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Zhao R, Zhang X, Wang S, Zhao N, Li D, Fan H. Factors affecting T2DM patients' behaviors associated with integrated treatment and prevention services in China. Int J Equity Health 2023; 22:223. [PMID: 37858125 PMCID: PMC10588159 DOI: 10.1186/s12939-023-02028-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/29/2023] [Indexed: 10/21/2023] Open
Abstract
OBJECTIVE To explore the relationship between type 2 diabetes mellitus (T2DM) patients' attitude, subjective norms (SN), perceived behavioral control (PBC), behavioral intention (BI) and behavior associated with integrated treatment and preventive (ITP) services. METHODS A convenient sampling method was employed at a community health center in Nanjing, China between January and July 2022. The collected data were processed using Epidata 3.1, SPSS 26.0, and AMOS 24.0. Descriptive statistics and a structural equation model based on the theory of planned behavior (TPB) were used to explore the correlation between the study variables. RESULTS 430 participants were eventually included, with a response rate of 98.6%. The mean age was 72.50 ± 5.69 years. The TPB model proved to be suitable and explained 41% of the variance in the BI. Attitude (β = 0.289, P < 0.001), SN (β = 0.314, P < 0.001) and PBC (β = 0.261, P < 0.001) were the main predictors of BI, and the SN was the strongest. BI (β = 0.452, P < 0.001) and PBC (β = 0.452, P < 0.001) had similar direct effects on patients' behavior. CONCLUSION The TPB model explained the behavioral variations associated with ITP services and provided a framework for developing targeted interventions and improving community-based ITP services for T2DM. To encourage patients to engage in desirable behaviors, interventions should focus on modifying patients' SN towards behavior associated with ITP services by promoting peer pressure and increasing the family's emphasis on health.
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Affiliation(s)
- Ran Zhao
- School of Public Health, Nanjing Medical University, 101 Longmian Road, Nanjing, P. R. China
| | - Xia Zhang
- School of Nursing, Nanjing Medical University, 101 Longmian Road, Nanjing, P. R. China
| | - Sizhe Wang
- School of Public Health, Nanjing Medical University, 101 Longmian Road, Nanjing, P. R. China
| | - Nan Zhao
- School of Nursing, Nanjing Medical University, 101 Longmian Road, Nanjing, P. R. China
| | - Dianjiang Li
- School of Public Health, Nanjing Medical University, 101 Longmian Road, Nanjing, P. R. China
| | - Hong Fan
- School of Public Health, Nanjing Medical University, 101 Longmian Road, Nanjing, P. R. China.
- School of Nursing, Nanjing Medical University, 101 Longmian Road, Nanjing, P. R. China.
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Zhong Q, Chen Y, Luo M, Lin Q, Tan J, Xiao S, Willey JA, Chen JL, Whittemore R, Guo J. The 18-month efficacy of an Intensive LifeStyle Modification Program (ILSM) to reduce type 2 diabetes risk among rural women: a cluster randomized controlled trial. Global Health 2023; 19:6. [PMID: 36703168 PMCID: PMC9881320 DOI: 10.1186/s12992-023-00910-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/20/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Many lifestyle interventions have demonstrated efficacy up to one-year follow-up, yet maintaining improvements at longer-term follow-up is a well-recognized worldwide challenge, especially in underserved areas. The purpose of this study is to compare the 18-month efficacy of an Intensive LifeStyle Modification Program to usual care in reducing the risk for type 2 diabetes (T2D) among women with a history of gestational diabetes mellitus (GDM). METHODS We conducted a two-arm, cluster randomized controlled trial among women with a history of GDM in China. A total of 16 towns (clusters) in two distinct rural areas in south-central China were randomly selected (8 towns per area) and assigned (1:1) to the intervention (Intensive LifeStyle Modification Program) or control (usual care) group with stratification in the two rural areas. The strategies for maintaining intervention effects were used (including setting recursive goals and providing a supportive environment, etc.) under the guidance of social cognitive theory. The primary outcome was a change in T2D risk; secondary outcomes included glycemic, weight-related, behavioral, and psychological variables. All outcomes were collected at baseline, 6, and 18 months. All participants entered the intention-to-treat analysis. Data were analyzed via generalized estimation equation models (accounting for clusters) at the individual level, with subgroup analysis included in the model. RESULTS The sample included 320 women from 16 clusters (20 women per cluster). At 18 months, the intervention group demonstrated a significant improvement in T2D risk score, fasting blood glucose, body mass index (BMI), waist circumference, intention to eat low glycemic index food, perceived stress, quality of life in psychological and environmental domains, and social support over time (p < 0.05) based on the intention-to-treat analysis set. Subgroup analysis showed a significant interaction effect on T2D risk score in subgroups of different BMI, waist circumference, and blood glucose (p < 0.05). CONCLUSIONS Over 18 months, the Intensive LifeStyle Modification Program reduced T2D risk among rural women with a history of GDM in China. Women who were overweight, had high abdominal adiposity, or had blood glucose intolerance benefited more from this intervention. This program serves as a potential diabetes prevention model for women with a history of GDM in low-resource settings worldwide. TRIAL REGISTRATION Registered on Chinese Clinical Trial Registry (ChiCTR1800015023) on 1st March 2018, http://www.chictr.org.cn/showproj.aspx?proj=25569.
