Development of a community-based diabetes management program for Pacific Islanders

The Role of Family Social Networks in Cardiovascular Health Behaviors Among Asian Americans, Native Hawaiians, and Pacific Islanders

Asian American, Native Hawaiians, and Other Pacific Islander (AANHPI) populations experience significant disparities in cardiovascular health. AANHPI populations also have strong, family-centered social relationships and networks. Since social networks may influence health behaviors, this review aimed to summarize research on the relationship between family social networks and cardiovascular health behaviors among AANHPI individuals. Current evidence suggests that family social network structures may play a particularly important role in smoking, dietary pattern, and physical activity behaviors among AANHPI individuals. Family networks may hinder or promote healthy behaviors through several social network mechanisms including social support, social influence, and social control. These effects vary across different AANHPI subgroups. Recommendations for future research on the role of social networks in health behaviors among AANHPI individuals are provided. Drawing on methodological advances and interventions that leverage social networks in AANHPI populations may be an avenue to improve health and reduce disparities.

Samoan migrants' perspectives on diabetes: A qualitative study

ISSUE ADDRESSED

The Samoan community in Australia has one of the highest rates of diabetes in Australia. We explored the experiences and perceptions of Samoan patients living with diabetes and their family members.

METHODS

Semi-structured interviews were conducted with adults from a Samoan background living in Australia who had diabetes and their family members. Participants were recruited from a single general practice with a high proportion of Pacific Islander patients, through self-response to waiting room flyers. Inductive thematic analysis was conducted using a constructivist-grounded theory approach. This qualitative project was part of the developmental phase of a larger project aiming to promote healthy lifestyles and decrease diabetes in the Samoan community in Sydney, Australia.

RESULTS

Twenty participants, aged 36-67 years, were interviewed. The majority was men (n = 13) and all were migrants to Australia. Participants reported a range of barriers to early detection and self-management of diabetes, including dietary practices common within their culture and the role of church and religion. They identified that pride in their heritage and role within families could be a barrier to care but also provided an opportunity for health promotion.

CONCLUSIONS

The cultural factors which influence the risk and management of diabetes in the Samoan community in Australia can be the barriers to health change but also provide opportunities for culturally targeted diabetes education and health promotion. SO WHAT?: These findings will inform the development of approaches for the prevention and management of diabetes within the Samoan-Australian community. These include health-promotion initiatives which take into account the role of cultural dietary practices, diabetes stigma, cultural pride and working with churches.

Diet and physical activity in the self-management of type 2 diabetes: barriers and facilitators identified by patients and health professionals

Aim To explore the views of individuals recently diagnosed with type 2 diabetes in relation to self-management of dietary intake and physical activity, and to compare these with the views of health professionals (HPs).

BACKGROUND

Diabetes education has become a priority area in primary and secondary care, and many education programmes are now embedded within a patient's care package. There are few contemporaneous explorations of patients' views about lifestyle self-management. Such research is vital in order to identify areas that require further support, refinement or enhancement in terms of patient education.

METHODS

Focus groups were held with patients recently diagnosed with type 2 diabetes (n = 16, 38% female, aged 45-73 years). In-depth semi-structured interviews were conducted with HPs (n = 7). Discussions focussed on self-management specifically in relation to making dietary and physical activity changes. All discussions were tape recorded, transcribed and analysed by emergent themes analysis using NVivo to manage the coded data. Findings Barriers were divided into six main categories: difficulty changing well-established habits, negative perception of the 'new' or recommended regimen, barriers relating to social circumstances, lack of knowledge and understanding, lack of motivation and barriers relating to the practicalities of making lifestyle changes. HPs generally echoed the views of patients. In conclusion, even against a background of diabetes education, recently diagnosed patients with type 2 diabetes discussed a wide range of barriers to self-management of diet and physical activity. The findings could help to provide HPs with a deeper understanding of the needs of recently diagnosed patients and may help refine current diabetes education activities and inform the development of educational resources.

