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Maafs-Rodríguez A, Folta SC. Effectiveness of Theory-Based Physical Activity and Nutrition Interventions in Aging Latino Adults: A Scoping Review. Nutrients 2023; 15:2792. [PMID: 37375696 DOI: 10.3390/nu15122792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/04/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
In the United States (US), Latino individuals older than 50 years face health disparities compared to their White counterparts. Considering the rising life expectancy and the projected increase of older Latino adults in the US, this scoping review aimed to determine the effectiveness of theory-based and culturally relevant strategies that promote healthy aging in Latinos. Web of Science and PubMed databases were searched between December 2022 and February 2023 for peer-reviewed articles assessing healthy aging interventions tailored to community-dwelling aging Latino adults. We included nine studies describing the effects of seven interventions on physical activity- or nutrition-related outcomes. Although not always statistically significant, interventions had a beneficial impact on well-being indicators. The most commonly used behavioral theories were Social Cognitive Theory and Attribution Theory. Latino cultural elements in these studies included partnering with community organizations that serve Latinos (such as Catholic churches), delivery of in-person bilingual group sessions by trusted community members (such as promotoras or Latino dance instructors), and incorporating values such as family and religion into the health curriculum, among others. Future strategies that promote healthy aging in Latino adults should proactively culturally adapt the theoretical foundations and the design, recruitment, and implementation processes to ensure their relevance and effectiveness.
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Affiliation(s)
- Ana Maafs-Rodríguez
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
| | - Sara C Folta
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
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Sanchez-Johnsen L, Dykema-Engblade A, Rosas CE, Calderon L, Rademaker A, Nava M, Hassan C. Mexican and Puerto Rican Men's Preferences Regarding a Healthy Eating, Physical Activity and Body Image Intervention. Nutrients 2022; 14:4634. [PMID: 36364897 PMCID: PMC9654900 DOI: 10.3390/nu14214634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/18/2022] [Accepted: 10/26/2022] [Indexed: 01/28/2024] Open
Abstract
This study examined the logistical, practical, and cultural preferences of Latinos regarding the design of a healthy eating, physical activity, and body image intervention. Puerto Rican and Mexican men (n = 203) completed an interview as part of an NIH-funded study. Overall, 66.5% preferred the intervention to be in Spanish only or both Spanish and English; 88.67% said it was moderately, very or extremely important for the intervention leader to be bilingual; and 66.01% considered it moderately to extremely important for the leader to be Hispanic or Latino. Most participants (83.74%) reported they would be willing to attend an intervention that met twice per week and 74.38% said they would be willing to attend an intervention that met for 1.5 to 2 h, twice weekly. Overall, the majority said they would be moderately to extremely interested in attending an exercise program if it consisted of aerobics with Latin or salsa movements (74.88%) and if it consisted of aerobics with Latin or salsa music (70.44%). Some participants were moderately to extremely interested in attending an intervention if it included dichos (Latino sayings) (65.02%) and cuentos (folktales or stories) (69.46%). The findings have implications for lifestyle and body image interventions aimed at preventing cardiometabolic diseases.
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Affiliation(s)
- Lisa Sanchez-Johnsen
- Department of Family and Preventive Medicine, Rush University Medical Center, 1645 West Jackson Blvd, Suite 302, Chicago, IL 60612, USA
- Department of Psychology, University of Illinois at Chicago, 1007 W Harrison St., Chicago, IL 60607, USA
| | - Amanda Dykema-Engblade
- Department of Psychology, Northeastern Illinois University, 5500 North St. Louis Ave, Chicago, IL 60625, USA
| | - Carlos E. Rosas
- Department of Family and Preventive Medicine, Rush University Medical Center, 1645 West Jackson Blvd, Suite 302, Chicago, IL 60612, USA
- Department of Psychology, University of Illinois at Chicago, 1007 W Harrison St., Chicago, IL 60607, USA
| | - Leonilda Calderon
- Puerto Rican Cultural Center, 2628 W. Division St., Chicago, IL 60612, USA
| | - Alfred Rademaker
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Drive, Suite #1400, Chicago, IL 60611, USA
| | - Magdalena Nava
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Ave Suite #1100, Chicago, IL 60601, USA
| | - Chandra Hassan
- Department of Surgery, University of Illinois at Chicago, 840 South Wood Street (MC 958), Chicago, IL 60612, USA
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Woodside J, Young IS, McKinley MC. Culturally adapting the Mediterranean Diet pattern - a way of promoting more 'sustainable' dietary change? Br J Nutr 2022; 128:693-703. [PMID: 35734884 PMCID: PMC9346614 DOI: 10.1017/s0007114522001945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Average diet quality is low in the UK and is socioeconomically patterned, contributing to the risk of non-communicable disease and poor health. Achieving meaningful dietary change in the long term is challenging, with intervention required on a number of different levels which reflect the multiple determinants of dietary choice. Dietary patterns have been identified which contribute positively to health outcomes; one of these is the Mediterranean diet (MD) which has been demonstrated to be associated with reduced non-communicable disease risk. Most research exploring the health benefits of the MD has been conducted in Mediterranean regions but, increasingly, research is also being conducted in non-Mediterranean regions. The MD is a dietary pattern that could have positive impacts on both health and environmental outcomes, while being palatable, appetising and acceptable. In this review, we consider the studies that have explored transferability of the MD. To achieve long-term dietary change towards a MD, it is likely that the dietary pattern will have to be culturally adapted, yet preserving the core health-promoting elements and nutritional composition, while considering the food system transition required to support changes at population level. Population-specific barriers need to be identified and ways sought to overcome these barriers, for example, key food availability and cost. This should follow a formal cultural adaptation framework. Such an approach is likely to enhance the extent of adherence in the longer term, thus having an impact on population health.
