Support and influence in the context of diabetes management: do racial/ethnic differences exist?

Motives for spousal involvement in a Partner's diabetes management: Considering the role of gender and links to diet-related involvement

Using data from 148 middle-aged and older adult spouses whose partners had type 2 diabetes, we sought to examine spouses' motives for involvement in their partners' diabetes management and whether these motives were related to common types of diabetes-related spousal involvement; we also sought to understand gender differences in these dynamics. Spouses indicated being motivated to be involved in their partners' diabetes management due to altruistic motives to the greatest extent and egoistic motives to the least extent. Results from multivariable regression analyses that controlled for gender, marital quality, and spouses' own conditions requiring dietary changes revealed that all types of motives were related to the frequency of providing diet-related spousal support, whereas only egoistic motives were related to the frequency of exerting diet-related spousal control. We did not find gender differences in any motives nor in associations with spousal involvement. Findings have potential implications for couples-oriented chronic illness interventions.

Communal Coping and Self-Care in Black and White Individuals Living with Type 2 Diabetes

Type 2 diabetes mellitus is both prevalent and profoundly impactful, and how people cope with the illness is related to a variety of individual and relational outcomes. The goal of this investigation was to test the logic of the recently extended Theoretical Model of Communal Coping (TMCC), a communication theory that argues that race (in this study, Black and White) moderates the relationship between communal coping and disease-related outcomes (i.e., glucose, diet, and exercise self-care). In general, survey data from 348 participants (n = 224 Black participants, n = 124 White participants) revealed that although communal coping was directly and positively related to self-care, the relationship between communal coping and self-care was stronger for Black participants than White participants. The results of the study have implications for the TMCC and for researchers, families managing type 2 diabetes, and healthcare practitioners.

Understanding the growing epidemic of type 2 diabetes in the Hispanic population living in the United States

The prevalence and incidence of type 2 diabetes (T2D) among the Hispanic population in the United States are higher than the national average. This is partly due to sociocultural factors, such as lower income and decreased access to education and health care, as well as a genetic susceptibility to obesity and higher insulin resistance. This review focuses on understanding the Hispanic population living in the United States from a multidisciplinary approach and underlines the importance of cultural, social, and biological factors in determining the increased risk of T2D in this population. An overview of the acute and chronic complications of T2D upon this population is included, which is of paramount importance to understand the toll that diabetes has upon this population, the health system, and society as a whole. Specific interventions directed to the Hispanic populations are needed to prevent and alleviate some of the burdens of T2D. Different prevention strategies based on medications, lifestyle modifications, and educational programmes are discussed herein. Diabetes self-management education (DSME) is a critical element of care of all people with diabetes and is considered necessary to improve patient outcomes. To be more effective, programmes should take into consideration cultural factors that influence the development and progression of diabetes. These interventions aim to enhance long-term effects by reducing the incidence, morbidity, and mortality of T2D in the Hispanic population of the United States.

Understanding body image among adults in mid-late life: Considering romantic partners and depressive symptoms in the context of diabetes

Although our bodies change as we age, there is limited research exploring body image among middle-aged and older adults. This study considered 70 adults with diabetes' (M_age = 60.01 years) body image and revealed relatively high levels of body dissatisfaction in this sample. Furthermore, participants' own and perceptions of their partners' dissatisfaction with their bodies were moderately associated, and participants' body dissatisfaction was associated with higher levels of depressive symptoms. These findings highlight the need for further research, exploring the social and psychological correlates of body image among men and women in mid-late adulthood.

Disease factors associated with spousal influence on diabetic diet: An exploratory comparison of Vietnamese American and White older adults

This study examined whether disease-specific factors were important for how and how often White versus Vietnamese American spouses influenced their partners' diabetic diet. Results from a cross-sectional survey of 145 older adult spouses whose partners had type 2 diabetes revealed that Vietnamese American spouses used more frequent spousal influence (positive and negative) than White spouses. In addition, most of the factors associated with spousal influence differed for Vietnamese American and White spouses. Findings from this study highlight the importance of proximal and sociocultural factors in understanding older spouses' influence on their partners' diabetic diet.

Postdiagnosis social networks and breast cancer mortality in the After Breast Cancer Pooling Project

BACKGROUND

Large social networks have been associated with better overall survival, though not consistently with breast cancer (BC)-specific outcomes. This study evaluated associations of postdiagnosis social networks and BC outcomes in a large cohort.

METHODS

Women from the After Breast Cancer Pooling Project (n = 9267) provided data on social networks within approximately 2 years of their diagnosis. A social network index was derived from information about the presence of a spouse/partner, religious ties, community ties, friendship ties, and numbers of living first-degree relatives. Cox models were used to evaluate associations, and a meta-analysis was used to determine whether effect estimates differed by cohort. Stratification by demographic, social, tumor, and treatment factors was performed.