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Affiliation(s)
- Qinyi Zhong
- grid.216417.70000 0001 0379 7164Xiangya School of Nursing, Central South University, 172 Tongzipo Road, Changsha, 410013 Hunan China
- grid.5379.80000000121662407Manchester Centre for Health Psychology, School of Health Science, University of Manchester, Manchester, Greater Manchester M13 9PL UK
| | - Yao Chen
- grid.216417.70000 0001 0379 7164Xiangya School of Nursing, Central South University, 172 Tongzipo Road, Changsha, 410013 Hunan China
| | - Mengchun Luo
- Maternal and Child Health Hospital of Yongding, Zhangjiajie, Hunan 427000 People’s Republic of China
| | - Qian Lin
- grid.216417.70000 0001 0379 7164Xiangya School of Public Health, Central South University, Changsha, Hunan 410013 People’s Republic of China
| | - Jianghong Tan
- grid.501248.aZhuzhou Central Hospital, Zhuzhou, Hunan 412000 People’s Republic of China
| | - Shuiyuan Xiao
- grid.216417.70000 0001 0379 7164Xiangya School of Public Health, Central South University, Changsha, Hunan 410013 People’s Republic of China
| | - James Allen Willey
- grid.266102.10000 0001 2297 6811Department of Family and Community Medicine, University of California, San Francisco, CA 94118 USA
| | - Jyu-Lin Chen
- grid.266102.10000 0001 2297 6811School of Nursing, University of California, San Francisco, CA 94118 USA
| | - Robin Whittemore
- grid.47100.320000000419368710School of Nursing, Yale University, New Haven, CT 06520 USA
| | - Jia Guo
- grid.216417.70000 0001 0379 7164Xiangya School of Nursing, Central South University, 172 Tongzipo Road, Changsha, 410013 Hunan China
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Gaur PK. Nanosuspension of flavonoid-rich fraction from Psidium guajava Linn for improved type 2-diabetes potential. J Drug Deliv Sci Technol 2021. [DOI: 10.1016/j.jddst.2021.102358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Elements and Performance Indicators of Integrated Healthcare Programmes on Chronic Diseases in Six Countries in the Asia-Pacific Region: A Scoping Review. Int J Integr Care 2021; 21:3. [PMID: 33613135 PMCID: PMC7879996 DOI: 10.5334/ijic.5439] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background and Aims: Globally, hospital-based healthcare models targeting acute care, are not effective in addressing chronic conditions. Integrated care programmes for chronic diseases have been widely developed and implemented in Europe and North America and to a much lesser extent in the Asia-Pacific region to meet such challenges. We completed a scoping review aiming to examine the elements of programmes identified in the literature from select study countries in the Asia-Pacific, and discuss important facilitators and barriers for design and implementation. Methods: The study design adopted a scoping review approach. Integrated care programmes in the study countries were searched in electronic databases using a developed search strategy and key words. Elements of care integration, barriers and facilitators were identified and charted following the Chronic Care Model (CCM). Results: Overall the study found a total of 87 integrated care programmes for chronic diseases in all countries, with 44 in China, 21 in Singapore, 12 in India, 5 in Vietnam, 4 in the Philippines and 1 in Fiji. Financial incentives were found to play a crucial role in facilitating integrated care and ensuring the sustainability of programmes. In many cases, the performance of programmes was found not to have been adequately assessed. Conclusion: Integrated care is important for addressing the challenges surrounding the delivery of long-term care and there is an increasing trend of integrated care programmes for chronic diseases in the Asia-Pacific. Evaluating the performance of integrated care programmes is crucial for developing strategies for implementing future programmes and improving already existing programmes.
