1
|
Pfoh ER, Linfield D, Speaker SL, Roufael JS, Yan C, Misra-Hebert AD, Rothberg MB. Patient Perspectives on Self-Monitoring of Blood Glucose When not Using Insulin: a Cross-sectional Survey. J Gen Intern Med 2022; 37:1673-1679. [PMID: 34389935 PMCID: PMC9130377 DOI: 10.1007/s11606-021-07047-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 07/14/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Professional societies have recommended against use of self-monitoring blood glucose (SMBG) in non-insulin-treated type 2 diabetes (NITT2D) to control blood sugar levels, but patients are still monitoring. OBJECTIVE To understand patients' motivation to monitor their blood sugar, and whether they would stop if their physician suggested it. DESIGN Cross-sectional in-person and electronic survey conducted between 2018 and 2020. PARTICIPANTS Adults with type 2 diabetes not using insulin who self-monitor their blood sugar. MAIN MEASURES The survey included questions about frequency and reason for using SMBG, and the impact of SMBG on quality of life and worry. It also asked, "If your doctor said you could stop checking your blood sugar, would you?" We categorized patients based on whether they would stop. To identify the characteristics independently associated with desire to stop SMBG, we performed a logistic regression using backward stepwise selection. KEY RESULTS We received 458 responses. The common reasons for using SMBG included the doctor wanted the patient to check (67%), desire to see the number (65%), and desire to see if their medications were working (61%). Forty-eight percent of respondents stated that using SMBG reduced their worry about their diabetes and 61% said it increased their quality of life. Fifty percent would stop using SMBG if given permission. In the regression model, respondents who said that they check their blood sugar levels because "I was told to" were more likely to want to stop (AOR: 1.69, 95%CI: 1.11, 2.58). Those that used SMBG due to habit and to understand their diabetes better had lower odds of wanting to stop (AOR: 0.33, 95%CI: 0.18-0.62; AOR: 0.60, 95%CI: 0.39-0.93, respectively). CONCLUSIONS Primary care physicians should discuss patients' reasons for using SMBG and offer them the option of discontinuing.
Collapse
Affiliation(s)
- Elizabeth R Pfoh
- Center for Value-Based Care Research, Cleveland Clinic, 9500 Euclid Avenue, G10, Cleveland, OH, 44195, USA.
| | - Debra Linfield
- Center for Value-Based Care Research, Cleveland Clinic, 9500 Euclid Avenue, G10, Cleveland, OH, 44195, USA
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Sidra L Speaker
- Center for Value-Based Care Research, Cleveland Clinic, 9500 Euclid Avenue, G10, Cleveland, OH, 44195, USA
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Joud S Roufael
- College of Public Health, Kent State University, Kent, OH, USA
| | - Chen Yan
- Center for Value-Based Care Research, Cleveland Clinic, 9500 Euclid Avenue, G10, Cleveland, OH, 44195, USA
| | - Anita D Misra-Hebert
- Center for Value-Based Care Research, Cleveland Clinic, 9500 Euclid Avenue, G10, Cleveland, OH, 44195, USA
- Healthcare Delivery and Implementation Science Center, Cleveland Clinic, Cleveland, OH, USA
| | - Michael B Rothberg
- Center for Value-Based Care Research, Cleveland Clinic, 9500 Euclid Avenue, G10, Cleveland, OH, 44195, USA
| |
Collapse
|
2
|
Opoku-Addai K, Korsah KA, Mensah GP. Nutritional self-care practices and skills of patients with diabetes mellitus: A study at a tertiary hospital in Ghana. PLoS One 2022; 17:e0265608. [PMID: 35320308 PMCID: PMC8942245 DOI: 10.1371/journal.pone.0265608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 03/04/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction
Nutritional management decreases and/or prevents the complications and deaths associated with diabetes mellitus. However, the majority of patients living with diabetes do not engage in optimal nutritional management of diabetes because they see it as the most difficult aspect of managing the condition. This study aimed to explore and describe the practices and skills on nutritional management of diabetes mellitus among patients living with diabetes attending a Ghanaian hospital.
Materials and methods
This study employed an exploratory, descriptive qualitative research design. Fifteen participants were recruited using purposive sampling, and interviewed with a semi-structured interview guide. Content analysis was performed on the data gathered, following which three main themes emerged.
Results
More than two-thirds of the participants of this study had adequate meal planning skills, ate the right quantity of foods, engaged in healthy eating habits, and consumed healthy sources of carbohydrates, fats and protein when eating. However, more than half of the participants had insufficient knowledge and skills in the reading and usage of food labels.
Conclusions
The participants of this study largely engaged in optimal nutritional management of diabetes due to their healthy dietary practices and preferences. It is recommended that health care professionals in Ghana find practical and robust ways to factor the reading and usage of food labels into the care and management of patients with diabetes.