RESULTS

There were 1448 recurrences and 1521 deaths (990 due to BC). Associations were similar in 3 of 4 cohorts. After covariate adjustments, socially isolated women (small networks) had higher risks of recurrence (hazard ratio [HR], 1.43; 95% confidence interval [CI], 1.15-1.77), BC-specific mortality (HR, 1.64; 95% CI, 1.33-2.03), and total mortality (HR, 1.69; 95% CI, 1.43-1.99) than socially integrated women; associations were stronger in those with stage I/II cancer. In the fourth cohort, there were no significant associations with BC-specific outcomes. A lack of a spouse/partner (P = .02) and community ties (P = .04) predicted higher BC-specific mortality in older white women but not in other women. However, a lack of relatives (P = .02) and friendship ties (P = .01) predicted higher BC-specific mortality in nonwhite women only.

CONCLUSIONS

In a large pooled cohort, larger social networks were associated with better BC-specific and overall survival. Clinicians should assess social network information as a marker of prognosis because critical supports may differ with sociodemographic factors. Cancer 2017;123:1228-1237. © 2016 American Cancer Society.

Self-Care Adherence and Psychological Functioning of Older Patients with Type 2 Diabetes: Effects of Persuasion, Social Pressure, and Self-Efficacy

This cross-sectional study examined the role of family members' use of persuasion versus pressure as distinct forms of social control by which family members attempt to encourage better diabetes management among older adults with type 2 diabetes mellitus (T2DM). The study also examined how self-efficacy might moderate the relationship between persuasion/pressure, psychological functioning, and self-care adherence. Participants were 96 men and 103 women with T2DM, with a mean age of 63.3 years. Regression results show that neither persuasion nor pressure was significantly related to self-care adherence, but persuasion and pressure were associated in complex ways with diabetes-related emotional distress and depressive symptoms for which significant interaction effects were found. Patients with lower self-efficacy benefited from persuasion, but were adversely affected by pressure. In contrast, patients with higher self-efficacy were adversely affected by persuasion, but were less negatively affected by pressure. Findings highlight the importance of reducing pressure-based social control, considering patients' self-efficacy when family members seek to influence patients' self-care behaviors, and targeting patient-family interactions in future interventions.

Physical activity-related social control and social support in older adults: Cognitive and emotional pathways to physical activity

A survey of 217 older adults assessed physical activity-related positive and negative social control and emotional and informational support, using structural equation modeling to investigate mediational effects of emotional responses and behavioral intentions on physical activity. There were significant indirect effects of social control and social support on intentions as mediated by positive, but not negative, emotional responses, and significant indirect effects of emotional responses on physical activity as mediated by intentions. These findings help to identify the cognitive and emotional pathways by which social control and social support may promote or detract from physical activity in later life.

Culturally appropriate health education for Type 2 diabetes in ethnic minority groups: an updated Cochrane Review of randomized controlled trials

AIMS

To give an updated perspective of interventions from additional data collected since our first review, conducted in 2008.

BACKGROUND

This updated Cochrane Review incorporates new information from recent randomized controlled trials on culturally appropriate diabetes health education interventions.

METHODS

An electronic literature search of six databases was repeated, with databases of ongoing trials checked and three journals hand-searched. Meta-analysis was carried out for sufficiently homogeneous outcomes, and common themes among trials were highlighted.

RESULTS

A total of 22 new trials were added to the original 11. Meta-analysis of 28 trials containing suitable data showed significant improvements in glycaemic control (HbA1c ) and diabetes knowledge over a period of 24 months, after the delivery of culturally appropriate education to participants, compared with those receiving 'conventional' care. There were no consistent benefits over the control group in other selected outcome measures, and lack of data continued to make analysis of several outcome measures difficult.

CONCLUSIONS

Research activity in this field has increased considerably over the past 6 years, with culturally appropriate diabetes education showing consistent benefits over conventional care in terms of glycaemic control and diabetes knowledge, sustained in the short- to mid-term. Further research is needed to determine the clinical significance of these improvements and their cost-effectiveness.

Spousal support in diabetes self-management among Korean immigrant older adults

The authors of the current article investigated domains of spousal support among diabetic Korean older adults and their spouses. Two focus groups were conducted with diabetic participants from the greater Los Angeles Korean community, and three were conducted with their spouses. In the focus groups, participants were asked to describe the spousal support given or received for diabetes self-management. Each group comprised four to nine participants. Focus groups were audiotaped, transcribed, and translated; two independent coders identified domains of spousal support. Content analysis identified six domains: diet, exercise, emotional support, medical regimen, communication with clinicians, and information. Diet was the most frequently described domain across all groups. Gender differences were noted in domains of information, communication, and medical regimen among diabetic participants. Both diabetic and spouse participants identified individualizing spousal support and recognizing diabetes management as teamwork as important elements of successful spousal support. Spousal support education for Korean older adults may have the greatest impact by incorporating these six domains, addressing gender differences, providing tips on individualizing support, and cultivating teamwork.

