Family Legacy of Diabetes-Related Behaviors: An Exploration of the Experiences of African American Parents and Adult Children

Personal Health Planning in Adult-Child Former Caregivers of Parents Living With Dementia

PURPOSE

To examine how former caregivers for parents living with dementia engage in personal health planning.

DESIGN

An inductive, qualitative study.

SETTING

Virtual, audio-recorded, semi-structured interviews.

PARTICIPANTS

Thirty-two midlife former primary caregivers for parents who died following advanced dementia 3 months to 3 years prior.

METHOD

Participants responded to a series of open-ended interview prompts. Interview recordings were transcribed and evaluated by a trained, diverse team to generate Consensual Qualitative Research (CQR) domains and categories.

RESULTS

Caregivers developed health planning outlooks (ie, mindsets regarding willingness and ability to engage in personal health planning) that guided health planning activities (ie, engaging in a healthy lifestyle, initiating cognitive/genetic testing, maintaining independence and aging in place, ensuring financial and legal security). An agentic outlook involved feeling capable of engaging in health planning activities and arose when caregivers witnessed the impact and feasibility of their parents' health planning. Anxiety-inducing and present-focused outlooks arose when caregivers faced barriers (eg, low self-efficacy, lack of social support, perception that parent's health planning did not enhance quality of life) and concluded that personal health planning would not be valuable or feasible.

CONCLUSION

Caregiving for a parent living with dementia (PLWD) shapes former caregivers' personal health planning. Interventions should support former caregivers who have developed low self-efficacy or pessimistic views on healthy aging to support them in addressing health planning activities.

Psychometric evaluation of a culturally adapted illness perception questionnaire for African Americans with type 2 diabetes

Background

Diabetes is burdensome to African Americans, who are twice as likely to be diagnosed, more likely to develop complications and are at a greater risk for death and disability than non-Hispanic whites. Medication adherence interventions are sometimes ineffective for African Americans because their unique illness perceptions are not adequately addressed. The Illness Perception Questionnaire-Revised (IPQ-R) that assesses illness perceptions has shown reliability and validity problems when used with African Americans. Thus, the study objective was to adapt the IPQ-R for African Americans and assess the validity and reliability of the culturally adapted questionnaire.

Methods

The parent study used an exploratory sequential mixed methods design, to explore African Americans’ illness perceptions qualitatively, used the results to adapt the IPQ-R, and tested the culturally adapted IPQ-R items quantitatively. In this paper, a preliminary culturally adapted IPQ-R refined based on the qualitative study, was administered to 170 middle-aged United States-based African Americans with type 2 diabetes in a face-to-face survey. Content, construct, convergent, and predictive validity, including reliability was examined. Pearson and item-total correlations, item analysis, exploratory factor analysis, multiple linear regression analysis, and test-retest were conducted.

Results

A revised culturally adapted IPQ-R was identified with a 9-factor structure and was distinct from the old factor structure of the original IPQ-R. The ‘consequences’ domain from the IPQ-R occurred as two factors (external and internal consequences) while the ‘emotional representations’ domain in the IPQ-R emerged as separate ‘present’ and ‘future’ emotional representation factors. Illness coherence’ was differently conceptualized as ‘illness interpretations’ to capture additional culturally adapted items within this domain. Most items had factor loadings greater than 0.4, with moderate factor score correlations. Necessity and concern beliefs in medicines significantly correlated with domains of the culturally adapted IPQ-R. Pearson’s correlation values were not greater than 0.7, indicating good convergent validity. The culturally adapted IPQ-R significantly predicted medication adherence. None of the correlation values were higher than 0.7 for the test-retest, indicating moderate reliability. Most domains of the culturally adapted IPQ-R had Cronbach’s alpha values higher than 0.7, indicating good internal consistency.

Conclusions

The results provide preliminary support for the validity of the culturally adapted IPQ-R in African Americans with diabetes, showing good construct, convergent and predictive validity, as well as reliability.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13172-2.

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

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

Putting Knowledge into Practice: Low-Income Women Talk about Food Choice Decisions

Insights into barriers and facilitators for healthy eating are needed to improve low-income women's diets and to decrease disease risk. The study objectives were to explore women's qualitative perceptions of influences on their food choices such as food security, their knowledge of nutrition-related health risk factors and self-efficacy for diet change, and their dietary intakes in practice. Thirty-six women, aged 19-50, who were eligible to receive income-based assistance were recruited in central Iowa. Focus group discussions on defining healthy foods, influences on food choice, and nutrition information sources were analyzed using a socioecological model framework. Demographics, nutrient intake estimates, food security status, health behaviors, and self-efficacy for nutrition behavior change were collected by survey. Most participants were White (61%), single (69%), food insecure (69%), and living with children (67%). Few women met dietary recommendations. Barriers to healthy eating include cost, convenience/preparation time, family taste preferences, and limitations of federal food assistance programs. Facilitators are high self-efficacy for nutrition change and health knowledge on average. These results challenge the strategy of using nutrition education to improve healthy eating and instead show that intervention messaging should focus on limited, achievable steps to improve dietary choices that fit within cost, convenience, and taste constraints.