual activity. CONCLUSION The use of a videotape intervention in the home setting provides an additional method of patient education. This approach appears ideal for this sensitive topic.
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Affiliation(s)
- Elaine E Steinke
- School of Nursing, Wichita State University, 1845 Fairmount, Wichita, KS 67260-0041, USA
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Brown SA, Becker HA, Garcia AA, Barton SA, Hanis CL. Measuring health beliefs in Spanish-speaking Mexican Americans with type 2 diabetes: adapting an existing instrument. Res Nurs Health 2002; 25:145-58. [PMID: 11933008 DOI: 10.1002/nur.10023] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Mexican Americans bear a disproportionate burden of type 2 diabetes, and although clinicians and researchers are beginning to develop culturally competent interventions, few instruments are available for measuring variables relevant to health outcomes. The purpose of this study was to determine the psychometric properties of a diabetes-related health belief instrument translated for use with Spanish-speaking Mexican Americans. Three hundred and twenty-six Spanish-speaking Mexican Americans from Starr County, a Texas-Mexico border community, diagnosed with type 2 diabetes participated in the study. Factor analysis was used to examine the factor structure of the instrument, and reliability testing was conducted to determine the internal consistency of the resulting factors. The final instrument had 25 items with four subscales-Barriers, Social Support for Diet, Impact of Job on Therapy, and Benefits of Therapy-and one item to measure, Control. Internal consistency coefficients for these subscales were .56, .62, .86, and .90, respectively. The translated instrument needs to be tested over time with other Hispanic populations.
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Affiliation(s)
- Sharon A Brown
- University of Texas at Austin School of Nursing, Austin, TX, USA
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Brown SA, Becker HA, Garcia AA, Barton SA, Hanis CL. Measuring health beliefs in Spanish-speaking Mexican Americans with type 2 diabetes: Adapting an existing instrument. Res Nurs Health 2002. [DOI: 10.1002/nur.10023 [pii]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Abstract
Evaluating conceptual and methodological issues are important considerations when developing a videotape for research intervention. The process of developing a videotape for research involves several critical steps to maintain scientific rigor during the project. Establishing content validity of the videotape script and maintaining scientific integrity while producing the videotape are key components. Issues such as copyright and intellectual property are important considerations. The use of videotape provides a consistent method of providing information to research subjects. Careful attention to the research process during each phase of development of the videotape will enhance the success of the project.
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Affiliation(s)
- E E Steinke
- School of Nursing, Wichita State University, Wichita, Kansas, USA
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Norris SL, Engelgau MM, Narayan KM. Effectiveness of self-management training in type 2 diabetes: a systematic review of randomized controlled trials. Diabetes Care 2001; 24:561-87. [PMID: 11289485 DOI: 10.2337/diacare.24.3.561] [Citation(s) in RCA: 1193] [Impact Index Per Article: 51.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To systematically review the effectiveness of self-management training in type 2 diabetes. RESEARCH DESIGN AND METHODS MEDLINE, Educational Resources Information Center (ERIC), and Nursing and Allied Health databases were searched for English-language articles published between 1980 and 1999. Studies were original articles reporting the results of randomized controlled trials of the effectiveness of self-management training in people with type 2 diabetes. Relevant data on study design, population demographics, interventions, outcomes, methodological quality, and external validity were tabulated. Interventions were categorized based on educational focus (information, lifestyle behaviors, mechanical skills, and coping skills), and outcomes were classified as knowledge, attitudes, and self-care skills; lifestyle behaviors, psychological outcomes, and quality of life; glycemic control; cardiovascular disease risk factors; and economic measures and health service utilization. RESULTS A total of 72 studies described in 84 articles were identified for this review. Positive effects of self-management training on knowledge, frequency and accuracy of self-monitoring of blood glucose, self-reported dietary habits, and glycemic control were demonstrated in studies with short follow-up (<6 months). Effects of interventions on lipids, physical activity, weight, and blood pressure were variable. With longer follow-up, interventions that used regular reinforcement throughout follow-up were sometimes effective in improving glycemic control. Educational interventions that involved patient collaboration may be more effective than didactic interventions in improving glycemic control, weight, and lipid profiles. No studies demonstrated the effectiveness of self-management training on cardiovascular disease-related events or mortality; no economic analyses included indirect costs; few studies examined health-care utilization. Performance, selection, attrition, and detection bias were common in studies reviewed, and external generalizability was often limited. CONCLUSIONS Evidence supports the effectiveness of self-management training in type 2 diabetes, particularly in the short term. Further research is needed to assess the effectiveness of self-management interventions on sustained glycemic control, cardiovascular disease risk factors, and ultimately, microvascular and cardiovascular disease and quality of life.
