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Shi Y, Wang C, Sevick MA, Bao H, Xu X, Jiang Y, Zhu Z, Wei A, Feldman NM, Hu L. Diabetes Distress and Associated Factors Among Chinese Americans with Type 2 Diabetes in New York City. Diabetes Metab Syndr Obes 2024; 17:2845-2853. [PMID: 39100965 PMCID: PMC11296360 DOI: 10.2147/dmso.s459478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 07/16/2024] [Indexed: 08/06/2024] Open
Abstract
Purpose The purpose of this study is to describe diabetes distress and related factors among Chinese Americans with type 2 diabetes in New York City (NYC). Methods We conducted a secondary data analysis of the baseline data from three research studies conducted among community-dwelling Chinese American adults with type 2 diabetes. Diabetes Distress Scale (DDS) was used to measure sources of diabetes distress including emotional-, regimen-, interpersonal-, and physician-related distress. A score of 2 or greater indicates moderate diabetes distress or higher. Patient Health Questionnaire-2 (PHQ-2) was used to measure depressive symptoms. Participants' sociodemographic information was also collected. Descriptive statistics were used to describe diabetes distress, and logistic least absolute shrinkage and selection operator (LASSO) regression was used to examine factors associated with diabetes distress level. Results Data from 178 participants (mean age 63.55±13.56 years) were analyzed. Most participants were married (76.40%), had a high school degree or less (65.73%), had a household annual income < $25,000 (70.25%), and reported limited English proficiency (93.22%). About 25.84% reported moderate or higher overall distress. The most common sources of distress were emotional burden (29.78%), followed by regimen- (28.65%), interpersonal- (18.54%), and physician-related distress (14.04%). Participants who were younger, female, limited English proficient, and had elevated depressive symptoms were more likely to have higher diabetes distress. Conclusion Diabetes distress is prevalent among Chinese immigrants with type 2 diabetes, especially emotional- and regimen-related distress. Given the known link between diabetes distress and poor glycemic control, it is critical to screen for diabetes distress at primary care clinics and incorporate psychological counseling in diabetes care in this underserved population.
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Affiliation(s)
- Yun Shi
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, New York, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Chan Wang
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Mary Ann Sevick
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, New York, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
- Department of Medicine, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Han Bao
- Jacobi Medical Center, New York, NY, USA
| | - Xinyi Xu
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, New York, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Yulin Jiang
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, New York, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Ziqiang Zhu
- Wellsure Medical Practice, New York, NY, USA
| | - Ashley Wei
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, New York, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | | | - Lu Hu
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, New York, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
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Shi Y, Wu B, Islam N, Sevick MA, Shallcross AJ, Levy N, Tamura K, Bao H, Lieu R, Xu X, Jiang Y, Hu L. Characterizing Mental Health Status and Service Utilization in Chinese Americans With Type 2 Diabetes in New York City: Cross-Sectional Study. JMIR Form Res 2024; 8:e59121. [PMID: 38954806 PMCID: PMC11252619 DOI: 10.2196/59121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/14/2024] [Accepted: 06/05/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Emerging evidence indicates that individuals with type 2 diabetes (T2D) are more prone to mental health issues than the general population; however, there is a significant lack of data concerning the mental health burden in Chinese Americans with T2D. OBJECTIVE The aim of this study was to explore the comorbid mental health status, health-seeking behaviors, and mental service utilization among Chinese Americans with T2D. METHODS A cross-sectional telephone survey was performed among 74 Chinese Americans with T2D in New York City. We used standardized questionnaires to assess mental health status and to gather data on mental health-seeking behaviors and service utilization. Descriptive statistics were applied for data analysis. RESULTS A total of 74 Chinese Americans with T2D completed the survey. Most participants (mean age 56, SD 10 years) identified as female (42/74, 57%), were born outside the United States (73/74, 99%), and had limited English proficiency (71/74, 96%). Despite nearly half of the participants (34/74, 46%) reporting at least one mental health concern (elevated stress, depressive symptoms, and/or anxiety), only 3% (2/74) were currently using mental health services. Common reasons for not seeking care included no perceived need, lack of information about Chinese-speaking providers, cost, and time constraints. The cultural and language competence of the provider was ranked as the top factor related to seeking mental health care. CONCLUSIONS Chinese Americans with T2D experience relatively high comorbid mental health concerns yet have low service utilization. Clinicians may consider team-based care to incorporate mental health screening and identify strategies to provide culturally and linguistically concordant mental health services to engage Chinese Americans with T2D.