Collapse
Affiliation(s)
- Kwabena Opoku-Addai
- School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
- Faculty of Health and Medical Sciences, Department of Nursing and Midwifery, Presbyterian University College, Asante Akyem, Agogo, Ghana
| | - Kwadwo Ameyaw Korsah
- School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Gwendolyn Patience Mensah
- School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
- * E-mail:
| |
Collapse
|
3
|
Myers A, Presswala L, Bissoonauth A, Gulati N, Zhang M, Izard S, Kozikowski A, Meyers K, Pekmezaris R. Telemedicine for Disparity Patients With Diabetes: The Feasibility of Utilizing Telehealth in the Management of Uncontrolled Type 2 Diabetes in Black and Hispanic Disparity Patients; A Pilot Study. J Diabetes Sci Technol 2021; 15:1034-1041. [PMID: 32865027 PMCID: PMC8442180 DOI: 10.1177/1932296820951784] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Non-Hispanic Black (NHB) and Hispanic/Latinx (H/L) patients bear a disproportionate burden of type 2 diabetes and associated complications. Regular visits to a primary care doctor or diabetes specialist are warranted to maintain glycemic control, but for a myriad of reasons disparity populations may have difficulties receiving diabetes care. We seek to determine the feasibility of telehealth added to care as usual and secondarily to improve health outcomes (hemoglobin A1c [HbA1c]) in NHB and H/L with uncontrolled type 2 diabetes managed with two or three noninsulin agents. METHODS Twenty-nine patients were randomized to monthly phone calls or weekly to biweekly telehealth visits. Feasibility outcomes were summarized descriptively for the telehealth arm. Differences scores for A1C level and surveys were computed between baseline and three months and compared across arms using a two-sample t test or Mann-Whitney U test. RESULTS Patients in the telehealth arm completed a median of eight visits (IQR: 5, 8), and 53% of those in the telephone arm completed 100% of their calls. Change in HbA1c was greater for those in the telephone arm (-2.57 vs -2.07%, P = .70) but the mean baseline HbA1c was higher in the telephone group (11.1% vs 10.3%). Although the change in HbA1c was not statistically different across arms, it was clinically significant. CONCLUSIONS Augmenting care as usual with telehealth provided by telephone or tablet can be of benefit in improving glycemic control in NHB and H/L with type 2 diabetes. Larger studies need to explore this further.
Collapse
Affiliation(s)
- Alyson Myers
- Department of Medicine, Division of
Endocrinology, North Shore University Hospital, Manhasset, New York, USA
- Donald and Barbara Zucker School of
Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Feinstein Institute of Medical Research,
Northwell Health, Manhasset, New York, USA
- Center for Health Innovations and
Outcomes Research, Northwell Health, Manhasset, New York, USA
- Alyson Myers, MD, Northwell Health, 300
Community Drive, Manhasset, New York 11030, USA.
| | - Lubaina Presswala
- Department of Medicine, Division of
Endocrinology, North Shore University Hospital, Manhasset, New York, USA
- Donald and Barbara Zucker School of
Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | | | - Neha Gulati
- Department of Medicine, Division of
Endocrinology, North Shore University Hospital, Manhasset, New York, USA
| | - Meng Zhang
- Feinstein Institute of Medical Research,
Northwell Health, Manhasset, New York, USA
- Center for Health Innovations and
Outcomes Research, Northwell Health, Manhasset, New York, USA
| | - Stephanie Izard
- Feinstein Institute of Medical Research,
Northwell Health, Manhasset, New York, USA
- Center for Health Innovations and
Outcomes Research, Northwell Health, Manhasset, New York, USA
| | - Andrzej Kozikowski
- National Commission on Certification of
Physician Assistants, Johns Creek, GA, USA
| | - Kerry Meyers
- Department of Medicine, Division of
Endocrinology, North Shore University Hospital, Manhasset, New York, USA
- Center for Health Innovations and
Outcomes Research, Northwell Health, Manhasset, New York, USA
| | - Renee Pekmezaris
- Donald and Barbara Zucker School of
Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Feinstein Institute of Medical Research,
Northwell Health, Manhasset, New York, USA
- Center for Health Innovations and
Outcomes Research, Northwell Health, Manhasset, New York, USA
| |
Collapse
|
4
|
An exploration of key barriers to healthcare providers' use of food prescription (FRx) interventions in the rural South. Public Health Nutr 2021; 24:1095-1103. [PMID: 33423706 DOI: 10.1017/s1368980020005376] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The purpose of this exploratory study was to examine the attitude towards food prescriptions (FRx) interventions among clinicians and identify potential barriers to their use in clinical practice. DESIGN The current study employed an exploratory research design using in-depth semi-structured interviews. Research participants were selected from primary care facilities, family practice offices and obesity clinics located in Mississippi and Louisiana. SETTING Providers selected for participation in the current study serve predominantly rural, low-income communities in the US South. PARTICIPANTS From an original population of fifty healthcare providers that included physicians, registered dieticians and nurse practitioners, from Oxford, Tupelo, Batesville, Jackson, and Charleston, MS and New Orleans, LA. Fifteen healthcare providers agreed to participate, including three physicians, four registered dieticians, three nurses and three nurse practitioners. RESULTS The current study found that while healthcare providers expressed a desire to use FRx interventions, there was a universal lack of understanding by healthcare providers of what FRx interventions were, how they were implemented and what outcomes they were likely to influence. CONCLUSIONS The current study identified key bottlenecks in the use of FRx interventions at the clinic level and data provided evidence for two key recommendations: (1) development and validation of a screening tool to be used by clinicians for enrolling patients in such interventions and (2) implementation of nutrition education in primary professional training, as well as in continuing education.