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Affiliation(s)
- Jayne Woodside
- Centre for Public Health, Institute for Clinical Science A, Grosvenor Road, Belfast, Queen’s University Belfast, BelfastBT12 6BJ, UK
- Institute for Global Food Security, Queen’s University Belfast, Belfast, UK
- Corresponding author: Jayne Woodside, email
| | - Ian S. Young
- Centre for Public Health, Institute for Clinical Science A, Grosvenor Road, Belfast, Queen’s University Belfast, BelfastBT12 6BJ, UK
- Institute for Global Food Security, Queen’s University Belfast, Belfast, UK
| | - Michelle C. McKinley
- Centre for Public Health, Institute for Clinical Science A, Grosvenor Road, Belfast, Queen’s University Belfast, BelfastBT12 6BJ, UK
- Institute for Global Food Security, Queen’s University Belfast, Belfast, UK
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Wang VHC, Foster V, Yi SS. Are recommended dietary patterns equitable? Public Health Nutr 2022; 25:464-470. [PMID: 34602107 PMCID: PMC8883773 DOI: 10.1017/s1368980021004158] [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] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 09/24/2021] [Accepted: 09/29/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Dietary recommendations (DR) in the USA may be inadequate at improving diets in racial/ethnic minority communities and may require redesign of the systems driving their development over the long term. Meanwhile, cultural adaptation of evidence-based DR may be an important strategy for mitigating nutrition disparities, but less is known about the adaptability of these recommendations to meet the needs of diverse groups. We examined the content and origin of major DRs - aspects that provide context on their potential universality across populations and evaluated their potential for cultural adaptation. DESIGN Case studies of Dietary Approaches to Stop Hypertension (DASH), the Mediterranean diet (MD), the EAT-Lancet diet (EAT) and the NOVA classification system. SETTING United States. PARTICIPANTS Racial/ethnic minority populations. RESULTS Current DR differ in their origin/evolution but are similar in their reductionist emphasis on physical health. DASH has been successfully adapted for some cultures but may be challenged by the need for intensive resources; MD may be more beneficial if applied as part of a broader set of food procurement/preparation practices than as just diet alone; EAT-Lancet adaptation may not honor existing country-specific practices that are already beneficial to human and environmental health (e.g. traditional/plant-based diets); evidence for cultural adaptation is limited with NOVA, but classification of levels of food processing has potential for widespread application. CONCLUSIONS For DR to equitably support diverse populations, they must move beyond a Eurocentric or 'general population' framing, be more inclusive of cultural differences and honour social practices to improve diet and reduce disparities.
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Affiliation(s)
- Vivian Hsing-Chun Wang
- Department of Public Health Policy and Management, School of Global Public Health, New York University, 708 Broadway, New York, NY10003, USA
| | - Victoria Foster
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Stella S Yi
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
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Haregu TN, Mahat K, Miller SM, Oldenburg B. Improving diabetes prevention and management amidst varied resources: from local implementation to global learnings. Transl Behav Med 2021; 10:1-4. [PMID: 32002548 DOI: 10.1093/tbm/ibz199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Tilahun Nigatu Haregu
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Kishori Mahat
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Suzanne M Miller
- Fox Chase Cancer Center/Temple University Health System, Philadelphia, PA, USA
| | - Brian Oldenburg
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Montero-Zamora P, St Fleur RG, Mejía-Trujillo J, Brown EC. Contextual Fit of a Family Evidence-Based Intervention for Preventing Youth Alcohol Use in Mexico. J Prim Prev 2021; 42:441-457. [PMID: 34189718 DOI: 10.1007/s10935-021-00640-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 12/12/2022]
Abstract
Reducing youth alcohol use is a public health priority that can be addressed by implementing evidence-based preventive interventions (EBPIs) with high fidelity. However, when EBPIs are delivered in a new geographical setting, lack of contextual fit might interfere with expected effects. The purpose of our study was to understand the contextual fit of the family preventive program, Guiding Good Choices (GGC), to inform its future adaptation in Zacatecas, Mexico. Four focus groups were conducted with parents of children aged 9-14 years (N = 43) from four private companies. After transcribing audiotaped sessions, we used a general inductive approach to obtain codes and derive themes. Parents expressed a high level of interest in program content, highlighting its potential to decrease underage drinking in Mexico. Surface-structure modifications of program audiovisual materials (e.g., new videos with Mexican actors and locations) and delivery methods were recommended by parents to maximize participant acceptability and engagement. Participant definitions of family and perception of family dynamics both support the cultural relevance of the program modules and activities related to this content. Underage drinking was acknowledged by parents as a major problem in Zacatecas. Our findings suggest a need for incorporating an extra session that focuses on addressing low alcohol literacy levels and parents' positive alcohol expectancies. Machismo was not considered a cultural factor that could affect attendance and program activities. In fact, we observed an opportunity to use local masculinity to ensure practice of parental skills at home. Due to the needs expressed by participants and the apparent compatibility and fit of the curriculum contents with the new context, we conclude that GGC could be an adequate EBPI for preventing underage drinking in Mexico.
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Affiliation(s)
- Pablo Montero-Zamora
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, 33136, USA.
| | - Ruth G St Fleur
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, 33136, USA
| | | | - Eric C Brown
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, 33136, USA
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Guo J, Luo J, Huang L, Yang J, Whittemore R. Adaptation and Feasibility Testing of a Coping Skills Training Program for Chinese Youth with Type 1 Diabetes. J Pediatr Nurs 2020; 54:e78-e83. [PMID: 32473824 DOI: 10.1016/j.pedn.2020.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE To adapt an evidence-based coping skills training program to the cultural context and healthcare system for youth with T1D in China, and to evaluate the feasibility, acceptability, and preliminary efficacy of the modified program. DESIGN AND METHODS A multiphase process was used based on a heuristic framework for program modification. This included information gathering, preliminary adaptation, and feasibility evaluation. RESULTS In Stage 1, the coping skills training protocol was translated and evaluated for relevance by the stakeholders (youth diagnosed with T1D, parents, and healthcare providers). Recommendations for revisions and culturally relevant scenarios were identified. In Stage 2, the program was adapted for youth with a wider age range. Scenarios and logistics of the program were changed, and a session on blood glucose management was added to enhance cultural relevance. In Stage 3, the feasibility of the modified program was evaluated with 15 youth participants diagnosed with T1D (mean age: 13.88 years). Problem-solving coping and the self-efficacy of the youth improved over time (p < .05). High attendance, engagement, and satisfaction were achieved. PRACTICE IMPLICATIONS The CST-China program has the potential to provide Chinese youth with T1D an interactive and engaging program to improve health outcomes. The adaptation process of a CST program can provide a reference for pediatric nurses to develop programs which are culturally relevant, acceptable to stakeholders, and aligned with the healthcare system in China. CONCLUSIONS A coping skills training program was systematically adapted and aligned to the healthcare system in China, with evidence of feasibility and acceptability in Chinese youth with T1D.