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Affiliation(s)
- Yun Shi
- Department of Population Health, New York University Grossman School of Medicine, New York University Langone Health, New York, NY, United States
- Center for Healthful Behavior Change, New York University Grossman School of Medicine, New York University Langone Health, New York, NY, United States
| | - Bei Wu
- New York University Rory Meyers College of Nursing, New York, NY, United States
| | - Nadia Islam
- Department of Population Health, New York University Grossman School of Medicine, New York University Langone Health, New York, NY, United States
| | - Mary Ann Sevick
- Department of Population Health, New York University Grossman School of Medicine, New York University Langone Health, New York, NY, United States
- Department of Medicine, New York University Grossman School of Medicine, New York University Langone Health, New York, NY, United States
| | - Amanda J Shallcross
- Department of Wellness and Preventive Medicine, Cleveland Clinic, Cleveland, OH, United States
| | - Natalie Levy
- Department of Population Health, New York University Grossman School of Medicine, New York University Langone Health, New York, NY, United States
| | - Kosuke Tamura
- Socio-Spatial Determinants of Health Laboratory, Population and Community Health Sciences Branch, Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United States
| | - Han Bao
- Jacobi Medical Center, Bronx, NY, United States
| | - Ricki Lieu
- Department of Population Health, New York University Grossman School of Medicine, New York University Langone Health, New York, NY, United States
- Center for Healthful Behavior Change, New York University Grossman School of Medicine, New York University Langone Health, New York, NY, United States
- Creighton University School of Medicine, Omaha, NE, United States
| | - Xinyi Xu
- Department of Population Health, New York University Grossman School of Medicine, New York University Langone Health, New York, NY, United States
- Center for Healthful Behavior Change, New York University Grossman School of Medicine, New York University Langone Health, New York, NY, United States
| | - Yulin Jiang
- Department of Population Health, New York University Grossman School of Medicine, New York University Langone Health, New York, NY, United States
- Center for Healthful Behavior Change, New York University Grossman School of Medicine, New York University Langone Health, New York, NY, United States
| | - Lu Hu
- Department of Population Health, New York University Grossman School of Medicine, New York University Langone Health, New York, NY, United States
- Center for Healthful Behavior Change, New York University Grossman School of Medicine, New York University Langone Health, New York, NY, United States
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3
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Hu L, Shi Y, Wylie-Rosett J, Sevick MA, Xu X, Lieu R, Wang C, Li H, Bao H, Jiang Y, Zhu Z, Yeh MC, Islam N. Feasibility of a family-oriented mHealth intervention for Chinese Americans with type 2 diabetes: A pilot randomized control trial. PLoS One 2024; 19:e0299799. [PMID: 38466714 PMCID: PMC10927140 DOI: 10.1371/journal.pone.0299799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 01/30/2024] [Indexed: 03/13/2024] Open
Abstract
OBJECTIVES To test the feasibility, acceptability, and potential efficacy of a mHealth intervention tailored for Chinese immigrant families with type 2 diabetes (T2D). METHODS We conducted a pilot randomized controlled trial (RCT) with baseline, 3-, and 6-month measurements. Participating dyads, T2D patients and families/friends from NYC, were randomized into the intervention group (n = 11) or the wait-list control group (n = 12). Intervention includes 24 videos covering T2D self-management, behavioral techniques, and family-oriented sessions. Feasibility and acceptability were measured respectively by the retention rate and video watch rate, and a satisfaction survey. Patients' HbA1c, weight, and self-management were also assessed to test potential efficacy. RESULTS Most T2D patients (n = 23; mean age 56.2±9.4 years; 52.2% male) and families/friends (n = 23, mean age 54.6±11.2 years; 52.2% female) had high school education or less (69.6% and 69.6%), annual household income < $25,000 (65.2% and 52.2%), and limited English proficiency (95.7% and 95.7%). The retention rates were not significantly different between the intervention and the control groups for both the patients (90.91% vs 83.3%, p = 0.589); and their families/friends (3-month: 90.9% vs 75%, p = 0.313; 6-month: 90.9% vs 83.3%, p = 0.589). The mean video watch rate was 76.8% (7%). T2D patients and families/friends rated satisfaction as 9.4 and 10 out of 10, respectively. Despite no between-group differences, the intervention group had significantly lower HbA1c (p = 0.014) and better self-management (p = 0.009), and lost 12 lbs. on average at 6 months (p = 0.079), compared to their baseline levels. CONCLUSIONS A culturally-tailored, family-based mHealth intervention is feasible and acceptable among low-income, limited English-proficient Chinese families with T2D in NYC. Significant changes in HbA1c and self-management within the intervention group indicate this intervention may have potential efficacy. Given the small sample size of this study, a future RCT with adequate power is needed to test efficacy.
