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Kusumawati N, Agritubella SM, Rosy A, Erlin F, Pijl H. Challenges in Type 2 Diabetes Prevention among Senior High School Students: A Qualitative Study. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2024; 12:175-187. [PMID: 39161866 PMCID: PMC11330554 DOI: 10.30476/ijcbnm.2024.101360.2413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 05/20/2024] [Accepted: 06/08/2024] [Indexed: 08/21/2024]
Abstract
Background Schools, a place where students spend much more time than home, play an important role in preventing the nation's future generation from type 2 diabetes mellitus (T2DM). This study aimed to explore challenges in T2DM prevention among senior high school students. Methods The study was conducted in Riau Province, Indonesia, from June to August 2023 using a qualitative content analysis. 31 respondents, determined by data saturation, were recruited using purposeful sampling. They were public senior high schools' principals, vice principals, school health services staff, school canteen tenants, students, parents, and primary health care personnel in six districts. Data were collected through semi-structured face-to-face interviews and document review. Graneheim and Lundman's content analysis method was used to analyze the data in Nvivo version 11 software. The Lincoln and Guba Qualitative research criteria for trustworthiness were used to ensure the rigor of the study. Results The main concepts obtained from the data were classified into three themes entitled, "Nonoptimal existing diabetes prevention programs in schools", "Inadequate knowledge of school community on T2DM", and "Inadequate policies to prevent diabetes in schools". Conclusion An evidence-based, well-organized, and systematic school-based diabetes prevention program is fundamental to help overcome challenges and prevent future T2DM incidence. It requires relevant stakeholders' high level of awareness, strong collaborations with the school community, and effective school policies.
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Affiliation(s)
- Nila Kusumawati
- Department of Nursing, Faculty of Health Sciences, Universitas Pahlawan Tuanku Tambusai, Riau Province, Indonesia
- Indonesian Diabetes Center, Universitas Pahlawan Tuanku Tambusai, Riau Province, Indonesia
| | | | - Alice Rosy
- Department of Nursing, Poltekkes Kemenkes Riau, Riau Province, Indonesia
| | - Fitry Erlin
- Department of Nursing, Institut Kesehatan Payung Negeri, Riau Province, Indonesia
| | - Hanno Pijl
- Leiden University Medical Center, Faculty of Internal Medicine, Leiden, the Netherlands
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Belko S, Hutchinson M, Hayden G, Pugliese R. Co-designing Diabetes Care With Patients. J Diabetes Sci Technol 2024; 18:53-58. [PMID: 37953533 PMCID: PMC10899829 DOI: 10.1177/19322968231213394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
More than 537 million adults worldwide are living with diabetes and navigating its health and lifestyle impact. People living with diabetes face unique challenges in managing their diet and exercise, monitoring their blood glucose, self-administering medications, and effectively integrating their disease into their social activities. In addition to diabetes being a challenging multifactorial disease, these challenges arise in part from patients having to navigate a complex ecosystem where sectors are siloed and its services, products, and environments are not designed with the patient in mind. To address these challenges, the ecosystem of diabetes care, including researchers, healthcare professionals, product and service developers, and policymakers, can adopt co-design methodologies providing patients and caregivers a seat at the table when creating solutions. Co-design in healthcare is an approach to problem-solving where patients are viewed as equal partners providing their own unique perspective and expertise, to design and develop devices, services, and environments. Co-design emphasizes the value of the user's insights and expertise. Incorporating patient perspective has been shown to increase patient empowerment and satisfaction, enhance healthcare technology value, and strengthen the collaboration between the patient and their interprofessional ecosystem. We describe opportunity spaces, successful examples, and strategies to better engage patients in research, policymaking, and healthcare product, service, and environment development through co-design methods. By incorporating co-design, the ecosystem of diabetes care can deliver more effective, high-quality patient-centered care, products, and services.
