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Wallace DD, Then-Paulino A, Jiménez Paulino G, Tejada Castro F, Castro SD, Palar K, Derose KP. The co-management of HIV and chronic non-communicable diseases in the Dominican Republic: A qualitative study. PLoS One 2023; 18:e0288583. [PMID: 37440525 PMCID: PMC10343047 DOI: 10.1371/journal.pone.0288583] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/01/2023] [Indexed: 07/15/2023] Open
Abstract
People living with HIV and a non-communicable disease (NCD) experience multi-level barriers when co-managing multiple conditions. We explored the factors affecting living with multiple chronic conditions in the Dominican Republic. We conducted 21 in-depth interviews from October 2019-February 2020 with Dominican adults who participated in a food security intervention and managed HIV and at least one chronic NCD. Using thematic analysis, we explored participant lived experiences co-managing multiple chronic conditions. All participants (mean age = 45.5 years) were linked to HIV care, but only three were linked to NCD-specific care. Individual-level barriers to managing NCDs included limited education and limited self-efficacy for self-management. Interpersonally, barriers included limited rapport building with an NCD-specific specialist. Structural barriers to managing NCDs were no health insurance, poor referral systems, and limited financial assistance. Health system adaptation requires equitably considering the needs of individuals managing multiple chronic conditions. Key factors to address include patient-provider relationships, improved referral systems, accessibility and availability of specialists, and financial assistance.
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Affiliation(s)
- Deshira D. Wallace
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Amarilis Then-Paulino
- Instituto de Investigación en Salud de la Facultad de Ciencias de la Salud, Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Alma Máter, Ciudad Universitaria, Santo Domingo, Dominican Republic
| | - Gipsy Jiménez Paulino
- Viceministerio de Garantía de la Calidad, Ministerio de Salud Pública, Santo Domingo, Dominican Republic
| | | | - Stephanie Daniela Castro
- Center for Diagnosis, Advanced Medicine, and Telemedicine (CEDIMAT), Santo Domingo, Dominican Republic
| | - Kartika Palar
- Department of Medicine, Division of HIV, Infectious Disease, and Global Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Kathryn P. Derose
- Department of Health Promotion & Policy, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America
- Department of Behavioral and Policy Sciences, RAND Corporation, Santa Monica, California, United States of America
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Wallace DD, Núñez I, Barrington C. Revising the Diabetes Distress Scale for Use Among Adults in the Dominican Republic: Findings From Cognitive Interviews. DIABETES EDUCATOR 2022; 48:459-468. [PMID: 36218379 PMCID: PMC9693704 DOI: 10.1177/26350106221128003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study is to assess the content validity of the Diabetes Distress Scale (DDS) among adults with type 2 diabetes mellitus (T2DM) living in rural Dominican Republic communities. METHODS Researchers conducted cognitive interviews with 20 adults with T2DM to assess how they answered a Spanish version of the 17-item DDS, a commonly used scale to measure diabetes distress. Interviews were done iteratively to allow for revisions and testing of those revisions with the participants. Analysis involved field notes, text summaries, and cognitive coding. RESULTS The sample was 55% women, had a mean age of 55 years, and came from 10 rural communities. The cognitive interviews highlighted needed changes across comprehension, judgment (clarity), recall, response process, and logical/structural issue domains. Participants generally understood the DDS; however, 4 items, the introduction, and response options were revised to improve participant response. The items were revised using wording from the participants themselves. By changing certain terms and splitting a couple of items, these items improved comprehension and judgment. The introduction was simplified from 2 paragraphs to 1 to reduce structural issues (ie, scale's features), and the response options were reduced from 6 options to 5 options to improve the response process. CONCLUSIONS Based on iterative study findings, the researchers propose expanding the 17-item DDS to 19 items to improve participant response. Revising the DDS to account for cultural and structural changes will improve clinical and public health understanding of the role of diabetes distress on T2DM management among Dominican adults.