Collapse
|
5
|
Peek ME, Vela MB, Chin MH. Practical Lessons for Teaching About Race and Racism: Successfully Leading Free, Frank, and Fearless Discussions. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:S139-S144. [PMID: 32889939 DOI: 10.1097/acm.0000000000003710] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Successfully teaching about race and racism requires a careful balance of emotional safety and honest truth-telling. Creating such environments where all learners can thrive and grow together is a challenge, but a consistently doable one. This article describes 12 lessons learned within 4 main themes: ground rules; language and communication; concepts of social constructs, intersectionality, and bidirectional biases; and structural racism, solutions, and advocacy. The authors' recommendations for how to successfully teach health professions students about race and racism come from their collective experience of over 60 years of instruction, research, and practice. Proficiency in discussing race and addressing racism will become increasingly relevant as health care institutions strive to address the social needs of patients (e.g., food insecurity, housing instability) that contribute to poor health and are largely driven by structural inequities. Having interprofessional team-based care, with teams better able to understand and counteract their own biases, will be critical to addressing the social and structural determinants of health for marginalized patients. Recognizing that implicit biases about race impact both patients and health professions students from underrepresented racial/ethnic backgrounds is a critical step toward building robust curricula about race and health equity that will improve the learning environment for trainees and reduce health disparities.
Collapse
Affiliation(s)
- Monica E Peek
- M.E. Peek is associate professor of medicine, Section of General Internal Medicine, member, Center for the Study of Race, Politics and Culture, and associate director, Chicago Center for Diabetes Translation Research, The University of Chicago, Chicago, Illinois
| | - Monica B Vela
- M.B. Vela is professor of medicine, Section of General Internal Medicine, member, Center for the Study of Race, Politics and Culture, and associate dean, Multicultural Affairs, The University of Chicago, Chicago, Illinois
| | - Marshall H Chin
- M.H. Chin is Richard Parrillo Family Professor of Healthcare Ethics, Department of Medicine, and director, Chicago Center for Diabetes Translation Research, The University of Chicago, Chicago, Illinois
| |
Collapse
|
6
|
Awang Ahmad NA, Sallehuddin MAA, Teo YC, Abdul Rahman H. Self-Care Management of Patients with diabetes: nurses' perspectives. J Diabetes Metab Disord 2020; 19:1537-1542. [PMID: 33520851 PMCID: PMC7843803 DOI: 10.1007/s40200-020-00688-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 11/05/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To explore nurses' experiences of providing education on self- care management to patients with diabetes. METHODS A qualitative phenomenological study using semi-structured interview on all nine certified diabetic nurse educators in the main hospital and health centres in Brunei. Prolonged engagement with participants and data, and member checking were employed to ensure thematic analysis was trustworthy. RESULTS Three main themes emerged; 1) Factors of effective teaching strategies that emphasizes on assessing patients' knowledge and education level to provide individualised instructional plan, which need to follow latest ministerial guidelines and effective pedagogy; 2) Barriers to provide effective education including psychological, financial, and lack of familial support, 3) Overcoming barriers through parallel health education and counselling, referring to medical social worker and non-governmental organizations, and inclusion of family members and carers in plan of care. CONCLUSION Diabetic nurse educator plays a crucial role to ensure patient with diabetes achieved competency and compliance with long term self-care management. Nurses' need to ensure psychological preparedness and patient literacy assessment when designing individualised health education session. While identifying and addressing key barriers for each patient to ensure effectiveness of management plan and improve quality of life. More research are still needed to explore experiences and innovation solutions from nurses in different parts of the world to better inform policymakers and improve organisational and national guidelines for management of patients with diabetes.
Collapse
Affiliation(s)
- Noor Azimah Awang Ahmad
- PAPRSB Institute of Health Sciences (PAPRSB IHS), Universiti Brunei Darussalam, Bandar Seri Begawan Darussalam, Brunei
| | | | - Yan Choo Teo
- PAPRSB Institute of Health Sciences (PAPRSB IHS), Universiti Brunei Darussalam, Bandar Seri Begawan Darussalam, Brunei
| | - Hanif Abdul Rahman
- PAPRSB Institute of Health Sciences (PAPRSB IHS), Universiti Brunei Darussalam, Bandar Seri Begawan Darussalam, Brunei
| |
Collapse
|
7
|
Thornton PL, Kumanyika SK, Gregg EW, Araneta MR, Baskin ML, Chin MH, Crespo CJ, de Groot M, Garcia DO, Haire-Joshu D, Heisler M, Hill-Briggs F, Ladapo JA, Lindberg NM, Manson SM, Marrero DG, Peek ME, Shields AE, Tate DF, Mangione CM. New research directions on disparities in obesity and type 2 diabetes. Ann N Y Acad Sci 2019; 1461:5-24. [PMID: 31793006 DOI: 10.1111/nyas.14270] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 10/18/2019] [Indexed: 12/12/2022]
Abstract
Obesity and type 2 diabetes disproportionately impact U.S. racial and ethnic minority communities and low-income populations. Improvements in implementing efficacious interventions to reduce the incidence of type 2 diabetes are underway (i.e., the National Diabetes Prevention Program), but challenges in effectively scaling-up successful interventions and reaching at-risk populations remain. In October 2017, the National Institutes of Health convened a workshop to understand how to (1) address socioeconomic and other environmental conditions that perpetuate disparities in the burden of obesity and type 2 diabetes; (2) design effective prevention and treatment strategies that are accessible, feasible, culturally relevant, and acceptable to diverse population groups; and (3) achieve sustainable health improvement approaches in communities with the greatest burden of these diseases. Common features of guiding frameworks to understand and address disparities and promote health equity were described. Promising research directions were identified in numerous areas, including study design, methodology, and core metrics; program implementation and scalability; the integration of medical care and social services; strategies to enhance patient empowerment; and understanding and addressing the impact of psychosocial stress on disease onset and progression in addition to factors that support resiliency and health.