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Long H, Huang W, Zheng P, Li J, Tao S, Tang S, Abdullah AS. Barriers and Facilitators of Engaging Community Health Workers in Non-Communicable Disease (NCD) Prevention and Control in China: A Systematic Review (2006⁻2016). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112378. [PMID: 30373205 PMCID: PMC6266440 DOI: 10.3390/ijerph15112378] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/22/2018] [Accepted: 10/23/2018] [Indexed: 12/13/2022]
Abstract
Background: Non-communicable diseases (NCDs) have become a dominant disease burden in China. Although China has a prevention-centered NCD strategy, the implementation effect in the community has been subjected to manpower and financial difficulties. Engaging community health workers (CHWs) in community-based interventions may be a cost-effective approach to relieve the resource shortage and improve health. This review aimed to synthesize evidence on types of NCD-related care that was provided by CHWs in China, and to identify relevant barriers and facilitators. Methods: A literature search was conducted in Medline, PubMed, ProQuest, and Google Scholar databases for English-written, peer-reviewed articles published from 1996 to 2016 that reported findings from NCD-related interventions delivered by CHWs in China. Each article was extracted independently by two researchers. Results: Twenty distinct studies met the inclusion criteria. The two most common types of CHW-led NCD-related care were diabetes and hypertension management (n = 7) and mental health care (n = 7). Thirteen studies discussed the barriers and 16 studies reported facilitators. The most common barriers included lack of support (n = 6), lack of resources (n = 4), and heavy reliance on technology (n = 4). The common facilitators included an integrated health system (n = 9), community and patient trust (n = 5), high quality training (n = 5), and CHWs’ capacity (n = 5). Fourteen studies mentioned training content, while only eight described detailed procedures and duration. Conclusions: This review suggests that trained and supervised Chinese CHWs had the capacity to provide grassroots NCDs preventive interventions. In order to increase the generalizability and sustainability of such programs, studies with robust designs are needed to explore the effectiveness of CHW-led programs, and the intervention strategies to improve the practice of CHWs in various settings.
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Affiliation(s)
- Hongfei Long
- Global Health Program, Duke Kunshan University, Kunshan 215347, Jiangsu, China.
| | - Wenting Huang
- Global Health Program, Duke Kunshan University, Kunshan 215347, Jiangsu, China.
| | - Pinpin Zheng
- Department of Preventive Medicine, School of Public Health, Fudan University, Shanghai 200032, China.
| | - Jiang Li
- Department of Preventive Medicine, School of Public Health, Fudan University, Shanghai 200032, China.
| | - Sha Tao
- Department of Preventive Medicine, School of Public Health, Fudan University, Shanghai 200032, China.
| | - Shenglan Tang
- Global Health Program, Duke Kunshan University, Kunshan 215347, Jiangsu, China.
- Duke Global Health Institute, Duke University, Durham, NC 27710, USA.
| | - Abu S Abdullah
- Global Health Program, Duke Kunshan University, Kunshan 215347, Jiangsu, China.
- Duke Global Health Institute, Duke University, Durham, NC 27710, USA.
- Boston University School of Medicine, Boston Medical Center, Boston, MA 02118, USA.