Testing the efficacy of culturally adapted coping skills training for Chinese American immigrants with type 2 diabetes using community-based participatory research

Chinese Americans demonstrate greater prevalence of diabetes than non-Hispanic whites and find standard diabetes care disregards their cultural health beliefs. Academic researchers and Chinatown agencies collaborated to culturally adapt and test an efficacious cognitive-behavioral intervention using community-based participatory research. Using a delayed-treatment repeated-measures design, 145 adult Chinese immigrants with Type 2 diabetes completed treatment. Immediate benefits of treatment were evident in the improvement (p < .05) in diabetes self-efficacy, diabetes knowledge, bicultural efficacy, family emotional and instrumental support, diabetes quality of life, and diabetes distress. Prolonged benefits were evident in all changed variables 2 months post-intervention. The CBPR approach enabled the development of a culturally acceptable, efficacious behavioral intervention, and provides a model for working with communities that demonstrate health disparities.

Cooking schools improve nutrient intake patterns of people with type 2 diabetes

OBJECTIVE

To determine whether cooking classes offered by the Cooperative Extension Service improved nutrient intake patterns in people with type 2 diabetes.

DESIGN

Quasi-experimental using pretest, posttest comparisons.

SETTING

Community locations including schools, churches, and senior centers.

PARTICIPANTS

One hundred seventeen people with type 2 diabetes, from diverse ethnic and socioeconomic backgrounds.

INTERVENTION

Series of classes for people with type 2 diabetes and their family members that incorporated Social Cognitive Theory tenets. The classes featured current nutrition recommendations for people with type 2 diabetes and hands-on cooking, where participants prepared and ate a meal together.

MAIN OUTCOME MEASURES

Three-day food records, completed prior to attending cooking schools and 1 month after, were used to measure changes in energy intake and selected nutrients.

ANALYSIS

Program efficacy was assessed using the Wilcoxon signed-rank test to compare differences between pre-training and post-training variables. ANCOVA was used to determine whether program efficacy was affected by sociodemographics.

RESULTS

Participants decreased (P < .05) intakes of energy, fat grams, percentage of calories from fat, saturated fat grams, cholesterol (mg), sodium (mg), and carbohydrate grams.

CONCLUSIONS AND IMPLICATIONS

Nutrition education incorporating hands-on cooking can improve nutrient intake in people with type 2 diabetes from diverse ethnic and socioeconomic backgrounds.

Making diabetes self-management education culturally relevant for Filipino Americans in Hawaii

PURPOSE

The purpose of this study was to identify the cultural values, traditions, and perceptions of diabetes risk and self-care among Filipino Americans in Hawaii with type 2 diabetes that facilitate or impede engagement in diabetes self-management behaviors and education classes.

METHODS

This qualitative study used 2 rounds of semistructured focus groups and interviews. Participants included 15 patients with type 2 diabetes recruited from a large health-maintenance organization in Hawaii and 7 health care and cultural experts recruited from the community. The taped and transcribed focus groups and interviews were coded thematically. Participants evaluated example materials for diabetes self-management education (DSME) with Filipino Americans.

RESULTS

Several aspects of Filipino American culture were identified as central to understanding the challenges of engaging in self-management behaviors and DSME: (1) undertaking self-management while prioritizing the family and maintaining social relationships, (2) modifying diet while upholding valued symbolic and social meanings of food, (3) participating in storytelling in the face of stigma associated with diabetes, and (4) reconciling spiritual and biomedical interpretations of disease causality and its management. Respondents also emphasized the role of several qualitative aspects of perceived risk (eg, dread, control) in moderating their behaviors. Participants suggested ways to make DSME culturally relevant.

CONCLUSIONS

Awareness of cultural values and qualitative aspects of perceived risk that influence Filipino Americans' engagement in diabetes self-care behaviors and classes may help to improve teaching methods, materials, and recruitment strategies.