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Affiliation(s)
- Deshira D Wallace
- Department of Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Ivania Núñez
- Department of Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Clare Barrington
- Department of Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina
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Love O, Peter D, Julie ST. Systematic review: Perceptions of type 2 diabetes of people of African descent living in high-income countries. J Adv Nurs 2022; 78:2277-2289. [PMID: 35441727 PMCID: PMC9546182 DOI: 10.1111/jan.15266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/04/2022] [Accepted: 04/05/2022] [Indexed: 11/29/2022]
Abstract
AIMS To describe how people of African descent perceive and understand type 2 diabetes, and to examine the impact of their perceptions and beliefs on the uptake of diet, exercise, weight control and adherence to medication recommendations. DESIGN Systematic literature review of quantitative and qualitative studies. DATA SOURCES We searched MEDLINE, CINAHL Complete, Psych INFO, Academic Search Premier, Education Research Complete, Web of Science and Scopus, World Health Organization (WHO), Diabetes UK and American Diabetes Association for articles published from January 1999 to December 2019. REVIEW METHODS Informed by the PRISMA guidelines, we independently reviewed titles and abstracts, identified articles for full-text review that met inclusion criteria, conducted a quality assessment and extracted data. Findings were synthesized using a thematic approach. RESULTS Twenty-six studies met the inclusion criteria. Knowledge and understanding of diabetes were poor. Beliefs and behaviours about diet, exercise, weight and health care were erroneous. Most diabetic participants could not recognize diabetes symptoms, failed to take their diagnosis seriously and did not adhere to medication recommendations. The resultant effect was an increased risk of complications with undesirable outcomes. CONCLUSION Poor diabetes perceptions are linked to negative consequences and may be responsible for poorer outcomes among people of African descent. This review highlights the need to consider this population's beliefs and practices in structuring culturally sensitive programmes for diabetes management. IMPACT This systematic literature review is the first to exclusively explore perceptions of people of African descent in relation to diabetes. It is important to consider people of African descents' diabetes perceptions and practices before formulating interventions for their diabetes management.
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Affiliation(s)
| | | | - Santy-Tomlinson Julie
- Odense University Hospitals, Odense, Denmark.,University of Southern Denmark, Odense, Denmark
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Wallace DD, Pereira NM, Rodriguez HG, Barrington C. Provider perspectives on emotional health care for adults with type 2 diabetes mellitus in the Dominican Republic. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000537. [PMID: 36962534 PMCID: PMC10021239 DOI: 10.1371/journal.pgph.0000537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 10/19/2022] [Indexed: 11/10/2022]
Abstract
The emotional burden of type 2 diabetes mellitus (T2D) can complicate self-management. Exploring the feasibility of mental and physical health co-management in limited-resourced settings is needed. Thus, we assessed providers' awareness of the emotional burden their patients experience and their roles in supporting their patients with T2D. We conducted a formative qualitative study using in-depth interviews with 14 providers, including physicians, nurses, and community health workers recruited at two rural health clinics in the Dominican Republic. We coded transcripts using inductive and deductive codes and developed themes through iterative comparative analysis. All providers recognized that patients experience an emotional burden managing life with T2D. Some providers viewed the provision of emotional support as integral to their role and believed that they could do so. Others viewed it as the responsibility of the family or expressed the need for additional guidance on how to provide emotional support. Providers also identified several barriers to integrating emotional support into routine clinical care including personality characteristics, lack of training, and insufficient staffing. While providers recognize the need for emotional support, they identified individual, clinical, and systems-level barriers. Strategies to address these barriers include training specific providers on emotional support provision, balancing workload, and building or strengthening referral systems.
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Affiliation(s)
- Deshira D Wallace
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Nastacia M Pereira
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Humberto Gonzalez Rodriguez
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Clare Barrington
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Sadeghzadeh C, Wallace DD, Gonzalez Rodriguez H, Barrington C. Coping with diabetes stress among adults in rural Dominican Republic: "I don't think about it". Chronic Illn 2021; 17:391-403. [PMID: 31619054 DOI: 10.1177/1742395319882069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES As type 2 diabetes prevalence increases across Latin America, understanding local approaches to coping with diabetes stress is essential to providing care that incorporates patients' values and preferences. This study explored a local phenomenon, "no le doy mente" (I don't think about it), used by adults with type 2 diabetes in the Dominican Republic to cope with diabetes stress. METHODS We conducted 19 qualitative in-depth interviews with adults with type 2 diabetes (10 men, 9 women) recruited from one rural clinic. Using an inductive analytic approach including iterative coding, memos, and matrices, we identified reasons, strategies, and perceived benefits of not thinking about type 2 diabetes among participants. RESULTS Participants described not thinking about diabetes as an active process to maintain a sense of normalcy despite significant life changes following diagnosis. They avoided thinking about diabetes by staying busy, proactively managing type 2 diabetes through diet and medication, and turning to their faith. Participants perceived that enacting no le doy mente helped to protect their overall health and well-being. DISCUSSION Future research should investigate provider perceptions of no le doy mente to align patient and provider communication and mindfulness-based stress reduction as a way to support people with type 2 diabetes avoid dwelling on negative thoughts about diabetes.