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Wu Z, Jin T, Weng J. A thorough analysis of diabetes research in China from 1995 to 2015: current scenario and future scope. SCIENCE CHINA-LIFE SCIENCES 2018; 62:46-62. [DOI: 10.1007/s11427-018-9377-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 07/26/2018] [Indexed: 12/16/2022]
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Huang W, Long H, Li J, Tao S, Zheng P, Tang S, Abdullah AS. Delivery of public health services by community health workers (CHWs) in primary health care settings in China: a systematic review (1996-2016). Glob Health Res Policy 2018; 3:18. [PMID: 29992191 PMCID: PMC5989355 DOI: 10.1186/s41256-018-0072-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 05/04/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Community Health Workers (CHWs) have been widely used in response to the shortage of skilled health workers especially in resource limited areas. China has a long history of involving CHWs in public health intervention project. CHWs in China called village doctors who have both treatment and public health responsibilities. This systematic review aimed to identify the types of public health services provided by CHWs and summarized potential barriers and facilitating factors in the delivery of these services. METHODS We searched studies published in Chinese or English, on Medline, PubMed, Cochrane, Google Scholar, and CNKI for public health services delivered by CHWs in China, during 1996-2016. The role of CHWs, training for CHWs, challenges, and facilitating factors were extracted from reviewed studies. RESULTS Guided by National Basic Public Health Service Standards, services provided by CHW covered five major areas of noncommunicable diseases (NCDs) including diabetes and/or hypertension, cancer, mental health, cardiovascular diseases, and common NCD risk factors, as well as general services including reproductive health, tuberculosis, child health, vaccination, and other services. Not many studies investigated the barriers and facilitating factors of their programs, and none reported cost-effectiveness of the intervention. Barriers challenging the sustainability of the CHWs led projects were transportation, nature of official support, quantity and quality of CHWs, training of CHWs, incentives for CHWs, and maintaining a good rapport between CHWs and target population. Facilitating factors included positive official support, integration with the existing health system, financial support, considering CHW's perspectives, and technology support. CONCLUSION CHWs appear to frequently engage in implementing diverse public health intervention programs in China. Facilitators and barriers identified are comparable to those identified in high income countries. Future CHWs-led programs should consider incorporating the common barriers and facilitators identified in the current study to maximize the benefits of these programs.
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Affiliation(s)
- Wenting Huang
- Global Health Program, Duke Kunshan University, Jiangsu, 215347 China
| | - Hongfei Long
- Global Health Program, Duke Kunshan University, Jiangsu, 215347 China
| | - Jiang Li
- Department of Preventive Medicine, School of Public Health, Fudan University, Shanghai, 200032 China
| | - Sha Tao
- Department of Preventive Medicine, School of Public Health, Fudan University, Shanghai, 200032 China
| | - Pinpin Zheng
- Department of Preventive Medicine, School of Public Health, Fudan University, Shanghai, 200032 China
| | - Shenglan Tang
- Global Health Program, Duke Kunshan University, Jiangsu, 215347 China
- Duke Global Health Institute, Duke University, Durham, NC 27710 USA
| | - Abu S. Abdullah
- Global Health Program, Duke Kunshan University, Jiangsu, 215347 China
- Duke Global Health Institute, Duke University, Durham, NC 27710 USA
- Boston University School of Medicine, Boston Medical Center, Boston, MA 02118 USA
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Yin Z, Perry J, Duan X, He M, Johnson R, Feng Y, Strand M. Cultural adaptation of an evidence-based lifestyle intervention for diabetes prevention in Chinese women at risk for diabetes: results of a randomized trial. Int Health 2018; 10:391-400. [DOI: 10.1093/inthealth/ihx072] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 12/21/2017] [Indexed: 01/26/2023] Open
Affiliation(s)
- Zenong Yin
- Department of Kinesiology, Health and Nutrition, College of Education and Human Development, University of Texas at San Antonio, 1 UTSA Circle, San Antonio, TX, USA