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Affiliation(s)
- Jia Guo
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China.
| | - Jiaxin Luo
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Lingling Huang
- Shenzhen University School of Medicine, Shenzhen, Guangdong, China.
| | - Jundi Yang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
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Al Slamah T, Nicholl BI, Alslail FY, Harris L, Melville CA, Kinnear D. Cultural adaptation of self-management of type 2 diabetes in Saudi Arabia (qualitative study). PLoS One 2020; 15:e0232904. [PMID: 32722666 PMCID: PMC7386581 DOI: 10.1371/journal.pone.0232904] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 04/23/2020] [Indexed: 11/22/2022] Open
Abstract
Background Saudi Arabia is continuously working on developing its health care system, however with the high prevalence of type 2 diabetes and comorbidities, such as cardiovascular diseases, self-management education programmes are essential. As part of a planned series of studies to develop a culturally sensitive type 2 diabetes self-management programme, this study explores the need versus barriers and facilitators relevant to implementing a national programme for type 2 diabetes self-management education within the community and health care system in Saudi Arabia. Methods A qualitative methodology was used to explore the views of a multidisciplinary group of diabetes health professionals and adult patients with type 2 diabetes. The views of nine health professionals working at a specialised diabetes care centre were gathered at two focus groups (four and five) that included doctors, nutritionists, health educators and nurses. Individual interviews with 12 patients with type 2 diabetes (six females and six males) attending the centre were also carried out. Recurring themes through the translated transcripts were studied and treated by the research group under pre-set protocols. Results Focus groups with health professionals revealed three main themes. 1. Resources: availability of resources and how they impacted on performance and patients’ care; 2.Familiarity with self-management education programmes: educating patients and raising awareness among them; and 3. Lifestyle: patients’ lifestyle and how it could affect their compliance with self-management programmes. Interviews with patients also revealed three main themes. 1. Habits: post diagnosis changes in patients’ attitudes and behaviours towards diet and physical activity; 2. Health education: awareness of managing type 2 diabetes through health centre advice or self-education; and 3. Culture and society: a lack of cultural or social support created by some social practices or conventions. Conclusion The findings from this study highlight a gap in type 2 diabetes care system that can be breached through the development of a Saudi specific self-management programme for type 2 diabetes. The identified barriers and facilitators can be used for adapting a self-management programme to the Saudi context. However, initial training is needed for local health professionals to understand the mechanisms of self-management programmes. Such programmes will need to infiltrate to the society, and the patients’ families, in particular to tackle the rising prevalence of type 2 diabetes in Saudi Arabia and provide a friendlier, more supportive environment for the current patients to self-manage their diabetes.
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Affiliation(s)
- Thamer Al Slamah
- Human Health Department, College of Applied Medical Sciences, Qassim University, Kingdom of Saudi Arabia, Riyadh, Saudi Arabia
- General Practice and Primary Care, Institute of Health and Wellbeing College of Medicine, Veterinary and Life Science, University of Glasgow, Glasgow, United Kingdom
| | - Barbara I. Nicholl
- General Practice and Primary Care, Institute of Health and Wellbeing College of Medicine, Veterinary and Life Science, University of Glasgow, Glasgow, United Kingdom
| | - Fatima Y. Alslail
- Director of the National Diabetes Control and Prevention Program, Ministry of Health, Kingdom of Saudi Arabia, Riyadh, Saudi Arabia
| | - Leanne Harris
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Craig A. Melville
- Mental Health and Wellbeing, Institute of Health and Wellbeing College of Medicine, Veterinary and Life Science, University of Glasgow, Glasgow, United Kingdom
| | - Deborah Kinnear
- Mental Health and Wellbeing, Institute of Health and Wellbeing College of Medicine, Veterinary and Life Science, University of Glasgow, Glasgow, United Kingdom
- * E-mail:
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Dunfee M, Cuy Castellanos D. Bridging the gaps between ecology and nutrition: a middle school–university collaboration. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2019. [DOI: 10.1080/19320248.2018.1484312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Madeline Dunfee
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
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Choi JS, Shim KS, Shin NE, Nieman CL, Mamo SK, Han HR, Lin FR. Cultural Adaptation of a Community-Based Hearing Health Intervention for Korean American Older Adults with Hearing Loss. J Cross Cult Gerontol 2019; 34:223-243. [PMID: 31264090 PMCID: PMC6814539 DOI: 10.1007/s10823-019-09376-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although hearing loss is known to be associated with many adverse health outcomes in older adults, current hearing healthcare remains expensive and inaccessible to most ethnic minorities in the US. We aim to adapt an affordable, community-based hearing intervention to older Korean Americans (KAs), describe the cultural adaption process, and report pilot trial outcomes. We undertook the first four stages of Barrera & Castro's cultural adaptation framework: information gathering, preliminary adaptation design, adaptation test, and adaptation refinement in 15 older KAs with hearing loss and 15 of their communication partners. We developed a culturally adapted intervention consisting of provision of an affordable listening device and aural rehabilitative training. Six weeks post-intervention, participants' mean hearing handicap score (range: 0-40) reduced from 15.7 to 6.4. Communication partners demonstrated improved social-emotional function. Post-intervention focus group revealed increased hearing benefit, confidence in hearing health navigation, and awareness in hearing health among study participants. The adapted intervention was well-accepted and feasible among older KAs. This study is the first to report the cultural adaptation process of a hearing care model into older KAs and its methodology may be applied to other minority groups.
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Affiliation(s)
- Janet S Choi
- Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of the University of Southern California, California, Los Angeles, USA
| | - Kyoo S Shim
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Na E Shin
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carrie L Nieman
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University, Baltimore, MD, USA
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Sara K Mamo
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Hae-Ra Han
- Department of Community-Public Health, School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Frank R Lin
- Departments of Otolaryngology-Head & Neck Surgery, Geriatric Medicine, Mental Health and Epidemiology, Johns Hopkins University, Baltimore, MD, USA.
- Johns Hopkins Center on Aging & Health, 2024 E. Monument St, Suite 2-700, Baltimore, MD, 21205, USA.
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Evaluation of ¡Vivir Mi Vida! to improve health and wellness of rural-dwelling, late middle-aged Latino adults: results of a feasibility and pilot study of a lifestyle intervention. Prim Health Care Res Dev 2018; 19:448-463. [PMID: 29729677 DOI: 10.1017/s1463423617000901] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
AimThe aim of this study was to determine the feasibility and efficacy of a culturally tailored lifestyle intervention, ¡Vivir Mi Vida! (Live My Life!). This intervention was designed to improve the health and well-being of high risk late middle-aged Latino adults and to be implemented in a rural primary care system. BACKGROUND Rural-dwelling Latino adults experience higher rates of chronic disease compared with their urban counterparts, a disparity exacerbated by limited access to healthcare services. Very few lifestyle interventions exist that are both culturally sensitive and compatible for delivery within a non-metropolitan primary care context. METHODS Participants were 37 Latino, Spanish-speaking adults aged 50-64-years-old, recruited from a rural health clinic in the Antelope Valley of California. ¡Vivir Mi Vida! was delivered by a community health worker-occupational therapy team over a 16-week period. Subjective health, lifestyle factors, and cardiometabolic measures were collected pre- and post-intervention. Follow-up interviews and focus groups were held to collect information related to the subjective experiences of key stakeholders and participants.FindingsParticipants demonstrated improvements in systolic blood pressure, sodium and saturated fat intake, and numerous patient-centered outcomes ranging from increased well-being to reduced stress. Although participants were extremely satisfied with the program, stakeholders identified a number of implementation challenges. The findings suggest that a tailored lifestyle intervention led by community health workers and occupational therapists is feasible to implement in a primary care setting and can improve health outcomes in rural-dwelling, late middle-aged Latinos.