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Affiliation(s)
- Claire Sadeghzadeh
- Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Deshira D Wallace
- Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Humberto Gonzalez Rodriguez
- Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Clare Barrington
- Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
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Wallace DD, Payán DD, Then-Paulino A, Armenta G, Fulcar MA, Acevedo R, Derose KP. Perceptions and determinants of healthy eating for people with HIV in the Dominican Republic who experience food insecurity. Public Health Nutr 2021; 24:3018-3027. [PMID: 32830629 PMCID: PMC7902734 DOI: 10.1017/s1368980020002694] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/20/2020] [Accepted: 07/06/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The current study aimed to understand how moderate and severe food-insecure people living with HIV (PLHIV) in the Dominican Republic perceive a healthy diet and explore facilitators and barriers to engaging in healthy dietary behaviours as a means of HIV self-management. DESIGN We conducted semi-structured interviews with PLHIV. We generated codes on food insecurity among PLHIV and used content analysis to organise codes for constant comparison between and within participants. SETTING Two urban HIV clinics in the Dominican Republic. PARTICIPANTS Thirty-two PLHIV participated in the interviews. RESULTS Factors that contributed to dietary behaviours include individual factors, such as knowledge of nutrition, views and attitudes on healthy dietary behaviours, beliefs about dietary needs for PLHIV and diet functionality. Interpersonal factors, including assistance from family and peers in providing food or funds, were deemed critical along with community and organisational factors, such as food assistance from HIV clinics, accessibility to a variety of food store types and the availability of diverse food options at food stores. Policy-level factors that influenced dietary behaviours were contingent on respondents' participation in the labour market (i.e. whether they were employed) and consistent access to government assistance. Food insecurity influenced these factors through unpredictability and a lack of control. CONCLUSIONS PLHIV who experience food insecurity face various barriers to engaging in healthy dietary behaviours. Their diets are influenced at multiple levels of influence ranging from individual to structural, requiring multi-level interventions that can address these factors concurrently.
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Affiliation(s)
- Deshira D Wallace
- RAND Corporation, 1776 Main Street, Santa Monica, 90407CA, USA
- Gillings School of Global Public Health, University of North Carolina, 302 Rosenau Hall, Chapel Hill, 27599NC, USA
| | - Denise D Payán
- University of California at Merced, Merced, 95343CA, USA
| | | | | | - María Altagracia Fulcar
- Dominican Republic Country Office, United Nations World Food Programme, Santo Domingo, Dominican Republic
| | - Ramón Acevedo
- CONAVIHSIDA – Consejo Nacional de VIH/SIDA, Santo Domingo, Dominican Republic
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Payán DD, Derose KP, Fulcar MA, Farías H, Palar K. "It Was as Though My Spirit Left, Like They Killed Me": The Disruptive Impact of an HIV-Positive Diagnosis among Women in the Dominican Republic. J Int Assoc Provid AIDS Care 2020; 18:2325958219849042. [PMID: 31109213 PMCID: PMC6748475 DOI: 10.1177/2325958219849042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
An HIV diagnosis may be associated with severe emotional and psychological distress,
which can contribute to delays in care or poor self-management. Few studies have explored
the emotional, psychological, and psychosocial impacts of an HIV diagnosis on women in
low-resource settings. We conducted in-depth interviews with 30 women living with HIV in
the Dominican Republic. Interviews were audio-recorded, transcribed, and analyzed using
the biographical disruption framework. Three disruption phases emerged (impacts of a
diagnosis, postdiagnosis turning points, and integration). Nearly all respondents
described the news as deeply distressful and feelings of depression and loss of self-worth
were common. Several reported struggling with the decision to disclose—worrying about
stigma. Postdiagnosis turning points consisted of a focus on survival and motherhood;
social support (family members, friends, HIV community) promoted integration. The findings
suggest a need for psychological resources and social support interventions to mitigate
the negative impacts of an HIV diagnosis.
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Affiliation(s)
- Denise Diaz Payán
- 1 Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, CA, USA.,2 RAND Corporation, Santa Monica, CA, USA
| | | | - María Altagracia Fulcar
- 3 United Nations World Food Programme, Dominican Republic Country Office, Santo Domingo, Dominican Republic
| | - Hugo Farías
- 4 United Nations World Food Programme, Regional Office for Latin America and the Caribbean, Panamá, Dominican Republic
| | - Kartika Palar
- 5 School of Medicine, University of California, San Francisco, San Francisco, CA, USA
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