| | - Judith Perry
- Medical Department, Shanxi Evergreen Service, Taiyuan, China
| | - Xiaoqin Duan
- Medical Department, Shanxi Evergreen Service, Taiyuan, China
| | - Meizi He
- Department of Kinesiology, Health and Nutrition, College of Education and Human Development, University of Texas at San Antonio, 1 UTSA Circle, San Antonio, TX, USA
| | - Ryan Johnson
- Director of Research, H’Image Doctor, Shenyang, Liaoning, China
| | - Yanling Feng
- Endocrinology Department, Number 1 People’s Hospital, Jinzhong, Shanxi, China
| | - Mark Strand
- School of Pharmacy and Department of Public Health, College of Health Professions, North Dakota State University, Fargo, ND, USA
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Feng R, Shen X, Chai J, Chen P, Cheng J, Liang H, Zhao T, Sha R, Li K, Wang D. Assessment and model guided cancer screening promotion by village doctors in China: a randomized controlled trial protocol. BMC Cancer 2015; 15:674. [PMID: 26458906 PMCID: PMC4603763 DOI: 10.1186/s12885-015-1688-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 10/07/2015] [Indexed: 11/29/2022] Open
Abstract
Background Proven cost-effectiveness contrasted by low uptake of cancer screening (CS) calls for new methodologies promoting the service. Contemporary interventions in this regard relies primarily on strategies targeting general or specific groups with limited attention being paid to individualized approaches. This trial tests a novel package promoting CS utilization via continuous and tailored counseling delivered by primary caregivers. It aims at demonstrating that high risk individuals in the intervention arm will, compared to those in the delayed intervention condition, show increased use of CS service. Methods/Design The trial adopts a quasi-randomized controlled trial design and involves 2160 high risk individuals selected, via rapid and detailed risk assessments, from about 72,000 farmers aged 35+ in 36 administrative villages randomized into equal intervention and delayed intervention arms. The CS intervention package uses: a) village doctors and village clinics to deliver personalized and thus relatively sophisticated CS counseling; b) two-stage risk assessment models in identifying high risk individuals to focus the intervention on the most needed; c) standardized operation procedures to guide conduct of counseling; d) real-time effectiveness and quality monitoring to leverage continuous improvement; e) web-based electronic system to enable prioritizing complex determinants of CS uptake and tailoring counseling sessions to the changing needs of individual farmers. The intervention arm receives baseline and semiannual follow up evaluations plus CS counseling for 5 years; while the delayed intervention arm, only the same baseline and follow-up evaluations for the first 5 years and CS counseling starting from the 6th year if the intervention proved effective. Evaluation measures include: CS uptake by high risk farmers and changes in their knowledge, perceptions and self-efficacy about CS. Discussion Given the complexity and heterogeneity in the determinant system of individual CS service seeking behavior, personalized interventions may prove to be an effective strategy. The current trial distinguishes itself from previous ones in that it not only adopts a personalized strategy but also introduces a package of pragmatic solutions based on proven theories for tackling potential barriers and incorporating key success factors in a synergetic way toward low cost, effective and sustainable CS promotion. Trial registration ISRCTN33269053 Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1688-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rui Feng
- Department of Literature Review and Analysis, Library of Anhui Medical University, Hefei, Anhui, China.
| | - Xingrong Shen
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China.
| | - Jing Chai
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China.
| | - Penglai Chen
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China.
| | - Jing Cheng
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China.
| | - Han Liang
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China.
| | - Ting Zhao
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China.
| | - Rui Sha
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China.
| | - Kaichun Li
- Luan Center for Disease Control and Prevention, Luan, Anhui, China.