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Sotos-Prieto M, Mattei J. Mediterranean Diet and Cardiometabolic Diseases in Racial/Ethnic Minority Populations in the United States. Nutrients 2018; 10:E352. [PMID: 29538339 PMCID: PMC5872770 DOI: 10.3390/nu10030352] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/25/2018] [Accepted: 03/06/2018] [Indexed: 01/02/2023] Open
Abstract
The Mediterranean diet (MedDiet) has been recommended to the general population by many scientific organizations as a healthy dietary pattern, based on strong evidence of association with improved cardiometabolic health, including lower risk of cardiovascular disease, diabetes, and obesity. However, most studies have been conducted in Mediterranean or European countries or among white populations in the United States (US), while few exist for non-Mediterranean countries or racial/ethnic minority populations in the US. Because most existing studies evaluating adherence to the MedDiet use population-specific definitions or scores, the reported associations may not necessarily apply to other racial/ethnic populations that may have different distributions of intake. Moreover, racial/ethnic groups may have diets that do not comprise the typical Mediterranean foods captured by these scores. Thus, there is a need to determine if similar positive effects from following a MedDiet are observed in diverse populations, as well as to identify culturally-relevant foods reflected within Mediterranean-like patterns, that can facilitate implementation and promotion of such among broader racial/ethnic groups. In this narrative review, we summarize and discuss the evidence from observational and intervention studies on the MedDiet and cardiometabolic diseases in racial/ethnic minority populations in the US, and offer recommendations to enhance research on MedDiet for such populations.
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Affiliation(s)
- Mercedes Sotos-Prieto
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
- Department of Food Sciences and Nutrition, School of Applied Health Sciences and Wellness, Ohio University, Athens, OH 45701, USA.
- Diabetes Institute, Ohio University, Athens, OH 45701, USA.
| | - Josiemer Mattei
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA.
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Schepens Niemiec SL, Blanchard J, Vigen CLP, Martínez J, Guzmán L, Fluke M, Carlson M. A Pilot Study of the ¡Vivir Mi Vida! Lifestyle Intervention for Rural-Dwelling, Late-Midlife Latinos: Study Design and Protocol. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2018. [PMID: 29514544 DOI: 10.1177/1539449218762728] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Older, rural-dwelling Latinos face multiple health disparities. We describe the protocol of a pilot study of a community health worker-occupational therapist-led lifestyle program, ¡Vivir Mi Vida! ( ¡VMV!), designed for delivery in primary care and adapted for late-midlife, Latino rural-living patients. Using mixed methods, we collected feasibility, acceptability, and preliminary efficacy data on ¡VMV!. Forty 50- to 64-year-old Latinos participated in a 16-week lifestyle intervention led by a community health worker-occupational therapist team. We conducted pre- and post-intervention assessments to evaluate the efficacy of ¡VMV! in improving psychosocial and clinical health outcomes. Focus groups and interviews were held post-intervention with participants and key stakeholders to assess feasibility and acceptability. This is the first trial designed to evaluate a lifestyle intervention that includes collaboration between occupational therapists and community health workers within primary care. The detailed description of methodology promotes research transparency and reproducibility of a community health worker-occupational therapist-led lifestyle intervention.
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Affiliation(s)
| | | | | | | | - Laura Guzmán
- 1 University of Southern California, Los Angeles, USA
| | - Michelle Fluke
- 2 Antelope Valley Partners for Health, Lancaster, CA, USA
| | - Mike Carlson
- 1 University of Southern California, Los Angeles, USA
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Boyce KS, Travers M, Rothbart B, Santiago V, Bedell J. Adapting Evidence-Based Teen Pregnancy Programs to Be LGBT-Inclusive: Lessons Learned. Health Promot Pract 2018; 19:445-454. [DOI: 10.1177/1524839918756888] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Madeline Travers
- New York City Department of Health and Mental Hygiene, Bronx, NY, USA
| | - Betty Rothbart
- New York City Department of Education, New York, NY, USA
| | - Vivian Santiago
- New York City Department of Health and Mental Hygiene, Bronx, NY, USA
| | - Jane Bedell
- New York City Department of Health and Mental Hygiene, Bronx, NY, USA
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Morgan-Consoli ML, Unzueta E. Female Mexican Immigrants in the United States: Cultural Knowledge and Healing. WOMEN & THERAPY 2017. [DOI: 10.1080/02703149.2017.1323473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Melissa L. Morgan-Consoli
- Counseling, Clinical and School Psychology Department, University of California Santa Barbara, Santa Barbara, California
| | - Emily Unzueta
- Counseling, Clinical and School Psychology Department, University of California Santa Barbara, Santa Barbara, California
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Delaney CL, Barrios P, Lozada C, Soto-Balbuena K, Martin-Biggers J, Byrd-Bredbenner C. Applying Common Latino Magazine Cover Line Themes to Health Communications. HISPANIC JOURNAL OF BEHAVIORAL SCIENCES 2016. [DOI: 10.1177/0739986316660373] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to describe strategies used in magazine cover lines to capture the attention of Latino consumers. A content analysis of cover lines ( n = 581) from six top-selling Latino women’s and parenting magazines ( n = 217 issues) sold in the United States identified 12 common themes: great/inspiring, beauty/health, bad/negative, love/passion, family/protective, strength/power, daring, informative/how-to, newness/uniqueness, improve/organize, happiness/fun, and easy/simple, with the first seven being unique to Latino-targeted magazines. Theses unique themes may be related to certain Latino cultural constructs, such as familismo, machismo, and respeto. Cover lines for nutrition education information mini-magazines were written using the strategies identified in the content analysis, then cognitive tested with 112 Spanish-speaking Latino parents. Parents felt the cover lines matched the guide content, were attention grabbing and catchy, and would motivate parents to read the mini-magazine. Findings can assist health communicators in creating brief Latino-targeted messages that are culturally responsive and capture reader interest.