Partners of patients with inflammatory bowel disease: how important is their support?

BACKGROUND

Chronic inflammatory bowel disease (IBD) causes significant distress for patients and their families. Data assessing the need of these patients for support and sharing with their partners are scarce. The aim of this study was to assess patients' views regarding sharing of information with their partners.

METHODS

Ambulatory IBD patients treated at the Chaim Sheba Medical Center between January 2011 and January 2013 were asked to complete an anonymous questionnaire. Patients who had a stable partner and completed more than 95% of the questionnaire were included.

RESULTS

Of 134 patients who agreed to complete the questionnaire, 101 met the inclusion criteria, 53 were men (mean age 45±15 years), and 50% had academic education. Only 42% of patients reported that their partner accompanied them to the doctor. However, 93% shared health problems with their partner, 64% would have liked their partner to receive more medical information, and 70% would like their partner to be more involved. The majority (88%) believed that more partner involvement could help them deal better with the disease, and 70% thought that support groups for partners should be established. No association was found between patients' demographic data and their answers. Patients who felt that partner involvement could help them to deal with the disease tended to share medical information with their partners and wanted them to be more involved in health care decision-making (P<0.001).

CONCLUSION

Most IBD patients in our study wanted their partner to be more involved with their health problems, and believed that greater partner involvement could help them deal better with their disease. Therefore, more attention should be focused on gaining better cooperation from patients' families.

Chronic illness intrusion: role impairment and time out of role in racially and ethnically diverse older adults

PURPOSE OF THE STUDY

Little is known about the effects of chronic illness on social role participation among racially and ethnically diverse older adults. This study was undertaken to better understand disruptions in role among African American, black Caribbean, white, Latino, and Asian older adults with arthritis, heart disease, or diabetes.

DESIGN AND METHODS

This study consisted of a cross-sectional secondary data analysis of the Collaborative Psychiatric Epidemiology Surveys. Role disruption was operationalized using time out of role and role impairment in the past 30 days. Data from participants aged 65 and older were used in negative binomial regression analyses.

RESULTS

Overall, prevalence of role impairment occurred more often than time out of role. Race and ethnicity were not associated with time out of role, but they were for role impairment. Whites experienced more role impairment than any other racial or ethnic group. Within-group analyses identified that chronic illness, role participation, and socioeconomic factors are related in different ways depending on race or ethnicity. It appears that for some racially and ethnically diverse older adults, higher income and education are protective against role disruption.

IMPLICATIONS

Race and ethnicity are factors in how the social roles of older adults are affected by chronic illness, and it appears that role disruption varies with type of illness. Interventions to support older adults with chronic illness should take into account the cultural factors related to role disruption.

Cultural adaptations of behavioral health interventions: a progress report

OBJECTIVE

To reduce health disparities, behavioral health interventions must reach subcultural groups and demonstrate effectiveness in improving their health behaviors and outcomes. One approach to developing such health interventions is to culturally adapt original evidence-based interventions. The goals of the article are to (a) describe consensus on the stages involved in developing cultural adaptations, (b) identify common elements in cultural adaptations, (c) examine evidence on the effectiveness of culturally enhanced interventions for various health conditions, and (d) pose questions for future research.

METHOD

Influential literature from the past decade was examined to identify points of consensus.

RESULTS

There is agreement that cultural adaptation can be organized into 5 stages: information gathering, preliminary design, preliminary testing, refinement, and final trial. With few exceptions, reviews of several health conditions (e.g., AIDS, asthma, diabetes) concluded that culturally enhanced interventions are more effective in improving health outcomes than usual care or other control conditions.

CONCLUSIONS

Progress has been made in establishing methods for conducting cultural adaptations and providing evidence of their effectiveness. Future research should include evaluations of cultural adaptations developed in stages, tests to determine the effectiveness of cultural adaptations relative to the original versions, and studies that advance our understanding of cultural constructs' contributions to intervention engagement and efficacy.

Barriers and facilitators to effective type 2 diabetes management in a rural context: a qualitative study with diabetic patients and health professionals

Although effective type 2 diabetes management is essential for the prevention of complications, it is rarely carried out. Type 2 diabetes deaths in rural areas are higher than in metropolitan areas. A focus group (n = 8) and telephone interviews with patients (n = 10), and telephone interviews with health professionals (n = 18) in rural areas were conducted to examine this issue in a rural context. Inductive thematic analysis was used to generate 13 themes of barriers and facilitators to type 2 diabetes management at intrapersonal (denial of the illness, motivation, knowledge and skills and lack of time), interpersonal (stress and relationships), organisational (access to recommended foods, transport, health professionals, and exercise options) and societal (engagement and societal attitudes) levels of influence. Across all themes, participants highlighted the difficulty of maintaining management behaviours.