| | - Debin Wang
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China. .,Collaboration Center for Cancer Control, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
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Chai J, Shen X, Feng R, Cheng J, Chen Y, Zha Z, Jia S, Liang H, Zhao T, Sha R, Shi Y, Li K, Wang D. eCROPS-CA: a systematic approach toward effective and sustainable cancer prevention in rural China. BMC Cancer 2015; 15:233. [PMID: 25886568 PMCID: PMC4416351 DOI: 10.1186/s12885-015-1253-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 03/25/2015] [Indexed: 12/21/2022] Open
Abstract
Background Effective prevention against cancers depends heavily on sustained individual efforts practicing protective behaviors and avoiding risk factors in a complex sociocultural context, which requires continuous and personalized supports. Contemporary prevention relies primarily on strategies targeting general population with limited attention being paid to individualized approaches. This study tests a novel package called, in acronym of core intervention components, eCROPS-CA that leverages protective behaviors against over 80% leading cancers among high risk individuals via continuous and tailored counseling by village doctors. Methods/Design The study utilizes a quesi-RCT design involving 4320 high risk individuals selected, via rapid and detailed risk assessments, from about 72,000 farmers aged 35+ in 36 administrative villages randomized into equal intervention and delayed intervention arms. The intervention arm receives baseline and semiannual follow up evaluations plus eCROPS-CA for 5 years; while the control arm, only the baseline and follow-up evaluations for the first 5 years and eCROPS-CA starting from the 6th year if the intervention is proved effective. eCROPS-CA comprises electronic supports and supervision (e), counseling cancer prevention (C), recipe for objective behaviors (R), operational toolkit (O), performance-based incentives (P), and screening and assessment (S). Evaluation measures include: incidence and stage of the leading cancers, cancer-related knowledge, attitudes and practices; easy biophysical indicators (e.g., body mass index, blood pressure); intervention compliance, acceptance of the package. Discussion The prevention package incorporates key success factors in a synergetic way toward cost-effectiveness and long-term sustainability. It targets a set rather than any single cancer; choses village doctors as key solution to the widespread lack of professional manpower in implementing personalized and thus relatively sophisticated prevention; adopts real-time monitoring in reaching continuous improvement; utilizes smart web aids to enable prioritizing complex determinants of objective behaviors, linking counseling sessions happened at different time points and hence delivering highly coordinated prevention; uses 2-stage risk assessment models in identifying high risk individuals so as to focus on the most needed; applies standardized operation procedures in simplifying and smoothing behavior intervention yet ensuring delivery of essential steps and key elements. Trials registry ISRCTN33269053 Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1253-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jing Chai
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China.
| | - Xingrong Shen
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China.
| | - Rui Feng
- Department of Literature Review and Analysis, Library of Anhui Medical University, Hefei, Anhui, China.
| | - Jing Cheng
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China.
| | - Yeji Chen
- Anhui Center for Disease Control and Prevention, Hefei, Anhui, China.
| | - Zhengqiu Zha
- Anhui Center for Disease Control and Prevention, Hefei, Anhui, China.
| | - Shangchun Jia
- Anhui Center for Disease Control and Prevention, Hefei, Anhui, China.
| | - Han Liang
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China.
| | - Ting Zhao
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China.
| | - Rui Sha
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China.
| | - Yong Shi
- Luan Center for Disease Control and Prevention, Luan, Anhui, China.
| | - Kaichun Li
- Luan Center for Disease Control and Prevention, Luan, Anhui, China.
| | - Debin Wang
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China. .,Collaboration Center for Cancer Control, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
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Liang H, Cheng J, Shen X, Chen P, Tong G, Chai J, Li K, Xie S, Shi Y, Wang D, Sun Y. Relationships between stressful life events and impaired fasting glucose among left-behind farmers in rural China. J Psychosom Res 2015; 78:178-83. [PMID: 25477301 DOI: 10.1016/j.jpsychores.2014.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 10/05/2014] [Accepted: 10/22/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE This study aims at examining the effects of stressful life events on risk of impaired fasting glucose among left-behind farmers in rural China. METHODS The study collected data about stressful life events, family history of diabetes, lifestyle, demographics and minimum anthropometrics from left-behind famers aged 40-70 years. Calculated life event index was applied to assess the combined effects of stressful life events experienced by the left-behind farmers and its association with impaired fasting glucose was estimated using binary logistic regression models. RESULTS The prevalence of abnormal fasting glucose was 61.4% by American Diabetes Association (ADA) standard and 32.4% by World Health Organization (WHO) standard. Binary logistic regression analysis revealed a coefficient of 0.033 (P<.001) by ADA standard or 0.028 (P<.001) by WHO standard between impaired fasting glucose and life event index. The overall odds ratios of impaired glucose for the second, third and fourth (highest) versus the first (lowest) quartile of life event index were 1.419 [95% CI=(1.173, 1.717)], 1.711 [95% CI=(1.413, 2.071)] and 1.957 [95% CI=(1.606, 2.385)] respectively by ADA standard. When more and more confounding factors were controlled for, these odds ratios remained statistically significant though decreased to a small extent. CONCLUSIONS The left-behind farmers showed over two-fold prevalence rate of pre-diabetes than that of the nation's average and their risk of impaired fasting glucose was positively associated with stressful life events in a dose-dependent way. Both the population studied and their life events merit special attention.