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Affiliation(s)
- Sara Belko
- Health Design Lab, Thomas Jefferson
University, Philadelphia, PA, USA
- Sidney Kimmel Medical College, Thomas
Jefferson University, Philadelphia, PA, USA
| | - Morgan Hutchinson
- Health Design Lab, Thomas Jefferson
University, Philadelphia, PA, USA
- Thomas Jefferson University,
Philadelphia, PA, USA
| | - Geoffrey Hayden
- Health Design Lab, Thomas Jefferson
University, Philadelphia, PA, USA
- Sidney Kimmel Medical College, Thomas
Jefferson University, Philadelphia, PA, USA
- Thomas Jefferson University,
Philadelphia, PA, USA
| | - Robert Pugliese
- Health Design Lab, Thomas Jefferson
University, Philadelphia, PA, USA
- Sidney Kimmel Medical College, Thomas
Jefferson University, Philadelphia, PA, USA
- Thomas Jefferson University,
Philadelphia, PA, USA
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Pike JM, Haberlin-Pittz KM, Alharbi BS, Perkins SM, Hannon TS. A co-designed, community-based intensive health behavior intervention promotes participation and engagement in youth with risk factors for type 2 diabetes. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2023; 4:1264312. [PMID: 38108040 PMCID: PMC10722280 DOI: 10.3389/fcdhc.2023.1264312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/31/2023] [Indexed: 12/19/2023]
Abstract
Background Obesity among youth (children and adolescents) is associated with increased risk for youth-onset type 2 diabetes. Lifestyle change can delay or prevent the development of type 2 diabetes, yet real-world implementation of health behavior recommendations is challenging. We previously engaged youth with risk factors for type 2 diabetes, their caregivers, and professionals in a human-centered design study to co-design a lifestyle change program. Here we report the outcomes for this 16-week co-designed lifestyle change program for youth at risk for T2D and their caregivers. Research design and methods This single-arm family-based cohort study included youth aged 7-18 years, with BMI ≥85th percentile (overweight or obese) and at least one additional risk factor for type 2 diabetes, and their caregivers. Clinical (BMI, HbA1c), self-reported physical activity, and quality of life outcomes were evaluated at baseline (B), post-intervention (M4), and 1 year (M12) following the intervention. Results Seventy-eight youth (mean age 12.4 ± 2.7y, 67% female, 37.8% white) and 65 caregivers were included in the data analysis. Youth baseline BMI z-scores (2.26 ± 0.47) and HbA1c (5.3 ± 0.3) were unchanged at follow up time points [BMI z-scores M4 (2.25 ± 0.52), M12 (2.16 ± 0.58), p-value 0.46], [HbA1c M4 (5.3 ± 0.3), M12 (5.2 ± 0.3), p-value (0.04)]. Youth reported increased physical activity at M4 (p = 0.004), but not at M12. Youth quality of life scores increased at M12 (p=0.01). Families who attended at least one session (n=41) attended an average of 9 out of 16 sessions, and 37 percent of families attended 13 or more sessions. Conclusion A co-designed, community-based lifestyle intervention promotes increased physical activity, improved quality of life, maintenance of BMI z-scores and HbA1c, and engagement in youth with risk factors for T2D.
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Affiliation(s)
- Julie M. Pike
- Department of Pediatric and Adolescent Comparative Effectiveness Research, Indiana University School of Medicine, Indianapolis, IN, United States
- Department of Pediatric Endocrinology, Riley Children’s Health, Indiana University Health, Indianapolis, IN, United States
| | - Kathryn M. Haberlin-Pittz
- Department of Pediatric and Adolescent Comparative Effectiveness Research, Indiana University School of Medicine, Indianapolis, IN, United States
- Department of Pediatric Endocrinology, Riley Children’s Health, Indiana University Health, Indianapolis, IN, United States
| | - Basmah S. Alharbi
- Department of Biostatistics and Health Data Science, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, United States
| | - Susan M. Perkins
- Department of Biostatistics and Health Data Science, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, United States
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Tamara S. Hannon
- Department of Pediatric and Adolescent Comparative Effectiveness Research, Indiana University School of Medicine, Indianapolis, IN, United States
- Department of Pediatric Endocrinology, Riley Children’s Health, Indiana University Health, Indianapolis, IN, United States
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"Research Jam": Engaging patients and other stakeholders through human-centered design to improve translational research. J Clin Transl Sci 2023; 7:e17. [PMID: 36755531 PMCID: PMC9879876 DOI: 10.1017/cts.2022.498] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 10/30/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022] Open
Abstract
Effective stakeholder engagement increases research relevance and utility. Though published principles of community-based participatory research and patient-centered outcomes research offer guidance, few resources offer effective techniques to engage stakeholders and translate their engagement into improvements in research process and outcomes. The Indiana Clinical and Translational Sciences Institute (Indiana CTSI) is home to Research Jam (RJ), an interdisciplinary team of researchers, project management professionals, and design experts, that employs human-centered design (HCD) to engage stakeholders in the research process. Establishing HCD services at the Indiana CTSI has allowed for accessible and innovative stakeholder-engaged research. RJ offers services for stakeholder-informed study design, measurement, implementation, and dissemination. RJ's services are in demand to address research barriers pertaining to a diverse array of health topics and stakeholder groups. As a result, the RJ team has grown significantly with both institutional and extramural support. Researchers involved in RJ projects report that working with RJ helped them learn how to better engage with stakeholders in research and changed the way they approach working with stakeholders. RJ can serve as a potential model for effectively engaging stakeholders through HCD to improve translational research.