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Affiliation(s)
- Lu Hu
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, NYU Langone Health, New York, NY, United States of America
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Yun Shi
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, NYU Langone Health, New York, NY, United States of America
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Judith Wylie-Rosett
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, New York, NY, United States of America
- Department of Medicine, Albert Einstein College of Medicine, New York, NY, United States of America
| | - Mary Ann Sevick
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, NYU Langone Health, New York, NY, United States of America
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
- Department of Medicine, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Xinyi Xu
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, NYU Langone Health, New York, NY, United States of America
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Ricki Lieu
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, NYU Langone Health, New York, NY, United States of America
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Chan Wang
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Huilin Li
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Han Bao
- Jacobi Medical Center, New York, NY, United States of America
| | - Yulin Jiang
- Institute for Excellence in Health Equity, Center for Healthful Behavior Change, NYU Langone Health, New York, NY, United States of America
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Ziqiang Zhu
- Wellsure Medical Practice, New York, NY, United States of America
| | - Ming-Chin Yeh
- School of Urban Public Health, Hunter College, City University of New York, New York, NY, United States of America
| | - Nadia Islam
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
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Zhang L, Chung S, Shi W, Candelaria D, Gallagher R. Online Health Information-Seeking Behaviours and eHealth Literacy among First-Generation Chinese Immigrants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3474. [PMID: 36834164 PMCID: PMC9965195 DOI: 10.3390/ijerph20043474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 02/13/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
Due to linguistic and cultural barriers, immigrants often have limited access to health information. Online health information is popular and accessible, but quality is questionable and its benefits dependent on an individual's eHealth literacy. This study examined online health information-seeking behaviours, eHealth literacy and its predictors among first-generation Chinese immigrants. A sample of 356 Chinese immigrants living in Australia completed an anonymous paper-based survey, including sociodemographic, clinical data, English proficiency, health literacy, online health information-seeking behaviours, and eHealth literacy. Linear regression models analyzed predictive factors of eHealth literacy. Participants were aged mean 59.3 years, female (68.3%), 53.1% completed university, and their English proficiency was rated fair/poor by 75.1%. Participants perceived online health information as useful (61.6%) and important (56.2%) to their health. Health information accessed was often related to lifestyle (61.2%), health resources (44.9%), diseases (36.0%), and medications (30.9%). Inadequate health literacy and eHealth literacy occurred in 48.3% and 44.9%, respectively. Age, number of technological devices used, education, and health status were independently associated with eHealth literacy. While most Chinese immigrants used online health information, many had inadequate eHealth literacy. Healthcare authorities and providers should support older immigrants, those with lower education and poorer health, and those less engaged with technology in online health information use by providing culturally and linguistically appropriate information, directing immigrants to credible websites, and involving them in health material development processes.
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Affiliation(s)
- Ling Zhang
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
- Charles Perkins Centre, University of Sydney, Camperdown, NSW 2006, Australia
| | - Sherrie Chung
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
| | - Wendan Shi
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
- Charles Perkins Centre, University of Sydney, Camperdown, NSW 2006, Australia
| | - Dion Candelaria
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
- Charles Perkins Centre, University of Sydney, Camperdown, NSW 2006, Australia
| | - Robyn Gallagher
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
- Charles Perkins Centre, University of Sydney, Camperdown, NSW 2006, Australia
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5
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Hu L, Islam N, Zhang Y, Shi Y, Li H, Wang C, Sevick MA. Leveraging Social Media to Increase Access to an Evidence-Based Diabetes Intervention Among Low-Income Chinese Immigrants: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e42554. [PMID: 36306161 PMCID: PMC9652737 DOI: 10.2196/42554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) in Chinese Americans is a rising public health concern for the US health care system. The majority of Chinese Americans with T2D are foreign-born older immigrants and report limited English proficiency and health literacy. Multiple social determinants of health limit access to evidence-based diabetes interventions for underserved Chinese immigrants. A social media-based diabetes intervention may be feasible to reach this community. OBJECTIVE The purpose of the Chinese American Research and Education (CARE) study was to examine the potential efficacy of a social media-based intervention on glycemic control in Chinese Americans with T2D. Additionally, the study aimed to explore the potential effects of the intervention on psychosocial and behavioral factors