Collapse
Affiliation(s)
- Pamela L Thornton
- Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, Maryland
| | - Shiriki K Kumanyika
- Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Edward W Gregg
- Epidemiology and Statistics Branch, Division of Diabetes Translation, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Maria R Araneta
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Monica L Baskin
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Carlos J Crespo
- Oregon Health and Science University and Portland State University Joint School of Public Health, Portland, Oregon
| | - Mary de Groot
- Indiana University School of Medicine, Indianapolis, Indiana
| | - David O Garcia
- Department of Health Promotion Sciences, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona
| | - Debra Haire-Joshu
- Washington University in St. Louis, School of Medicine and the Brown School, St. Louis, Missouri
| | | | - Felicia Hill-Briggs
- Johns Hopkins School of Medicine and Welch Center for Prevention, Epidemiology & Clinical Research, Baltimore, Maryland
| | - Joseph A Ladapo
- David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California
| | | | | | | | | | - Alexandra E Shields
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute, Massachusetts General Hospital and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Deborah F Tate
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Carol M Mangione
- David Geffen School of Medicine at the University of California, and UCLA Fielding School of Public Health, Los Angeles, Los Angeles, California
| |
Collapse
|
8
|
Harris J, Haltbakk J, Dunning T, Austrheim G, Kirkevold M, Johnson M, Graue M. How patient and community involvement in diabetes research influences health outcomes: A realist review. Health Expect 2019; 22:907-920. [PMID: 31286639 PMCID: PMC6803418 DOI: 10.1111/hex.12935] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 05/24/2019] [Accepted: 05/26/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Patient and public involvement in diabetes research is an international requirement, but little is known about the relationship between the process of involvement and health outcomes. OBJECTIVE This realist review identifies who benefits from different types of involvement across different contexts and circumstances. Search strategies Medline, CINAHL and EMBASE were searched to identify interventions using targeted, embedded or collaborative involvement to reduce risk and promote self-management of diabetes. People at risk/with diabetes, providers and community organizations with an interest in addressing diabetes were included. There were no limitations on date, language or study type. DATA EXTRACTION AND SYNTHESIS Data were extracted from 29 projects using elements from involvement frameworks. A conceptual analysis of involvement types was used to complete the synthesis. MAIN RESULTS Projects used targeted (4), embedded (8) and collaborative (17) involvement. Productive interaction facilitated over a sufficient period of time enabled people to set priorities for research. Partnerships that committed to collaboration increased awareness of diabetes risk and mobilized people to co-design and co-deliver diabetes interventions. Cultural adaptation increased relevance and acceptance of the intervention because they trusted local delivery approaches. Local implementation produced high levels of recruitment and retention, which project teams associated with achieving diabetes health outcomes. DISCUSSION AND CONCLUSIONS Achieving understanding of community context, developing trusting relationships across sectors and developing productive partnerships were prerequisites for designing research that was feasible and locally relevant. The proportion of diabetes studies incorporating these elements is surprisingly low. Barriers to resourcing partnerships need to be systematically addressed.