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Alaofè H, Okechukwu A, Yeo S, Magrath P, Amoussa Hounkpatin W, Ehiri J, Rosales C. Formative Qualitative Research: Design Considerations for a Self-Directed Lifestyle Intervention for Type-2 Diabetes Patients Using Human-Centered Design Principles in Benin. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11552. [PMID: 36141824 PMCID: PMC9517468 DOI: 10.3390/ijerph191811552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
Given the burgeoning prevalence of Type-2 Diabetes (T2D) in Benin and other sub-Saharan countries, tailored diabetes self-management interventions are urgently needed. Human-centered designs can be useful for identifying beneficiaries' needs while keeping in mind feasibility and viability in a given context. Therefore, this study examined the acceptability and community perceptions of a self-directed lifestyle program for T2D patients in Cotonou, southern Benin. Data were collected using focus group discussions (FDGs) with T2D patients (n = 3; 32 participants), academic partners (n = 2; 16 participants), and community partners (n = 2; 12 participants). All FDG sessions were audio-recorded, transcribed from French into English verbatim, and analyzed using MAXQDA 2020. Most participants found the program to be useful and feasible. However, they preferred pictorial brochures as training materials and suggested community health workers as facilitators, assisted by clinicians or dietitians. They recommended community-based delivery mechanisms and mobile applications like WhatsApp to enhance patient adherence. Participants' characteristics, tangible health benefits, incentives, and simple curriculums were cited as critical to program feasibility, effectiveness, and acceptability. This study provides a deeper understanding of potential diabetes self-management participants' needs and concerns. Moreover, it highlights the need to consider key stakeholders' needs and voices for effective intervention.
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Affiliation(s)
- Halimatou Alaofè
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ 85724, USA
| | - Abidemi Okechukwu
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ 85724, USA
| | - Sarah Yeo
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ 85724, USA
| | - Priscilla Magrath
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ 85724, USA
| | - Waliou Amoussa Hounkpatin
- School of Nutrition and Food Science and Technology, Faculty of Agricultural Sciences, University of Abomey-Calavi, Abomey-Calavi 01 BP 526, Benin
| | - John Ehiri
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ 85724, USA
| | - Cecilia Rosales
- Division of Public Health Practice & Translational Research, University of Arizona, Phoenix Plaza Building, 550 E. Van Buren Street, Phoenix, AZ 85006, USA
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Emerson A, Pickett M, Moore S, Kelly PJ. A Scoping Review of Digital Health Interventions to Promote Healthy Romantic Relationships in Adolescents. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 24:625-639. [PMID: 35976523 PMCID: PMC9935752 DOI: 10.1007/s11121-022-01421-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2022] [Indexed: 11/30/2022]
Abstract
Despite a robust field of study in healthy romantic relationship education and risk prevention interventions that employ traditional forms of delivery, the field of digital health interventions (DHIs) in healthy relationship programming for adolescents remains undefined. The purpose of this scoping review was to summarize the scope of published research in DHIs that promote healthy romantic relationships in adolescents. We conducted database searches, 2000-2022; hand searches; reference list and literature review searches, and emailed study authors to identify articles. Included were experimental, development, and feasibility studies. We summarized features of selected studies and their healthy relationship aims/components and identified patterns of emphasis and areas of future need. Sixteen publications describing 15 unique DHIs were reviewed with interventions developed and or trialed in 11 countries. We identified 10 web-based or downloadable applications, four serious game applications, one video-voice program, and one social media-based program. DHIs focused on improving knowledge/attitudes/skills of healthy adolescent romantic relationships directly or through prevention-focused programs. Interventions that measured outcomes found small effects, primarily in healthy romantic relationship communication skills. DHIs offer unique opportunities to provide user-responsive and culturally specified programming for adolescents and to involve adolescents themselves in processes of program design, development, and evaluation. Further research is warranted to define relevant outcomes for adolescents and validated measures to evaluate them. Future research might seek to address the social ecology of adolescent romantic relationships beyond the individual and interpersonal and explore combinations of virtual and adult-moderated in-person delivery to ensure youth are adequately supported.