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Affiliation(s)
- S L Norris
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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Smith CE, Holcroft C, Rebeck SL, Thompson NC, Werkowitch M. Journal writing as a complementary therapy for reactive depression: a rehabilitation teaching program. Rehabil Nurs 2000; 25:170-6. [PMID: 11998082 DOI: 10.1002/j.2048-7940.2000.tb01901.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Brief, recurrent, reactive, or situational depression is a common and costly comorbidity that affects chronically ill patients and their family members. This article describes a program that teaches those individuals how to monitor and cope with symptoms of depression by writing daily in a journal. Twenty patients and family members attended teaching sessions at which videotaped scenes of other patients managing symptoms of depression were shown. After viewing the six scenes, participants wrote about their reactions to each scene and listed the emotions they had experienced that were similar to those shown in the tape. They were then asked to record daily for 4 months their emotions and reactions to situations and to also daily self-rate their levels of energy. They were also provided with a list of recommended activities in which to engage when they were depressed. Two psychiatric nurses evaluated the writings and concluded that the program was influential in helping patients and families overcome many emotionally draining reactions to adverse circumstances.
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Affiliation(s)
- C E Smith
- School of Nursing, University of Kansas Medical Center, Kansas City, KS, USA
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Brown SA, Harrist RB, Villagomez ET, Segura M, Barton SA, Hanis CL. Gender and treatment differences in knowledge, health beliefs, and metabolic control in Mexican Americans with type 2 diabetes. DIABETES EDUCATOR 2000; 26:425-38. [PMID: 11151290 DOI: 10.1177/014572170002600310] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this project was to describe metabolic control, knowledge, and health beliefs of Mexican Americans with type 2 diabetes. METHODS The study site was Starr County, Texas, a border community located on the Rio Grande River and bordering northern Mexico. Of the total sample of 360 persons, 252 agreed to participate in this intervention study and were randomized either to the treatment group or the control group that waited 1 year to begin the intervention. RESULTS The majority of individuals were Spanish-speaking females with a mean age of 54 years and a mean diabetes duration of 8 years. For those treated with diet only, males exhibited higher fasting blood glucose levels than females. Gender effects were seen for cholesterol level, with females exhibiting higher levels than males. Males expressed stronger perceptions of control and social support for diet. Bivariate relationships were found between acculturation and diabetes knowledge. The health belief subscales of control and impact on job together explained 16% of the variance in HbA1c values. CONCLUSIONS Males and females held differing beliefs about ability to control their diabetes and degree of social support for diet. The impact of gender differences on ability to integrate diabetes self-care and on effectiveness of diabetes programs has not been determined but should be considered in future research.
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Affiliation(s)
- S A Brown
- The University of Texas at Austin, The University of Texas Health Science Center at Houston (Dr Brown)
| | - R B Harrist
- School of Public Health, The University of Texas Health Science Center at Houston (Dr Harrist and Ms Barton)
| | - E T Villagomez
- Bayer Pharmaceutical Company, San Antonio, Texas (Ms Villagomez)
| | - M Segura
- Starr County Memorial Hospital, Rio Grande City, Texas (Mr Segura)
| | - S A Barton
- School of Public Health, The University of Texas Health Science Center at Houston (Dr Harrist and Ms Barton)
| | - C L Hanis
- The Human Genetics Center, The University of Texas Health Science Center at Houston (Dr Hanis)
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Fain JA, Nettles A, Funnell MM, Charron D. Diabetes patient education research: an integrative literature review. DIABETES EDUCATOR 1999; 25:7-15. [PMID: 10711080 DOI: 10.1177/014572179902500618] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this study is to summarize the accumulated state of knowledge in the area of diabetes patient education research and highlight important issues that research has left unanswered. METHODS An integrative literature review was conducted on the topic of diabetes patient education between the years 1985 and 1998. Keywords used in the computerized search were diabetes mellitus, patient education, health education, research, and behavior change. The databases searched were MEDLINE, CINAHL, HealthSTAR, EMBASE, and CHID-HE. A total of 78 papers were reviewed. RESULTS Most studies lacked a theoretical framework and the majority of studies were conducted in an outpatient setting. HbA1c was the most frequently employed outcome measure, with little, if any, description of the interventions. CONCLUSIONS Much has been learned in terms of the effectiveness of diabetes education on improving knowledge. However, other topic areas and outcomes need further exploration.