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Schepens Niemiec SL, Carlson M, Martínez J, Guzmán L, Mahajan A, Clark F. Developing Occupation-Based Preventive Programs for Late-Middle-Aged Latino Patients in Safety-Net Health Systems. Am J Occup Ther 2015; 69:6906240010. [PMID: 26565102 PMCID: PMC4643379 DOI: 10.5014/ajot.2015.015958] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Latino adults between ages 50 and 60 yr are at high risk for developing chronic conditions that can lead to early disability. We conducted a qualitative pilot study with 11 Latinos in this demographic group to develop a foundational schema for the design of health promotion programs that could be implemented by occupational therapy practitioners in primary care settings for this population. One-on-one interviews addressing routines and activities, health management, and health care utilization were conducted, audiotaped, and transcribed. Results of a content analysis of the qualitative data revealed the following six domains of most concern: Weight Management; Disease Management; Mental Health and Well-Being; Personal Finances; Family, Friends, and Community; and Stress Management. A typology of perceived health-actualizing strategies was derived for each domain. This schema can be used by occupational therapy practitioners to inform the development of health-promotion lifestyle interventions designed specifically for late-middle-aged Latinos.
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Affiliation(s)
- Stacey L Schepens Niemiec
- Stacey L. Schepens Niemiec, PhD, OTR/L, is Research Assistant Professor, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles;
| | - Mike Carlson
- Mike Carlson, PhD, is Research Professor, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - Jenny Martínez
- Jenny Martínez, OTD, OTR/L, is Assistant Professor of Clinical Occupational Therapy, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - Laura Guzmán
- Laura Guzmán is Project Assistant, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - Anish Mahajan
- Anish Mahajan, MD, MS, MPH, is Director of System Planning, Improvement and Data Analytics, Los Angeles County Department of Health Services, Los Angeles, CA
| | - Florence Clark
- Florence Clark, PhD, OTR/L, is Professor, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
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Baig AA, Benitez A, Quinn MT, Burnet DL. Family interventions to improve diabetes outcomes for adults. Ann N Y Acad Sci 2015; 1353:89-112. [PMID: 26250784 DOI: 10.1111/nyas.12844] [Citation(s) in RCA: 164] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Diabetes self-care is a critical aspect of disease management for adults with diabetes. Since family members can play a vital role in a patient's disease management, involving them in self-care interventions may positively influence patients' diabetes outcomes. We systematically reviewed family-based interventions for adults with diabetes published from 1994 to 2014 and assessed their impact on patients' diabetes outcomes and the extent of family involvement. We found 26 studies describing family-based diabetes interventions for adults. Interventions were conducted across a range of patient populations and settings. The degree of family involvement varied across studies. We found evidence for improvement in patients' self-efficacy, perceived social support, diabetes knowledge, and diabetes self-care across the studies. Owing to the heterogeneity of the study designs, types of interventions, reporting of outcomes, and family involvement, it is difficult to determine how family participation in diabetes interventions may affect patients' clinical outcomes. Future studies should clearly describe the role of family in the intervention, assess quality and extent of family participation, and compare patient outcomes with and without family involvement.
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Affiliation(s)
- Arshiya A Baig
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Amanda Benitez
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Michael T Quinn
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Deborah L Burnet
- Department of Medicine, University of Chicago, Chicago, Illinois
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Al-Bannay HR, Jongbloed LE, Jarus T, Alabdulwahab SS, Khoja TA, Dean E. Outcomes of a type 2 diabetes education program adapted to the cultural contexts of Saudi women. A pilot study. Saudi Med J 2015; 36:869-73. [PMID: 26108595 PMCID: PMC4503910 DOI: 10.15537/smj.2015.7.11681] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To explore the outcomes of a pilot intervention of a type 2 diabetes (T2D) education program, based on international standards, and adapted to the cultural and religious contexts of Saudi women. METHODS This study is an experiment of a pilot intervention carried out between August 2011 and January 2012 at the primary health clinics in Dammam. Women at risk of or diagnosed with T2D (N=35 including dropouts) were assigned to one of 2 groups; an intervention group participated in a pilot intervention of T2D education program, based on international standards and tailored to their cultural and religious contexts; and a usual care group received the usual care for diabetes in Saudi Arabia. Outcomes included blood glucose, body composition, 6-minute walk distance, life satisfaction, quality of life, and diabetes knowledge. The intervention group participated in a focus group of their program experience. Data analysis was based on mixed methods. RESULTS Based on 95% confidence interval comparisons, improvements were noted in blood sugar, 6-minute walk distance, quality of life, and diabetes knowledge in participants of the intervention group. They also reported improvements in lifestyle-related health behaviors after the education program. CONCLUSION Saudi women may benefit from a T2D education program based on international standards and adapted to their cultural and religious contexts.
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Affiliation(s)
- Hana R Al-Bannay
- Program in Rehabilitation Sciences, University of British Columbia, Vancouver, Canada. E-mail.
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Sanders Thompson VL, Johnson-Jennings M, Bauman AA, Proctor E. Use of culturally focused theoretical frameworks for adapting diabetes prevention programs: a qualitative review. Prev Chronic Dis 2015; 12:E60. [PMID: 25950567 PMCID: PMC4436044 DOI: 10.5888/pcd12.140421] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction Diabetes disproportionately affects underserved racial/ethnic groups in the United States. Diabetes prevention interventions positively influence health; however, further evaluation is necessary to determine what role culture plays in effective programming. We report on the status of research that examines cultural adaptations of diabetes prevention programs. Methods We conducted database searches in March and April 2014. We included studies that were conducted in the United States and that focused on diabetes prevention among African Americans, American Indians/Alaska Natives, Asian Americans/Pacific Islanders, and Latinos. Results A total of 58 studies were identified for review; 29 were excluded from evaluation. Few adaptations referenced or followed recommendations for cultural adaptation nor did they justify the content modifications by providing a rationale or evidence. Cultural elements unique to racial/ethnic populations were not assessed. Conclusion Future cultural adaptations should use recommended processes to ensure that culture’s role in diabetes prevention–related behavioral changes contributes to research.
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Affiliation(s)
- Vetta L Sanders Thompson
- Washington University in St. Louis, Brown School, One Brookings Dr, CB 1196, St. Louis, MO, 63130.
| | | | - Ana A Bauman
- Washington University in St. Louis, Brown School, St. Louis, Missouri
| | - Enola Proctor
- Washington University in St. Louis, Brown School, St. Louis, Missouri
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Barrera M, Toobert DJ, Strycker LA. Relative contributions of naturalistic and constructed support: two studies of women with type 2 diabetes. J Behav Med 2014; 37:59-69. [PMID: 23109138 DOI: 10.1007/s10865-012-9465-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Do distinct sources of social support have differential effects on health? Although previous research has contrasted family and friend support (naturalistic support), research on the relative effects of naturalistic support and constructed support (e.g., support groups) is extremely rare. Two studies of women with type 2 diabetes were conducted that assessed the independent effects of naturalistic and constructed support on physical activity and glycosylated hemoglobin (HbA1c). Participants were women diagnosed with type 2 diabetes from the intervention arms of two randomized controlled trials: primarily European American women (Study 1; N = 163) and exclusively Hispanic women (Study 2; N = 142). Measures assessed physical activity, HbA1c, and friend and family support at baseline and at 6 months, as well as group support after 6 months of intervention. In Study 1, only group support was related to increases in physical activity (ΔR(2) = .036). In Study 2, group support and family support showed independent effects on increases in physical activity (ΔR(2) = .047 and .060, respectively). Also, group support was related to decreases in HbA1c in Study 1 (ΔR(2) = .031) and Study 2 (ΔR(2) = .065). Overall, constructed (group) support was related to outcomes most consistently, but naturalistic (family) support showed some independent relation to physical activity improvement.