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Affiliation(s)
- Amanda Emerson
- University of Missouri-Kansas City, School of Nursing and Health Studies, 2464 Charlotte St, Kansas City, MO, 64108, USA. .,University of Kansas School of Nursing, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66016, USA.
| | - Michelle Pickett
- Medical College of Wisconsin, 8915 West Connell Court, Milwaukee WI, 53226
| | - Shawana Moore
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta GA, 30322 USA
| | - Patricia J Kelly
- Thomas Jefferson University, College of Nursing, 901 Walnut Street, Philadelphia PA, 19107 uSA
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Mukherjee TI, Zerbe A, Falcao J, Carey S, Iaccarino A, Kolada B, Olmedo B, Shadwick C, Singhal H, Weinstein L, Vitale M, De Gusmao EDP, Abrams EJ. Human-Centered Design for Public Health Innovation: Codesigning a Multicomponent Intervention to Support Youth Across the HIV Care Continuum in Mozambique. GLOBAL HEALTH, SCIENCE AND PRACTICE 2022; 10:e2100664. [PMID: 35487546 PMCID: PMC9053144 DOI: 10.9745/ghsp-d-21-00664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 03/08/2022] [Indexed: 11/15/2022]
Abstract
Adolescents and young people represent a growing proportion of people living with HIV (AYAHIV), and there is an urgent need to design, implement, and test interventions that retain AYAHIV in care. Using a human-centered design (HCD) approach, we codesigned CombinADO, an intervention to promote HIV viral suppression and improve antiretroviral therapy (ART) adherence and retention in care among AYAHIV in Nampula, Mozambique. The HCD process involves formative design research with AYAHIV, health care providers, parents/caretakers, and experts in adolescent HIV; synthesis of findings to generate action-oriented insights; ideation and prototyping of intervention components; and a pilot study to assess feasibility, acceptability, and uptake of intervention components.CombinADO promotes ART adherence and retention in care by fostering peer connectedness and belonging, providing accessible medical knowledge, demystifying and destigmatizing HIV, and cultivating a sense of hope among AYAHIV. Successful prototypes included a media campaign to reduce HIV stigma and increase medical literacy; a toolkit to help providers communicate and address the unique needs of AYAHIV clients; peer-support groups to improve medical literacy, empower youth, and provide positive role models for people living with HIV; support groups for parents/caregivers; and discreet pill containers to promote adherence outside the home. In the next phase, the effectiveness of CombinaADO on retention in care, ART adherence, and viral suppression will be evaluated using a cluster-randomized control trial.We demonstrate the utility of using HCD to cocreate a multicomponent intervention to retain AYAHIV in care. We also discuss how the HCD methodology enriches participatory methods and community engagement. This is then illustrated by the youth-driven intervention development of CombinADO by fostering youth empowerment, addressing power imbalances between youth and adult stakeholders, and ensuring that language and content remain adolescent friendly.
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Affiliation(s)
- Trena I Mukherjee
- Department of Epidemiology, Columbia Mailman School of Public Health, New York, NY, USA.
| | - Allison Zerbe
- ICAP at Columbia University Mailman School of Public Health, New York, NY, USA
| | | | | | | | | | | | | | | | | | | | | | - Elaine J Abrams
- Department of Epidemiology, Columbia Mailman School of Public Health, New York, NY, USA
- ICAP at Columbia University Mailman School of Public Health, New York, NY, USA
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Crucefix AL, Fleming APL, Lebus CS, Slowther AM, Fritz Z. Sharing a written medical summary with patients on the post-admission ward round: A qualitative study of clinician and patient experience. J Eval Clin Pract 2021; 27:1235-1242. [PMID: 33960593 DOI: 10.1111/jep.13574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/15/2021] [Accepted: 04/18/2021] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Sharing aspects of the traditional medical record with patients has been successful in primary and antenatal care, but has not been investigated in the UK inpatient setting. Our aim was to evaluate the impact on patient and clinician experience of providing patients with a written lay summary of their care-plan in the acute care setting. METHOD We carried out a qualitative interview study on two acute medicine wards in an NHS University Teaching Hospital for a 4-week period in 2019. A summary record, designed in response to suggestions from doctors and patients from a previous study, was distributed to patients on the first ward round after admission. Eligible participants included all doctors and nurses working on and all patients and their families attending the acute medical units; patients were excluded if they lacked capacity to consent or were under 18. We interviewed 20 patients, 10 relatives, 10 doctors and 7 nurses. RESULTS Patients felt that the summary improved their ability to remember details about their care so they could more accurately and easily update their relatives. They did not feel that the summary induced anxiety. Patient-doctor communication was improved: patients felt empowered to ask more questions and doctors felt that it solidified their plan and encouraged them to avoid medical jargon. Most patients felt the summary included the 'right' amount of information. Healthcare professionals were more concerned about the risk of breaching confidentiality than patients. Doctors felt that providing summaries was time-consuming; there were differing opinions about whether this was a worthwhile investment of time. Clinicians recognized that the traditional medical record has many roles. CONCLUSIONS A summary record could empower patients and improve patient-doctor communication but would require additional clinician and administrative time.
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Affiliation(s)
| | | | | | | | - Zoë Fritz
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge Clinical School, Cambridge, UK
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