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Affiliation(s)
- J A Fain
- The University of Massachusetts Medical Center, Graduate School of Nursing, Worcester (Dr Fain)
| | - A Nettles
- Ms Nettles was chair of the 1999 Research Summit Planning Committee and is a healthcare consultant in Wayzata, Minnesota
| | - M M Funnell
- University of Michigan DRTC, Ann Arbor (Ms Funnell)
| | - D Charron
- University of Pittsburgh School of Nursing, Health Promotion and Development, Pennsylvania (Dr Charron Prochownik)
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Brown SA, Hanis CL. Culturally competent diabetes education for Mexican Americans: the Starr County Study. DIABETES EDUCATOR 1999; 25:226-36. [PMID: 10531848 DOI: 10.1177/014572179902500208] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Few culturally competent health programs have been designed for Mexican Americans, a group that bears a disproportionate burden of Type 2 diabetes. In Starr County, a Texas-Mexico border community, investigators designed and tested a culturally competent intervention aimed at improving the health of this target population. The purpose of this article is to describe the development process of this diabetes education and support group intervention. METHODS The development stages were (1) community assessment, (2) intervention design, (3) selection or development of outcomes, (4) pilot testing, and (5) a randomized clinical investigation. RESULTS Focus group participants identified knowledge deficits regarding diabetes and self-management strategies, and suggested characteristics of an effective intervention for Mexican Americans. Outcome measures included metabolic control indicators, a newly developed knowledge instrument, and an existing health belief instrument. Preliminary analyses indicated that the intervention was successful in significantly improving metabolic control in the target population. CONCLUSIONS Developing successful diabetes interventions for minority groups requires a number of stages, careful planning, assessment of cultural characteristics of the target population, and a systematic approach to implementation.
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Affiliation(s)
- S A Brown
- The School of Nursing, The University of Texas at Austin (Dr Brown)
| | - C L Hanis
- The Human Genetics Center, The University of Texas Health Science Center at Houston (Dr Hanis)
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O'Donnell CR, O'Donnell L, San Doval A, Duran R, Labes K. Reductions in STD infections subsequent to an STD clinic visit. Using video-based patient education to supplement provider interactions. Sex Transm Dis 1998; 25:161-8. [PMID: 9524995 DOI: 10.1097/00007435-199803000-00010] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Video-based patient education has been effective in a variety of clinical settings. The authors studied the efficacy of a video-based educational intervention in an inner-city public sexually transmitted diseases (STD) clinic. GOAL To evaluate the efficacy of video-based patient education in reducing STD infections subsequent to a clinic visit. DESIGN African-American and Hispanic men attending a large public STD clinic were assigned at random to either an experimental video-based educational intervention or a control condition in which they received regular clinic services. Patients in the experimental group were exposed to video-based interventions that provided information about STDs and their prevention, portrayed positive attitudes about condom use, and modeled appropriate strategies for encouraging condom use in different sexual relationships. During 1992, 2,004 subjects were tracked for an average of 17 months through the New York City STD surveillance database for the occurrence of new STD infections. RESULTS The overall rate of new infection among male STD clinic patients was 24.2%. Rate of new infection was significantly lower among those exposed to video-based prevention education than among controls (22.5% compared with 26.8%, p < .05). Subjects reporting multiple sex partners had a significantly higher new infection rate but also experienced the greatest impact of educational intervention. There was a 32.2% new infection rate among high-risk controls compared with a 24.8% rate among high-risk intervention groups (p < 0.025). CONCLUSION Results of this randomized clinical trial indicate that using video-based patient education to supplement regular STD clinic services and provider interactions can be effective in reducing rates of new STD infection, particularly among those at greatest risk.