Collapse
Affiliation(s)
- Janet Harris
- School of Health and Related Research (ScHARR)University of SheffieldSheffieldUK
| | - Johannes Haltbakk
- Faculty of Health and Social SciencesWestern Norway University of Applied SciencesBergenNorway
| | - Trisha Dunning
- Centre for Quality and Patient Safety ResearchDeakin University and Barwon Health PartnershipGeelongVictoriaAustralia
| | | | - Marit Kirkevold
- Faculty of Health and Social SciencesWestern Norway University of Applied SciencesBergenNorway
- Department of Nursing Science, Institute of Health and SocietyUniversity of OsloOsloNorway
| | - Maxine Johnson
- School of Health and Related Research (ScHARR)University of SheffieldSheffieldUK
| | - Marit Graue
- Faculty of Health and Social SciencesWestern Norway University of Applied SciencesBergenNorway
| |
Collapse
|
9
|
Jindal G. Assessing the Value of an Online Repository of Local Resources for People Who Have Chronic Health Conditions. JOURNAL OF CONSUMER HEALTH ON THE INTERNET 2019. [DOI: 10.1080/15398285.2019.1611171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Gagan Jindal
- College of Information Studies, University of Maryland, College Park, MD, USA
| |
Collapse
|
10
|
Waller K, Furber S, Bauman A, Allman-Farinelli M, van den Dolder P, Hayes A, Facci F, Franco L, Webb A, Moses R, Colagiuri S. DTEXT - text messaging intervention to improve outcomes of people with type 2 diabetes: protocol for randomised controlled trial and cost-effectiveness analysis. BMC Public Health 2019; 19:262. [PMID: 30832638 PMCID: PMC6399841 DOI: 10.1186/s12889-019-6550-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 02/15/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Diabetes prevalence is rapidly increasing, with type 2 diabetes predicted to be the leading contributor of non-communicable disease in Australia by 2020. It is anticipated that rates of type 2 diabetes will continue to increase if factors such as overweight and obesity, low physical activity and poor nutrition are not addressed. The majority of Australians with type 2 diabetes do not meet the guidelines for optimal diabetes management, and access to diabetes education is limited. This highlights the need for new interventions that can reduce existing barriers to diabetes education, attain greater population reach and support self-management strategies for people with type 2 diabetes. Mobile phone text messages have shown promising results as an intervention for people with chronic disease. They have the ability to achieve high levels of engagement and broad population reach, whilst requiring minimal resources. There is however, no evidence on the effect of text messaging to improve the health of people with type 2 diabetes in Australia. METHODS/DESIGN This randomised controlled trial aims to investigate if a 6 month text message intervention (DTEXT) can lead to improvements in glycated haemoglobin (HbA1c) and diabetes self-management among Australian residents in New South Wales (NSW) with type 2 diabetes. Community dwelling adults (n = 340) will be recruited with the primary outcome being change in HbA1c at 6 months. Secondary outcomes include behaviour change for diabetes self-management, self-efficacy, quality of life and intervention acceptability. An economic evaluation will be conducted using a funder plus patient perspective. DISCUSSION This study will provide evidence on the effectiveness and cost effectiveness of a text message intervention to reduce HbA1c and enhance self-management of type 2 diabetes in the Australian population. If successful, this intervention could be used as a model to complement and extend existing diabetes care in the Australian health care system. TRIAL REGISTRATION The study has been registered with the Australian New Zealand Clinical Trials Registry, Trial ID: ACTRN12617000416392 . Registered: 23 March 2017.
Collapse
Affiliation(s)
- Karen Waller
- Illawarra Shoalhaven Local Health District, Warrawong, Australia.
| | - Susan Furber
- Illawarra Shoalhaven Local Health District, Warrawong, Australia
| | | | | | | | | | - Franca Facci
- Illawarra Shoalhaven Local Health District, Warrawong, Australia
| | - Lisa Franco
- Illawarra Shoalhaven Local Health District, Warrawong, Australia
| | - Alison Webb
- Illawarra Shoalhaven Local Health District, Warrawong, Australia
| | - Robert Moses
- Illawarra Shoalhaven Local Health District, Warrawong, Australia
| | | |
Collapse
|
11
|
Quiñones MM, Lombard-Newell J, Sharp D, Way V, Cross W. Case study of an adaptation and implementation of a Diabetes Prevention Program for individuals with serious mental illness. Transl Behav Med 2018; 8:195-203. [PMID: 29346678 DOI: 10.1093/tbm/ibx064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The Diabetes Prevention Program (DPP) is an evidence-based lifestyle intervention developed to decrease the risk for type 2 diabetes and promote weight loss in individuals at risk for diabetes. Individuals with serious mental illness have a greater risk for developing diabetes compared with the general population. In this article, the authors provide a detailed description of the adaptation process of the DPP for individuals with serious mental illness (DPP-SMI). The adaptation process was based on a cultural adaptation framework for modifying evidence-based interventions. To assess the effectiveness of the DPP-SMI, 11 individuals from a community mental health residential agency completed a 22-session pilot study of the adapted program and provided physiological measures before and after the intervention. As primary outcomes, participants were expected to report decreased body weight and increased physical activity per week. Completers had an average weight loss of 19 lbs (8%) and their physical activity increased from 161 to 405 min per week. These preliminary results together with participants' feedback informed further refinement of the DPP-SMI. This case study supports that individuals with serious mental illness can benefit from the DPP-SMI, which is tailored to meet the unique needs of this population group.
Collapse
Affiliation(s)
- Maria M Quiñones
- School of Nursing, University of Rochester Medical Center, Rochester, NY
| | | | - Daryl Sharp
- School of Nursing, University of Rochester Medical Center, Rochester, NY
| | | | - Wendi Cross
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY
| |
Collapse
|
12
|
Tung EL, Gunter KE, Bergeron NQ, Lindau ST, Chin MH, Peek ME. Cross-Sector Collaboration in the High-Poverty Setting: Qualitative Results from a Community-Based Diabetes Intervention. Health Serv Res 2018; 53:3416-3436. [PMID: 29355934 PMCID: PMC6153162 DOI: 10.1111/1475-6773.12824] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To characterize the motivations of stakeholders from diverse sectors who engaged in cross-sector collaboration with an academic medical center. DATA SOURCE Primary qualitative data (2014-2015) were collected from 22 organizations involved in a cross-sector diabetes intervention on the South Side of Chicago. STUDY DESIGN In-depth, semistructured interviews; participants included leaders from all stakeholder organization types (e.g., businesses, community development, faith-based) involved in the intervention. DATA COLLECTION METHODS Data were transcribed verbatim from audio and video recordings. Analysis was conducted using the constant comparison method, derived from grounded theory. PRINCIPAL FINDINGS All stakeholders described collaboration as an opportunity to promote community health in vulnerable populations. Among diverse motivations across organization types, stakeholders described collaboration as an opportunity for: financial support, brand enhancement, access to specialized skills or knowledge, professional networking, and health care system involvement in community-based efforts. Based on our findings, we propose a framework for implementing a working knowledge of stakeholder motivations to facilitate effective cross-sector collaboration. CONCLUSIONS We identified several factors that motivated collaboration across diverse sectors with health care systems to promote health in a high-poverty, urban setting. Understanding these motivations will be foundational to optimizing meaningful cross-sector collaboration and improving diabetes outcomes in the nation's most vulnerable communities.