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Affiliation(s)
- Han Liang
- School of Health Service Management, Anhui Medical University, Hefei, China.
| | - Jing Cheng
- School of Health Service Management, Anhui Medical University, Hefei, China; Department of Epidemiology and Statistics, School of Public Health, Anhui Medical University, Hefei, China.
| | - Xingrong Shen
- School of Health Service Management, Anhui Medical University, Hefei, China.
| | - Penglai Chen
- School of Health Service Management, Anhui Medical University, Hefei, China.
| | - Guixian Tong
- School of Health Service Management, Anhui Medical University, Hefei, China.
| | - Jing Chai
- School of Health Service Management, Anhui Medical University, Hefei, China.
| | - Kaichun Li
- Lu'an Center for Diseases Prevention and Control, Lu'an, China.
| | - Shaoyu Xie
- Lu'an Center for Diseases Prevention and Control, Lu'an, China.
| | - Yong Shi
- Lu'an Center for Diseases Prevention and Control, Lu'an, China.
| | - Debin Wang
- School of Health Service Management, Anhui Medical University, Hefei, China.
| | - Yehuan Sun
- Department of Epidemiology and Statistics, School of Public Health, Anhui Medical University, Hefei, China.
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Shen XR, Chai J, Feng R, Liu TZ, Tong GX, Cheng J, Li KC, Xie SY, Shi Y, Wang DB. Refining and validating a two-stage and web-based cancer risk assessment tool for village doctors in China. Asian Pac J Cancer Prev 2015; 15:10683-90. [PMID: 25605159 DOI: 10.7314/apjcp.2014.15.24.10683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The big gap between efficacy of population level prevention and expectations due to heterogeneity and complexity of cancer etiologic factors calls for selective yet personalized interventions based on effective risk assessment. This paper documents our research protocol aimed at refining and validating a two-stage and web- based cancer risk assessment tool, from a tentative one in use by an ongoing project, capable of identifying individuals at elevated risk for one or more types of the 80% leading cancers in rural China with adequate sensitivity and specificity and featuring low cost, easy application and cultural and technical sensitivity for farmers and village doctors. The protocol adopted a modified population-based case control design using 72, 000 non-patients as controls, 2, 200 cancer patients as cases, and another 600 patients as cases for external validation. Factors taken into account comprised 8 domains including diet and nutrition, risk behaviors, family history, precancerous diseases, related medical procedures, exposure to environment hazards, mood and feelings, physical activities and anthropologic and biologic factors. Modeling stresses explored various methodologies like empirical analysis, logistic regression, neuro-network analysis, decision theory and both internal and external validation using concordance statistics, predictive values, etc..
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Affiliation(s)
- Xing-Rong Shen
- School of Health Service Management, Anhui Medical University, Hefei, Anhui, China E-mail :
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Feng R, Wang DB, Chai J, Cheng J, Li HP. Total delay for treatment among cancer patients: a theory-guided survey in China. Asian Pac J Cancer Prev 2014; 15:4339-47. [PMID: 24935394 DOI: 10.7314/apjcp.2014.15.10.4339] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE This study aimed at exploring treatment delay (TD) among cancer patients in China with an attempt to develop a practical methodology facilitating frontline Chinese clinicians in promoting earlier cancer diagnosis and treatment. MATERIALS AND METHODS The study comprised framework development, qualitative interviews and paired factor rating. Framework development utilized systematic literature review, soft systems thinking and consensus groups. Qualitative interviews employed a checklist of open questions soliciting information about all the domains included the framework from cancer patients drawn via stratified randomized sampling of inpatients at 10 hospitals in Hefei, China. Paired factor rating used a self-developed computer aid and the interviewed patients as referring cases to weigh the relative importance of the factors listed in the framework in terms of their contributions to specific components of total delay (TD). RESULTS a) A conceptual framework was proposed consisting of a 6-step path to TD and 36 category determinants. b) A total of 227 patients were interviewed; their TD was 267.3 mean or 108 median days ranging from 0 to 2475 days; average appraisal, illness, behavioral, preparation and treatment delay accounted for 52.1%, 9.4%, 0.30%, 8.8% and 29.4% of the TD respectively. Individual side factors were rated substantially more important than environmental side factors (60% vs. 40%); most influential TD factors included cancer symptoms, overall health, family relations and knowledge about cancer and health. CONCLUSIONS The framework proposed together with the interviewing and rating approaches used provide a potential new methodology for understanding cancer patients' TD and promoting earlier cancer treatment.