Cardiovascular risk factors among Chamorros

Background

Little is known regarding the cardiovascular disease risk factors among Chamorros residing in the United States.

Methods

The Chamorro Directory International and the CDC's Behavioral Risk Factor Surveillance System Questionnaire (BRFSS) were used to assess the health related practices and needs of a random sample of 228 Chamorros.

Results

Inactivity, hypertension, elevated cholesterol and diabetes mellitus were more prevalent in this Chamorro sample compared to the US average. Participants who were 50-and-older or unemployed were more likely to report hypertension, diabetes and inactivity, but they were also more likely to consume more fruits and vegetables than their younger and employed counterparts. Women were more likely to report hypertension and diabetes, whereas men were more likely to have elevated BMI and to have never had their blood cholesterol checked.

Conclusion

The study provides data that will help healthcare providers, public health workers and community leaders identify where to focus their health improvement efforts for Chamorros and create culturally competent programs to promote health in this community.

Ethnic disparities: control of glycemia, blood pressure, and LDL cholesterol among US adults with type 2 diabetes

OBJECTIVE

To examine ethnic disparities in the quality of diabetes care among adults with diabetes in the US through a systematic qualitative review.

DATA SOURCES

Material published in the English language was searched from 1993 through June 2003 using PubMed, Web of Science, Cumulative Index to Nursing and Allied Health, the Cochrane Library, Combined Health Information Database, and Education Resources Information Center.

STUDY SELECTION AND DATA EXTRACTION

Studies of patients with diabetes in which at least 50% of study participants were ethnic minorities and studies that made ethnic group comparisons were eligible. Research on individuals having prediabetes, those <18 years of age, or women with gestational diabetes were excluded. Reviewers used a reproducible search strategy. A standardized abstraction and grading of articles for publication source and content were used. Data on glycemia, blood pressure, and low-density lipoprotein cholesterol (LDL-C) were extracted in patients with diabetes. A total of 390 studies were reviewed, with 78 meeting inclusion criteria.

DATA SYNTHESIS

Ethnic minorities had poorer outcomes of care than non-Hispanic whites. These disparities were most pronounced for glycemic control and least evident for LDL-C control. Most studies showed blood pressure to be poorly controlled among ethnic minorities.

CONCLUSIONS

Control of risk factors for diabetes (glycemia, blood pressure, LDL-C) is challenging and requires routine assessment. These findings indicate that additional efforts are needed to promote diabetes quality of care among minority populations.

Barriers to the treatment of adolescent type 2 diabetes--a survey of provider perceptions

OBJECTIVE

Type 2 diabetes mellitus (T2DM) is increasingly common among children and adolescents. However, achievement of good metabolic control has been difficult in this population. The aim of this study was to survey pediatric endocrine and diabetes specialists regarding the issues they consider to be barriers to successful treatment of adolescent T2DM.

METHODS

An electronic questionnaire was administered to 220 physicians and nurses attending a conference on pediatric diabetology in 2001.

RESULTS

The issues that were most strongly perceived as barriers to successful treatment of adolescents with T2DM were prevalence of high-risk lifestyle in other family members (98%), lack of immediate risk to life reducing patient motivation (89%), lack of guidelines regarding optimal treatment (73%), prevalence of behavioral and/or psychiatric disorders (71%), and cultural/language barriers (65%). The survey also revealed that in the majority of clinics, T2DM education programs were not designed specifically for type 2 patients nor delivered by a specifically trained education team. Furthermore, despite the fact that cultural and ethnic differences were identified as important barries to care, educational materials designed for particular racial and cultural groups were used in only 37% of the clinics.

CONCLUSIONS

This survey identifies a number of areas perceived by clinicians to be significant barriers to successful treatment of T2DM in adolescent patients. Given the multiple challenges identified by the survey, programs addressed specifically to the characteristics of adolescents with T2DM will be necessary, including materials appropriate to the developmental stage and ethnic background of patients.