Collapse
Affiliation(s)
- Elizabeth L. Tung
- Section of General Internal MedicineChicago Center for Diabetes Translation ResearchUniversity of ChicagoChicagoIL
| | - Kathryn E. Gunter
- Section of General Internal MedicineChicago Center for Diabetes Translation ResearchUniversity of ChicagoChicagoIL
| | - Nyahne Q. Bergeron
- Section of General Internal MedicineChicago Center for Diabetes Translation ResearchUniversity of ChicagoChicagoIL
| | - Stacy Tessler Lindau
- Department of Obstetrics and GynecologyDepartment of Medicine‐GeriatricsChicago Center for Diabetes Translation Researchthe MacLean Center for Clinical Medical Ethics, and the Comprehensive Cancer CenterUniversity of ChicagoChicagoIL
| | - Marshall H. Chin
- Section of General Internal MedicineChicago Center for Diabetes Translation ResearchMacLean Center for Clinical Medical EthicsUniversity of ChicagoChicagoIL
| | - Monica E. Peek
- Section of General Internal MedicineChicago Center for Diabetes Translation ResearchMacLean Center for Clinical Medical EthicsUniversity of ChicagoChicagoIL
| |
Collapse
|
13
|
van Ommen B, Wopereis S, van Empelen P, van Keulen HM, Otten W, Kasteleyn M, Molema JJW, de Hoogh IM, Chavannes NH, Numans ME, Evers AWM, Pijl H. From Diabetes Care to Diabetes Cure-The Integration of Systems Biology, eHealth, and Behavioral Change. Front Endocrinol (Lausanne) 2018; 8:381. [PMID: 29403436 PMCID: PMC5786854 DOI: 10.3389/fendo.2017.00381] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 12/26/2017] [Indexed: 12/23/2022] Open
Abstract
From a biological view, most of the processes involved in insulin resistance, which drives the pathobiology of type 2 diabetes, are reversible. This theoretically makes the disease reversible and curable by changing dietary habits and physical activity, particularly when adopted early in the disease process. Yet, this is not fully implemented and exploited in health care due to numerous obstacles. This article reviews the state of the art in all areas involved in a diabetes cure-focused therapy and discusses the scientific and technological advancements that need to be integrated into a systems approach sustainable lifestyle-based healthcare system and economy. The implementation of lifestyle as cure necessitates personalized and sustained lifestyle adaptations, which can only be established by a systems approach, including all relevant aspects (personalized diagnosis and diet, physical activity and stress management, self-empowerment, motivation, participation and health literacy, all facilitated by blended care and ehealth). Introduction of such a systems approach in type 2 diabetes therapy not only requires a concerted action of many stakeholders but also a change in healthcare economy, with new winners and losers. A "call for action" is put forward to actually initiate this transition. The solution provided for type 2 diabetes is translatable to other lifestyle-related disorders.
Collapse
Affiliation(s)
- Ben van Ommen
- Netherlands Organization for Applied Scientific Research (TNO), Department of Microbiology and Systems Biology, Leiden, Netherlands
| | - Suzan Wopereis
- Netherlands Organization for Applied Scientific Research (TNO), Department of Microbiology and Systems Biology, Leiden, Netherlands
| | - Pepijn van Empelen
- Netherlands Organization for Applied Scientific Research (TNO), Department of Child Health, Leiden, Netherlands
| | - Hilde M. van Keulen
- Netherlands Organization for Applied Scientific Research (TNO), Department of Child Health, Leiden, Netherlands
| | - Wilma Otten
- Netherlands Organization for Applied Scientific Research (TNO), Department of Child Health, Leiden, Netherlands
| | - Marise Kasteleyn
- Leiden University Medical Center (LUMC), Department of Public Health and Primary Care, Leiden, Netherlands
| | - Johanna J. W. Molema
- Netherlands Organization for Applied Scientific Research (TNO), Department of Work Health Technology, Leiden, Netherlands
| | - Iris M. de Hoogh
- Netherlands Organization for Applied Scientific Research (TNO), Department of Microbiology and Systems Biology, Leiden, Netherlands
| | - Niels H. Chavannes
- Leiden University Medical Center (LUMC), Department of Public Health and Primary Care, Leiden, Netherlands
| | - Mattijs E. Numans
- Leiden University Medical Center (LUMC), Department of Public Health and Primary Care, Leiden, Netherlands
| | - Andrea W. M. Evers
- Department of Health, Medical and Neuropsychology, Leiden University Medical Centre, Leiden University, Leiden, Netherlands
- Department of Psychiatry, Leiden University Medical Centre, Leiden University, Leiden, Netherlands
| | - Hanno Pijl
- Leiden University Medical Center (LUMC), Department of Internal Medicine, Leiden, Netherlands
| |
Collapse
|
14
|
Whitney E, Kindred E, Pratt A, O'Neal Y, Harrison RCP, Peek ME. Culturally Tailoring a Patient Empowerment and Diabetes Education Curriculum for the African American Church. DIABETES EDUCATOR 2017; 43:441-448. [PMID: 28793835 DOI: 10.1177/0145721717725280] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The African American church has long been recognized as a valuable partner for health interventions in the community. While an extensive literature exists documenting the potential efficacy of diabetes education programs in church settings, there has yet to be an effort to leverage spiritual beliefs and practices to promote diabetes self-management and shared decision making within a faith-based framework that is culturally tailored to the African American church. The purpose of this article is to describe the translation of a clinic-based diabetes education program into faith-based education curriculum tailored for use in the African American church. Conclusions Themes extracted from focus groups and input from a faith-based community partner provided a methodical and patient-informed foundation for culturally tailoring and piloting a diabetes self-management curriculum for the African American church setting. This study illustrates how spirituality can be incorporated into interventions to enhance health promotion and behavioral change among African Americans with diabetes. Participants in our study described how religious beliefs play an active role in many aspects of diabetes care, including self-management behaviors, coping strategies, and patient/provider communication. In addition, this intervention can serve as a model for the development of patient-centered health interventions.