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Affiliation(s)
- C R O'Donnell
- Education Development Center Inc., Newton, Massachusetts, USA
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22
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Kalichman SC. HIV-AIDS prevention videotapes: A review of empirical findings. J Prim Prev 1996; 17:259-79. [DOI: 10.1007/bf02248795] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Steinberg TG, Diercks MJ, Millspaugh J. An evaluation of the effectiveness of a videotape for discharge teaching of organ transplant recipients. JOURNAL OF TRANSPLANT COORDINATION : OFFICIAL PUBLICATION OF THE NORTH AMERICAN TRANSPLANT COORDINATORS ORGANIZATION (NATCO) 1996; 6:59-63. [PMID: 9188359 DOI: 10.7182/prtr.1.6.2.e720443244wxv3p1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Patients' understanding of discharge teaching is an essential factor for compliance with medications and follow-up care after an organ transplant. This study compared the knowledge gained by the current method of individualized discharge teaching with that same teaching method plus a videotape. Fifty participants were assigned alternately to two groups. A written test was used to assess knowledge after teaching. Test scores indicated that the two methods were equally effective. Qualitative data gathered during interviews indicated that both groups were equally satisfied with their education. It was concluded that videotaped education is an acceptable and effective strategy when used in conjunction with other methods. Varying the medium for education will meet the unique learning needs of more patients.
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Fleming C, Simmons D, Leakehe L, Voyle J. Ethnic differences in the perception of a video developed for a multiethnic diabetes prevention programme in south Auckland, New Zealand. Diabet Med 1995; 12:701-7. [PMID: 7587010 DOI: 10.1111/j.1464-5491.1995.tb00573.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Videos were developed to help increase diabetes awareness among local Maori, Pacific Islands and European communities. The Maori and Pacific Islands versions incorporated modifications to the basic content to make them more appropriate for the target audience. Lay audiences, comprising 108 Europeans, 94 Maori and 90 Pacific Islands people in 12 different sites, viewed the version of the video tailored to their ethnic group. The Maori version was also viewed by 32 Diabetes Nurse Specialists. Likert scale ratings and open-ended questions were used to evaluate the video. The video was rated highly by all audiences and most subjects were able to repeat the main messages of the video. Compared with Maori and Pacific Islands subjects, Europeans found the video the easiest to understand but gained the least information. Maori and Pacific Islands subjects would have preferred a longer video ( > 17 minutes). Different viewing sites revealed evidence of within-ethnic-group heterogeneity. Pacific Islands subjects particularly appreciated the educational components, while Maori and Europeans were more likely to comment on presentation. Audio-visual material is perceived differently by different ethnic groups, such differences need to be addressed when embarking on diabetes awareness campaigns.
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Affiliation(s)
- C Fleming
- Department of Medicine, Middlemore Hospital, Auckland, New Zealand
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Brown SA, Hanis CL. A community-based, culturally sensitive education and group-support intervention for Mexican Americans with NIDDM: a pilot study of efficacy. DIABETES EDUCATOR 1995; 21:203-10. [PMID: 7758387 DOI: 10.1177/014572179502100307] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The purpose of this study was to determine the feasibility of providing a diabetes patient education and group-support intervention that was directed by a Mexican-American clinical nurse specialist (CNS), dietitian, and community worker; consistent with national standards; and designed for the Mexican-American culture. In a rural Texas-Mexico border community, subjects with diabetes were randomly selected to participate in the intervention, and a family member of each subject participated as a support person. The intervention involved 8 weeks of educational sessions with instruction on nutrition, blood glucose self-monitoring, exercise, and other diabetes self-management topics, and provided group support. Group discussion was facilitated using a series of Spanish-language videotapes that had been developed and previously tested in the target Mexican-American community. Results suggested statistically significant improvements in diabetes knowledge, fasting blood sugar levels, and glycosylated hemoglobin levels. The study documented the feasibility and potential benefits of the intervention.
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Elshaw EB, Young EA, Saunders MJ, McGurn WC, Lopez LC. Utilizing a 24-hour dietary recall and culturally specific diabetes education in Mexican Americans with diabetes. DIABETES EDUCATOR 1994; 20:228-35. [PMID: 7851238 DOI: 10.1177/014572179402000309] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Two objectives were established for this study: 1) to assess the impact of a culturally specific, intensive diabetes education program on dietary patterns, and 2) to assess nutrient consumption relative to the Recommended Dietary Allowances. The study population consisted of elderly Mexican Americans with diabetes living in Harlingen and Brownsville, Texas. The experimental group (n = 78) participated in an intense, 2-hour nutrition education session, while the control group (n = 74) did not. The education session was conducted for groups of eight subjects via videotapes and interactive discussion. All groups experienced significant weight loss except the women in the experimental group. After the education program, however, the experimental women had increased the percentage of calories consumed daily from carbohydrate. Mean calcium consumption was substantially less than the RDA in all groups, and inadequate amounts of ascorbic acid and vitamin A often were consumed. Intensive, frequent, long-term follow-up appears essential for more sustained results.
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