Illness representations of type 2 diabetes patients are associated with perceptions of diabetes threat in relatives

In the fight against the type 2 diabetes epidemic, patients might be asked to discuss familial susceptibility to type 2 diabetes in their family. Illness representations of patients ( N = 546) were assessed to explore their impact on perceived type 2 diabetes threat in relatives. Reporting high type 2 diabetes burden, emotional impact and perceiving type 2 diabetes as an inheritable disease seemed to increase patients’ family risk perception and worries about relatives’ future health. Patients with coherent illness understanding reported positive beliefs regarding type 2 diabetes prevention in relatives. Findings may give direction in how illness representations may be used to guide patients in the process of family risk disclosure.

Spousal undermining of older diabetic patients' disease management

Marriage can enhance health for individuals with a chronic disease, yet spouses may also undermine disease management. The current study investigated spousal undermining of dietary regimen in 129 patients with type 2 diabetes mellitus. A total of 40 patients reported that their spouses tempted them with forbidden foods, and 15 reported that their spouses conveyed disregard for their diabetic diet. Spousal tempting was associated with worse dietary adherence, and spousal disregard with worse nondietary adherence. Spousal undermining is relatively rare but is associated with patients' disease management and warrants further investigation to better understand how spouses influence partners' day-to-day management of chronic diseases.

Parents' emotional intelligence and children's type I diabetes management

We hypothesized that parents' emotional intelligence associates with their children's type I diabetes outcomes. Eighty-one parents, the main caregivers of their diabetic children, filled out two measures of emotional intelligence and a demographic questionnaire. Three indicators of diabetes management were collected from the patients' files: hemoglobin A1c, mean blood tests per day, and mean blood glucose levels. Emotional intelligence associated with all glycemic management indices, though differences were found between the two measures. Of the demographic factors, income level showed some association with the outcome measures. The results are discussed in light of existing theories and models.

Dietary behaviors of a racially and ethnically diverse sample of overweight and obese Californians

OBJECTIVES

To examine racial/ethnic differences in the dietary behaviors of overweight or obese adults using the 2007 California Health Interview Survey.

METHOD

Data were obtained from the 2007 California Health Interview Survey, a population-based sample of noninstitutionalized adults in California. The sample included 26,721 adults aged 18 years and older whose body mass index status indicated that they were overweight or obese (body mass index ≥ 25), with 19,264 non-Hispanic White; 1,749 African American/Black; 1,616 Asian/Pacific Islander; and 4,092 Latino respondents. Respondents were compared with regard to consumption of five categories of food: fruits, vegetables, French fries, soft drinks, and fast-food. Multivariable regression analyses were conducted to examine racial/ethnic differences in dietary behaviors, with and without adjustment for age, gender, nativity, marital status, education, income, and food insecurity.

RESULTS

The findings suggested there were significant racial/ethnic differences in food preferences and that English proficiency, in part, explained some of these differences. Overweight/obese African American/Black respondents reported eating fruit (aBeta = -0.73, [95% confidence interval = -1.29, -0.17]) and vegetables (aBeta = -0.71 [-1.18, -0.24]) fewer times per day and fast-food (aBeta = 0.21, [0.04, 0.38]) more times per day compared with their non-Hispanic White counterparts. Irrespective of language proficiency, Asian/Pacific Islanders reported eating significantly less fruit compared with non-Hispanic Whites. Limited English proficient (LEP) Asian/Pacific Islanders were found to eat vegetables (aBeta = 1.41, [0.47, 2.63]) more times per day than non-Hispanic Whites, in contrast to English proficient Asian/Pacific Islanders who were found to eat vegetables (aBeta = -0.64, [-1.11, -0.18]) fewer times per day compared with non-Hispanic Whites. Both LEP and English proficient Latinos ate vegetables less often and drank soft drinks and ate fast-food more often than non-Hispanic Whites.

CONCLUSIONS

Efforts to intervene with individuals who are overweight or obese must include culturally and linguistically tailored interventions that consider how individuals' dietary behaviors are influenced by their racial/ethnic backgrounds.

Young adult African American patients with type 2 diabetes: a high risk patient sub-group with few supports for good diabetes management

This study examined age differences in support, BMI, and HbA1c among African American patients with type 2 diabetes. Participants were 158 African American adults with type 2 diabetes. Average HbA1c was 1% higher among patients aged 20-49 than patients 60-77, and double the number of younger patients had a BMI ≥35 than older patients. Younger patients reported less trust in their physician and greater disagreement with recommendations. They reported relying less on partners, greater unresolved conflict with partners around diabetes, and less church involvement. The association between age and HbA1c was partially mediated by patients' trust of their physician.