Collapse
Affiliation(s)
- Eric Whitney
- The Pritzker School of Medicine, The University of Chicago, Chicago, Illinois (Mr Whitney, Dr Pratt)
| | - Elijah Kindred
- The University of Chicago, Divinity School, Chicago, Illinois (Mr Kindred)
| | - Abdullah Pratt
- The Pritzker School of Medicine, The University of Chicago, Chicago, Illinois (Mr Whitney, Dr Pratt).,Department of Emergency Medicine, The University of Chicago Medical Center, Chicago, Illinois (Dr Pratt)
| | - Yolanda O'Neal
- The University of Chicago, Section of General Internal Medicine, Chicago, Illinois (Mrs O'Neal, Dr Peek)
| | - Rev Chauncey P Harrison
- New Beginnings Church of Chicago, Chicago, Illinois (Mr Harrison).,Trinity United Church of Christ, Chicago, Illinois (Mr Harrison)
| | - Monica E Peek
- The University of Chicago, Section of General Internal Medicine, Chicago, Illinois (Mrs O'Neal, Dr Peek)
| |
Collapse
|
15
|
Sathe NA, Nocon RS, Hughes B, Peek ME, Chin MH, Huang ES. The Costs of Participating in a Diabetes Quality Improvement Collaborative: Variation Among Five Clinics. Jt Comm J Qual Patient Saf 2016; 42:18-25. [PMID: 26685930 DOI: 10.1016/s1553-7250(16)42002-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Quality improvement collaboratives (QICs) support rapid testing and implementation of interventions through the collective experience of participating organizations to improve care quality and reduce costs. Although QICs have been societally cost-effective in improving the care of chronic diseases, they may not be adopted by outpatient clinics if their costs are high. Diabetes QICs warrant reexamination as secular trends in the quality of diabetes care, new care guidelines for diabetes, and evolving strategies for quality improvement may have altered implementation costs. METHODS The costs over the first four years-from June 2009 through May 2013-of an ongoing diabetes QIC were characterized by activities and over time. The QIC, linking six clinics on Chicago's South Side, tailored interventions to minority populations and built community partnerships. Costs were calculated from clinic surveys regarding activities, labor, and purchases. RESULTS Data were obtained from five of the six participating clinics. Cost/diabetic patient/year ranged across clinic sites from $6 (largest clinic) to $68 (smallest clinic). Clinics spent 62%-88% of their total QIC costs on labor. The cost/diabetic patient/year changed over time from Year 1 (range across clinics, $5-$51), Year 2 ($11-$84), Year 3 ($4-$57), to Year 4 ($4-$80), with costs peaking at Year 2 for all clinics except Clinic 4, where costs peaked at Year 4. DISCUSSION Cost experiences of QICs in clinics were di- verse over time and setting. High per-patient costs may stem from small clinic size, a sicker patient population, and variation in personnel type used. Cost decreases over time may represent increasing organizational learning and efficiency. Sharing resources may have achieved additional cost savings. This practical information can help administrators and policy makers predict, manage, and support costs of QICs as payers increasingly seek high-value health care.