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Affiliation(s)
- Manuel Barrera
- Department of Psychology, Arizona State University, Box 871104, Tempe, AZ, 85287-1104, USA,
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Attridge M, Creamer J, Ramsden M, Cannings‐John R, Hawthorne K. Culturally appropriate health education for people in ethnic minority groups with type 2 diabetes mellitus. Cochrane Database Syst Rev 2014; 2014:CD006424. [PMID: 25188210 PMCID: PMC10680058 DOI: 10.1002/14651858.cd006424.pub3] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Ethnic minority groups in upper-middle-income and high-income countries tend to be socioeconomically disadvantaged and to have a higher prevalence of type 2 diabetes than is seen in the majority population. OBJECTIVES To assess the effectiveness of culturally appropriate health education for people in ethnic minority groups with type 2 diabetes mellitus. SEARCH METHODS A systematic literature search was performed of the following databases: The Cochrane Library, MEDLINE, EMBASE, PsycINFO, the Education Resources Information Center (ERIC) and Google Scholar, as well as reference lists of identified articles. The date of the last search was July 2013 for The Cochrane Library and September 2013 for all other databases. We contacted authors in the field and handsearched commonly encountered journals as well. SELECTION CRITERIA We selected randomised controlled trials (RCTs) of culturally appropriate health education for people over 16 years of age with type 2 diabetes mellitus from named ethnic minority groups residing in upper-middle-income or high-income countries. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. When disagreements arose regarding selection of papers for inclusion, two additional review authors were consulted for discussion. We contacted study authors to ask for additional information when data appeared to be missing or needed clarification. MAIN RESULTS A total of 33 trials (including 11 from the original 2008 review) involving 7453 participants were included in this review, with 28 trials providing suitable data for entry into meta-analysis. Although the interventions provided in these studies were very different from one study to another (participant numbers, duration of intervention, group versus individual intervention, setting), most of the studies were based on recognisable theoretical models, and we tried to be inclusive in considering the wide variety of available culturally appropriate health education.Glycaemic control (as measured by glycosylated haemoglobin A1c (HbA1c)) showed improvement following culturally appropriate health education at three months (mean difference (MD) -0.4% (95% confidence interval (CI) -0.5 to -0.2); 14 trials; 1442 participants; high-quality evidence) and at six months (MD -0.5% (95% CI -0.7 to -0.4); 14 trials; 1972 participants; high-quality evidence) post intervention compared with control groups who received 'usual care'. This control was sustained to a lesser extent at 12 months (MD -0.2% (95% CI -0.3 to -0.04); 9 trials; 1936 participants) and at 24 months (MD -0.3% (95% CI -0.6 to -0.1); 4 trials; 2268 participants; moderate-quality evidence) post intervention. Neutral effects on health-related quality of life measures were noted and there was a general lack of reporting of adverse events in most studies - the other two primary outcomes for this review. Knowledge scores showed improvement in the intervention group at three (standardised mean difference (SMD) 0.4 (95% CI 0.1 to 0.6), six (SMD 0.5 (95% CI 0.3 to 0.7)) and 12 months (SMD 0.4 (95% CI 0.1 to 0.6)) post intervention. A reduction in triglycerides of 24 mg/dL (95% CI -40 to -8) was observed at three months, but this was not sustained at six or 12 months. Neutral effects on total cholesterol, low-density lipoprotein (LDL) cholesterol or high-density lipoprotein (HDL) cholesterol were reported at any follow-up point. Other outcome measures (blood pressure, body mass index, self-efficacy and empowerment) also showed neutral effects compared with control groups. Data on the secondary outcomes of diabetic complications, mortality and health economics were lacking or were insufficient.Because of the nature of the intervention, participants and personnel delivering the intervention were rarely blinded, so the risk of performance bias was high. Also, subjective measures were assessed by participants who self-reported via questionnaires, leading to high bias in subjective outcome assessment. AUTHORS' CONCLUSIONS Culturally appropriate health education has short- to medium-term effects on glycaemic control and on knowledge of diabetes and healthy lifestyles. With this update (six years after the first publication of this review), a greater number of RCTs were reported to be of sufficient quality for inclusion in the review. None of these studies were long-term trials, and so clinically important long-term outcomes could not be studied. No studies included an economic analysis. The heterogeneity of the studies made subgroup comparisons difficult to interpret with confidence. Long-term, standardised, multi-centre RCTs are needed to compare different types and intensities of culturally appropriate health education within defined ethnic minority groups, as the medium-term effects could lead to clinically important health outcomes, if sustained.
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Affiliation(s)
- Madeleine Attridge
- 3rd Floor Neuadd Meirionnydd, Cardiff UniversityCochrane Institute of Primary Care and Public HealthHeath ParkCardiffUKCF14 4YS
| | | | - Michael Ramsden
- 8th Floor, Neuadd Meirionnydd, Cardiff UniversityWales DeaneryHeath ParkCardiffUKCF14 4YS
| | - Rebecca Cannings‐John
- 4th Floor, Neuadd Meirionnydd, Cardiff UniversitySouth East Wales Trials UnitHealth ParkCardiffUKCF14 4XN
| | - Kamila Hawthorne
- 5th Floor, Cochrane Building, School of Medicine, Cardiff UniversityInstitute of Medical EducationHeath ParkCardiffUKCF14 4XN
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Inam A, Tariq PN, Zaman S. Cultural adaptation of preschool PATHS (Promoting Alternative Thinking Strategies) curriculum for Pakistani children. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2014; 50:232-9. [PMID: 25130573 DOI: 10.1002/ijop.12090] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 06/25/2014] [Accepted: 06/25/2014] [Indexed: 02/03/2023]
Abstract
Cultural adaptation of evidence-based programmes has gained importance primarily owing to its perceived impact on the established effectiveness of a programme. To date, many researchers have proposed different frameworks for systematic adaptation process. This article presents the cultural adaptation of preschool Promoting Alternative Thinking Strategies (PATHS) curriculum for Pakistani children using the heuristic framework of adaptation (Barrera & Castro, 2006). The study was completed in four steps: information gathering, preliminary adaptation design, preliminary adaptation test and adaptation refinement. Feedbacks on programme content suggested universality of the core programme components. Suggested changes were mostly surface structure: language, presentation of materials, conceptual equivalence of concepts, training needs of implementation staff and frequency of programme delivery. In-depth analysis was done to acquire cultural equivalence. Pilot testing of the outcome measures showed strong internal consistency. The results were further discussed with reference to similar work undertaken in other cultures.