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Affiliation(s)
- Rui Feng
- Library Department of Literature Retrieval and Analysis, 2School of Health Services Management, 3School of Nursing, Anhui Medical University, Hefei, China E-mail :
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Chen P, Chai J, Cheng J, Li K, Xie S, Liang H, Shen X, Feng R, Wang D. A smart web aid for preventing diabetes in rural China: preliminary findings and lessons. J Med Internet Res 2014; 16:e98. [PMID: 24691410 PMCID: PMC4004141 DOI: 10.2196/jmir.3228] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 02/05/2014] [Accepted: 03/13/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Increasing cases of diabetes, a general lack of routinely operational prevention, and a long history of separating disease prevention and treatment call for immediate engagement of frontier clinicians. This applies especially to village doctors who work in rural China where the majority of the nation's vast population lives. OBJECTIVE This study aims to develop and test an online Smart Web Aid for Preventing Type 2 Diabetes (SWAP-DM2) capable of addressing major barriers to applying proven interventions and integrating diabetes prevention into routine medical care. METHODS Development of SWAP-DM2 used evolutionary prototyping. The design of the initial system was followed by refinement cycles featuring dynamic interaction between development of practical and effective standardized operation procedures (SOPs) for diabetes prevention and Web-based assistance for implementing the SOPs. The resulting SOPs incorporated proven diabetes prevention practices in a synergetic way. SWAP-DM2 provided support to village doctors ranging from simple educational webpages and record maintenance to relatively sophisticated risk scoring and personalized counseling. Evaluation of SWAP-DM2 used data collected at baseline and 6-month follow-up assessment: (1) audio recordings of service encounters; (2) structured exit surveys of patients' knowledge, self-efficacy, and satisfaction; (3) measurement of fasting glucose, body mass index, and blood pressure; and (4) qualitative interviews with doctors and patients. Data analysis included (1) descriptive statistics of patients who received SWAP-DM2-assisted prevention and those newly diagnosed with prediabetes and diabetes; (2) comparison of the variables assessed between baseline and follow-up assessment; and (3) narratives of qualitative data. RESULTS The 17 participating village doctors identified 2219 patients with elevated diabetes risk. Of these, 84.85% (1885/2219) consented to a fasting glucose test with 1022 new prediabetes and 113 new diabetes diagnoses made within 6 months. The prediabetic patients showed substantial improvement from baseline to 6-month follow-up in vegetable intake (17.0%, 43/253 vs 88.7%, 205/231), calorie intake (1.6%, 4/253 vs 71.4%, 165/231), leisure-time exercises (6.3%, 16/253 vs 21.2%, 49/231), body weight (mean 62.12 kg, SD 9.85 vs mean 58.33 kg, SD 9.18), and body mass index (mean 24.80 kg/m(2), SD 3.21 vs mean 23.36 kg/m(2), SD 2.95). The prediabetic patients showed improvement in self-efficacy for modifying diet (mean 5.31, SD 2.81 vs mean 8.53, SD 2.25), increasing physical activities (mean 4.52, SD 3.35 vs mean 8.06, SD 2.38), engaging relatives (mean 3.93, SD 3.54 vs mean 6.93, SD 2.67), and knowledge about diabetes and risks of an imbalanced diet and inadequate physical activity. Most participating doctors and patients viewed SWAP-DM2 as useful and effective. CONCLUSIONS SWAP-DM2 is helpful to village doctors, acceptable to patients, and effective in modifying immediate determinants of diabetes at least in the short term, and may provide a useful solution to the general lack of participation in diabetes prevention by frontier clinicians in rural China. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number (ISRCTN): 66772711; http://www.controlled-trials.com/ISRCTN66772711.
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Affiliation(s)
- Penglai Chen
- School of Health Services Management, Anhui Medical University, Hefei, China
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