Collapse
Affiliation(s)
- Neha A Sathe
- Pritzker School of Medicine, University of Chicago, USA
| | | | | | | | | | | |
Collapse
|
16
|
Goddu AP, Raffel KE, Peek ME. A story of change: The influence of narrative on African-Americans with diabetes. PATIENT EDUCATION AND COUNSELING 2015; 98:1017-24. [PMID: 25986500 PMCID: PMC4492448 DOI: 10.1016/j.pec.2015.03.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 03/24/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To understand if narratives can be effective tools for diabetes empowerment, from the perspective of African-American participants in a program that improved diabetes self-efficacy and self-management. METHODS In-depth interviews and focus groups were conducted with program graduates. Participants were asked to comment on the program's film, storytelling, and role-play, and whether those narratives had contributed to their diabetes behavior change. An iterative process of coding, analyzing, and summarizing transcripts was completed using the framework approach. RESULTS African-American adults (n=36) with diabetes reported that narratives positively influenced the diabetes behavior change they had experienced by improving their attitudes/beliefs while increasing their knowledge/skills. The social proliferation of narrative - discussing stories, rehearsing their messages with role-play, and building social support through storytelling - was reported as especially influential. CONCLUSION Utilizing narratives in group settings may facilitate health behavior change, particularly in minority communities with traditions of storytelling. Theoretical models explaining narrative's effect on behavior change should consider the social context of narratives. PRACTICE IMPLICATIONS Narratives may be promising tools to promote diabetes empowerment. Interventions using narratives may be more effective if they include group time to discuss and rehearse the stories presented, and if they foster an environment conducive to social support among participants.
Collapse
Affiliation(s)
- Anna P Goddu
- Department of Medicine, University of Chicago, Chicago, USA; Center for Health and the Social Sciences, University of Chicago, Chicago, USA; Chicago Center for Diabetes Translation Research, Chicago, USA
| | - Katie E Raffel
- Pritzker School of Medicine, University of Chicago, Chicago, USA
| | - Monica E Peek
- Department of Medicine, University of Chicago, Chicago, USA; Center for Health and the Social Sciences, University of Chicago, Chicago, USA; Chicago Center for Diabetes Translation Research, Chicago, USA; Center for the Study of Race, Politics and Culture, University of Chicago, Chicago, USA.
| |
Collapse
|
17
|
Clark NM, Quinn M, Dodge JA, Nelson BW. Alliance system and policy change: necessary ingredients for improvement in diabetes care and reduction of disparities. Health Promot Pract 2015; 15:11S-22S. [PMID: 25359245 DOI: 10.1177/1524839914543829] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Reducing diabetes inequities requires system and policy changes based on real-life experiences of vulnerable individuals living with the condition. While introducing innovative interventions for African American, Native American, and Latino low-income people, the five community-based sites of the Alliance to Reduce Disparities in Diabetes recognized that policy changes were essential to sustain their efforts. Data regarding change efforts were collected from site leaders and examined against documents provided routinely to the National Program Office at the University of Michigan. A policy expert refined the original lists to include only confirmed policy changes, scope of change (organizational to national), and stage of accomplishment (1, beginning; 2, adoption; 3, implementation; and 4, full maintenance). Changes were again verified through site visits and telephone interviews. In 3 years, Alliance teams achieved 53 system and policy change accomplishments. Efforts were implemented at the organizational (33), citywide (13), state (5), and national (2) levels, and forces helping and hindering success were identified. Three types of changes were deemed especially significant for diabetes control: data sharing across care-providing organizations, embedding community health workers into the clinical care team, and linking clinic services with community assets and resources in support of self-management.
Collapse
|
18
|
Chin MH, Goddu AP, Ferguson MJ, Peek ME. Expanding and sustaining integrated health care-community efforts to reduce diabetes disparities. Health Promot Pract 2015; 15:29S-39S. [PMID: 25359247 DOI: 10.1177/1524839914532649] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
To reduce racial and ethnic disparities in diabetes care and outcomes, it is critical to integrate health care and community approaches. However, little work describes how to expand and sustain such partnerships and initiatives. We outline our experience creating and growing an initiative to improve diabetes care and outcomes in the predominantly African American South Side of Chicago. Our project involves patient education and activation, a quality improvement collaborative with six clinics, provider education, and community partnerships. We aligned our project with the needs and goals of community residents and organizations, the mission and strategic plan of our academic medical center, various strengths and resources in Chicago, and the changing health care marketplace. We use the Robert Wood Johnson Foundation Finding Answers: Disparities Research for Change conceptual model and the Consolidated Framework for Implementation Research to elucidate how we expanded and sustained our project within a shifting environment. We recommend taking action to integrate health care with community projects, being inclusive, building partnerships, working with the media, and understanding vital historical, political, and economic contexts.
Collapse
|
19
|
Abstract
Designing and implementing effective lifestyle modification strategies remains one of the great challenges in diabetes care. Historically, programs have focused on individual behavior change with little or no attempt to integrate change within the broader social framework or community context. However, these contextual factors have been shown to be associated with poor diabetes outcomes, particularly in low-income minority populations. Recent evidence suggests that one way to address these disparities is to match patient needs to existing community resources. Not only does this position patients to more quickly adapt behavior in a practical way, but this also refers patients back to their local communities where a support mechanism is in place to sustain healthy behavior. Technology offers a new and promising platform for connecting patients to meaningful resources (also referred to as "assets"). This paper summarizes several noteworthy innovations that use technology as a practical bridge between healthcare and community-based resources that promote diabetes self-care.
Collapse
Affiliation(s)
- Elizabeth L. Tung
- Section of General Internal Medicine, Chicago Center of Diabetes Translation Research, University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637, USA
| | - Monica E. Peek
- Section of General Internal Medicine, Chicago Center of Diabetes Translation Research, University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637, USA
| |
Collapse
|