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Affiliation(s)
- Ayesha Inam
- National Institute of Psychology, Quaid-i-Azam University, Islamabad, Pakistan
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Barrera M, Castro FG, Strycker LA, Toobert DJ. Cultural adaptations of behavioral health interventions: a progress report. J Consult Clin Psychol 2013; 81:196-205. [PMID: 22289132 PMCID: PMC3965302 DOI: 10.1037/a0027085] [Citation(s) in RCA: 382] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
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.
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Affiliation(s)
- Manuel Barrera
- Department of Psychology, Arizona State University (Tempe, Arizona) and Oregon Research Institute (Eugene, Oregon)
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Cultural adaptation of an evidence-based nursing intervention to improve medication adherence among people living with HIV/AIDS (PLWHA) in China. Int J Nurs Stud 2012; 50:487-94. [PMID: 22981372 DOI: 10.1016/j.ijnurstu.2012.08.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 08/17/2012] [Accepted: 08/28/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND Adapting nursing interventions to suit the needs and culture of a new population (cultural adaptation) is an important early step in the process of implementation and dissemination. While the need for cultural adaptation is widely accepted, research-based strategies for doing so are not well articulated. Non-adherence to medications for chronic disease is a global problem and cultural adaptation of existing evidence-based interventions could be useful. OBJECTIVES This paper aims to describe the cultural adaptation of an evidence-based nursing intervention to improve medication adherence among people living with HIV/AIDS and to offer recommendations for adaptation of interventions across cultures and borders. SITE: The intervention, which demonstrated efficacy in a randomized controlled trial in North America, was adapted for the cultural and social context of Hunan Province, in south central China. SOURCES OF DATA The adaptation process was undertaken by intervention stakeholders including the original intervention study team, the proposed adaptation team, and members of a Community Advisory Board, including people living with HIV/AIDS, family members, and health care workers at the target clinical sites. PROCEDURES The adaptation process was driven by quantitative and qualitative data describing the new population and context and was guided by principles for cultural adaptation drawn from prevention science research. RESULTS The primary adaptation to the intervention was the inclusion of family members in intervention activities, in response to the cultural and social importance of the family in rural China. In a pilot test of the adapted intervention, self-reported medication adherence improved significantly in the group receiving the intervention compared to the control group (p=0.01). Recommendations for cultural adaptation of nursing interventions include (1) involve stakeholders from the beginning; (2) assess the population, need, and context; (3) evaluate the intervention to be adapted with attention to details of the original studies that demonstrated efficacy; (4) compare important elements of the original intervention with those of the proposed new population and context to identify primary points for adaptation; (5) explicitly identify sources of tension between intervention fidelity and cultural adaptive needs; (6) document the process of adaptation, pilot the adapted intervention, and evaluate its effectiveness before moving to dissemination and implementation on a large scale.
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Glasgow RE, Kurz D, King D, Dickman JM, Faber AJ, Halterman E, Woolley T, Toobert DJ, Strycker LA, Estabrooks PA, Osuna D, Ritzwoller D. Twelve-month outcomes of an Internet-based diabetes self-management support program. PATIENT EDUCATION AND COUNSELING 2012; 87:81-92. [PMID: 21924576 PMCID: PMC3253192 DOI: 10.1016/j.pec.2011.07.024] [Citation(s) in RCA: 123] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Revised: 07/05/2011] [Accepted: 07/29/2011] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Internet-based programs offer potential for practical, cost-effective chronic illness self-management programs. METHODS We report 12-month results of an Internet-based diabetes self-management program, with and without additional support, compared to enhanced usual care in a 3-arm practical randomized trial. Patients (n=463) were randomized: 77.3% completed 12-month follow-up. Primary outcomes were changes in health behaviors of healthy eating, physical activity, and medication taking. Secondary outcomes were hemoglobin A1c, body mass index, lipids, blood pressure, and psychosocial factors. RESULTS Internet conditions improved health behaviors significantly vs. usual care over the 12-month period (d for effect size=.09-.16). All conditions improved moderately on biological and psychosocial outcomes. Latinos, lower literacy, and higher cardiovascular disease risk patients improved as much as other participants. CONCLUSIONS The Internet intervention meets the reach and feasibility criteria for a potentially broad public health impact. However, 12-month magnitude of effects was small, suggesting that different or more intensive approaches are necessary to support long-term outcomes. Research is needed to understand the linkages between intervention and maintenance processes and downstream outcomes. PRACTICE IMPLICATIONS Automated self-management interventions should be tailored and integrated into primary care; maintenance of patient self-management can be enhanced through links to community resources.
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Affiliation(s)
- Russell E Glasgow
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA.
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Ferrer-Wreder L, Sundell K, Mansoory S. Tinkering with Perfection: Theory Development in the Intervention Cultural Adaptation Field. CHILD & YOUTH CARE FORUM 2011. [DOI: 10.1007/s10566-011-9162-6] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Toobert DJ, Strycker LA, Barrera M, Osuna D, King DK, Glasgow RE. Outcomes from a multiple risk factor diabetes self-management trial for Latinas: ¡Viva Bien! Ann Behav Med 2011; 41:310-23. [PMID: 21213091 DOI: 10.1007/s12160-010-9256-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Culturally appropriate interventions are needed to assist Latinas in making multiple healthful lifestyle changes. PURPOSE The purpose of this study was to test a cultural adaptation of a successful multiple health behavior change program, ¡Viva Bien! METHODS Random assignment of 280 Latinas with type 2 diabetes to usual care only or to usual care + ¡Viva Bien!, which included group meetings for building skills to promote the Mediterranean diet, physical activity, stress management, supportive resources, and smoking cessation. RESULTS ¡Viva Bien! participants compared to usual care significantly improved psychosocial and behavioral outcomes (fat intake, stress management practice, physical activity, and social-environmental support) at 6 months, and some improvements were maintained at 12 months. Biological improvements included hemoglobin A1c and heart disease risk factors. CONCLUSIONS The ¡Viva Bien! multiple lifestyle behavior program was effective in improving psychosocial, behavioral, and biological/quality of life outcomes related to heart health for Latinas with type 2 diabetes.
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Toobert DJ, Strycker LA, King DK, Barrera M, Osuna D, Glasgow RE. Long-term outcomes from a multiple-risk-factor diabetes trial for Latinas: ¡Viva Bien! Transl Behav Med 2011; 1:416-426. [PMID: 22022345 PMCID: PMC3196590 DOI: 10.1007/s13142-010-0011-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Latinas with type 2 diabetes are in need of culturally sensitive interventions to make recommended longterm lifestyle changes and reduce heart disease risk. To test the longer-term (24-month) effects of a previously successful, culturally adapted, multiple-healthbehavior- change program, ¡Viva Bien!, 280 Latinas were randomly assigned to usual care or ¡Viva Bien!. Treatment included group meetings to promote a culturally adapted Mediterranean diet, physical activity, supportive resources, problem solving, stress-management practices, and smoking cessation. ¡Viva Bien! participants achieved and maintained some lifestyle improvements from baseline through 24 months, including significant improvements for psychosocial outcomes, fat intake, social-environmental support, body mass index, and hemoglobin A1c. Effects tended to diminish over time. The ¡Viva Bien! multiple-behavior program was effective in improving and maintaining some psychosocial, behavioral, and biological outcomes related to heart health across 24 months for Latinas with type 2 diabetes, a high-risk, underserved population (ClinicalTrials.gov number, NCT00233259).
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Affiliation(s)
- Deborah J Toobert
- />Oregon Research Institute, 1715 Franklin Blvd, Eugene, OR 97403-1983 USA
| | - Lisa A Strycker
- />Oregon Research Institute, 1715 Franklin Blvd, Eugene, OR 97403-1983 USA
| | - Diane K King
- />Institute for Health Research Address Kaiser Permanente Colorado, P.O. Box 378066, Denver, CO 80237-8066 USA
| | - Manuel Barrera
- />Psychology Department, Arizona State University, Box 871104, Tempe, AZ 85287-1104 USA
| | - Diego Osuna
- />University of Colorado Health Sciences Center, Institute for Health Research, Kaiser Permanente Colorado, P.O. Box 378066, Denver, CO 80237-8066 USA
| | - Russell E Glasgow
- />Dissemination and Implementation Science, Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Blvd., Room 6144, Rockville, MD 20852 USA
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Barrera M, Toobert D, Strycker L, Osuna D. Effects of acculturation on a culturally adapted diabetes intervention for Latinas. Health Psychol 2011; 31:51-4. [PMID: 21859212 DOI: 10.1037/a0025205] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To inform the refinement of a culturally adapted diabetes intervention, we evaluated acculturation's association with variables at several sequential steps: baseline measures of diet and physical activity, intervention engagement, putative mediators (problem solving and social resources), and outcomes (fat consumption and physical activity). METHOD Latina women (N = 280) recruited from health organizations were randomly assigned to a culturally adapted lifestyle intervention (¡Viva Bien!) or usual care. A brief version of the Acculturation Rating Scale for Mexican Americans-II (ARSMA-II) acculturation scales (Anglo and Latina orientations) was administered at baseline. Assessments at baseline, 6 months, and 12 months included social supportive resources for diet and exercise, problem solving, saturated fat consumption, and physical activity. RESULTS Latina orientation was negatively related to saturated fat intake and physical activity at baseline. Latina orientation also was positively related to session attendance during Months 6-12 of the intervention. Independent of 6-month intervention effects, Anglo orientation was significantly positively related to improvements in problem solving and dietary supportive resources. Anglo orientation related negatively to improved physical activity at 6 and 12 months. There were no Acculturation × Intervention interactions on putative mediators or outcomes. CONCLUSION The cultural adaptation process was successful in creating an engaging and effective intervention for Latinas at all levels of acculturation. However, independent of intervention effects, acculturation was related to putative mediating variables (problem solving and social resources) and an outcome variable (physical activity), an indication of acculturation's general influence on lifestyle and coping factors.
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Affiliation(s)
- Manuel Barrera
- Department of Psychology, Arizona State University, Tempe, AZ 85287-1104, USA.
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Ritzwoller DP, Sukhanova AS, Glasgow RE, Strycker LA, King DK, Gaglio B, Toobert DJ. Intervention costs and cost-effectiveness for a multiple-risk-factor diabetes self-management trial for Latinas: economic analysis of ¡Viva Bien! Transl Behav Med 2011; 1:427-435. [PMID: 22081776 DOI: 10.1007/s13142-011-0037-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Information on cost-effectiveness of multiple-risk-factor lifestyle interventions for Latinas with diabetes is lacking. The aim of this paper is to evaluate costs and cost-effectiveness for ¡Viva Bien!, a randomized trial targeting Latinas with type 2 diabetes. We estimated 6-month costs; calculated incremental costs per behavioral, biologic, and quality-of-life change; and performed sensitivity analyses from health plan and participant perspectives. Recruitment, intervention, and participant costs were estimated at $45,896, $432,433, and $179,697, respectively. This translates to $4,634 in intervention costs per ¡Viva Bien! participant; $7,723 in both per unit reduction in hemoglobin A1c and per unit reduction in body mass index. Although costs may be higher than interventions that address one risk factor, potential risks for longer-term health-care costs are high for this at-risk group. Given the benefits of ¡Viva Bien!, cost reductions are recommended to enhance its efficiency, adoption, and long-term maintenance without diluting its effectiveness.
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Affiliation(s)
- Debra P Ritzwoller
- Institute for Health Research, Kaiser Permanente Colorado, P.O. Box378066, Denver, CO 80237-8066, USA
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Toobert DJ, Strycker LA, Glasgow RE, Osuna D, Doty AT, Barrera M, Geno CR, Ritzwoller DP. Viva bien!: Overcoming recruitment challenges in a multiple-risk-factor diabetes trial. Am J Health Behav 2010; 34:432-41. [PMID: 20218755 DOI: 10.5993/ajhb.34.4.5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To describe recruitment of Latinas in a randomized clinical trial conducted within 2 health care organizations. METHODS The study relied on project-initiated telephone calls as part of a multifaceted recruitment approach. Chi-square and t tests were conducted to compare participants and nonparticipants on a number of variables. RESULTS From 4045 telephone contacts, 280 Latinas agreed to participate. Most were ineligible due to non-Latino ethnicity (89%). Of eligible candidates, 61% took part. Few significant differences were found on participant vs nonparticipant characteristics. CONCLUSIONS Using appropriate recruitment procedures, a representative sample of Latinas can be obtained.
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