involved in successful T2D management. In this report, we describe the design and protocol of the CARE trial. METHODS CARE was a pilot randomized controlled trial (RCT; n=60) of a 3-month intervention. Participants were randomized to one of two arms (n=30 each): wait-list control or CARE intervention. Each week, CARE intervention participants received two culturally and linguistically tailored diabetes self-management videos for a total of 12 weeks. Video links were delivered to participants via WeChat, a free and popular social media app among Chinese immigrants. In addition, CARE intervention participants received biweekly phone calls from the study's community health workers to set goals related to T2D self-management and work on addressing goal-achievement barriers. Hemoglobin A1c (HbA1c), self-efficacy, diabetes self-management behaviors, dietary intake, and physical activity were measured at baseline, 3 months, and 6 months. Piecewise linear mixed-effects modeling will be performed to examine intergroup differences in HbA1c and psychosocial and behavioral outcomes. RESULTS This pilot RCT study was approved by the Institutional Review Board at NYU Grossman School of Medicine in March 2021. The first participant was enrolled in March 2021, and the recruitment goal (n=60) was met in March 2022. All data collection is expected to conclude by November 2022, with data analysis and study results ready for reporting by December 2023. Findings from this pilot RCT will further guide the team in planning a future large-scale study. CONCLUSIONS This study will serve as an important first step in exploring scalable interventions to increase access to evidence-based diabetes interventions among underserved, low-income, immigrant populations. This has significant implications for chronic care in other high-risk immigrant groups, such as low-income Hispanic immigrants, who also bear a high T2D burden, face similar barriers to accessing diabetes programs, and report frequent social media use (eg, WhatsApp). TRIAL REGISTRATION ClinicalTrials.gov NCT03557697; https://clinicaltrials.gov/ct2/show/NCT03557697. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/42554.
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Affiliation(s)
- Lu Hu
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, New York, NY, United States
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States
| | - Nadia Islam
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States
| | - Yiyang Zhang
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, New York, NY, United States
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States
| | - Yun Shi
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, New York, NY, United States
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States
| | - Huilin Li
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States
| | - Chan Wang
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States
| | - Mary Ann Sevick
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, New York, NY, United States
- Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States
- Department of Medicine, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States
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Huang S, Ash GI, Nam S, Jeon S, McMahon E, Whittemore R. Objectively-Measured Physical Activity and Sedentary Behaviors and Related Factors in Chinese Immigrants in the US with Prior Gestational Diabetes Mellitus. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191811409. [PMID: 36141683 PMCID: PMC9517195 DOI: 10.3390/ijerph191811409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/30/2022] [Accepted: 09/08/2022] [Indexed: 05/24/2023]
Abstract
Chinese immigrants in the US are disproportionately affected by gestational diabetes mellitus (GDM) and type 2 diabetes (T2D). The aims of this study were to describe their physical activity (PA) and sedentary behaviors (SB) patterns and to identify determinates of objectively-measured PA and SB among Chinese immigrants in the US with prior GDM. We conducted a cross-sectional study among 106 Chinese immigrants with prior GDM across the US. PA and SB were measured by GT9X+ hip accelerometers for 7 consecutive days. Validated questionnaires in English and Chinese were used to assess knowledge and risk perceptions as well as cultural and psychosocial characteristics. Descriptive, bivariate, and multiple regression analyses were performed. Only 27% of participants met the PA guidelines. The median duration of moderate-vigorous-intensity PA (MVPA) per week was 79 (IQR 38-151) minutes. Participants had an average of 9.2 ± 1.4 h of sedentary time per day. Living with parents (who may provide family support) was associated with more MVPA minutes per week, more steps per day, and a greater likelihood of meeting PA guidelines. Higher levels of acculturative stress were associated with fewer MVPA minutes per week. Being employed and having a lower BMI were associated with more SB. Strategies are needed to increase MVPA among this high-risk group, including decreasing acculturative stress and increasing family support. Different strategies are needed to decrease SB among this population.
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Affiliation(s)
- Shuyuan Huang
- Rutgers-NYU Center for Asian Health Promotion and Equity, NYU Rory Meyers College of Nursing, New York, NY 10010, USA
| | - Garrett I. Ash
- Pain Research, Informatics, Multi-Morbidities, and Education (PRIME), VA Connecticut Healthcare System, West Haven, CT 06516, USA
- Yale School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Soohyun Nam
- Yale School of Nursing, Yale University, West Haven, CT 06477, USA
| | - Sangchoon Jeon
- Yale School of Nursing, Yale University, West Haven, CT 06477, USA
| | - Erin McMahon
- College of Nursing, The University of Arizona, Tucson, AZ 85721, USA
| | - Robin Whittemore
- Yale School of Nursing, Yale University, West Haven, CT 06477, USA
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7
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Mavragani A, Islam N, Trinh-Shevrin C, Wu B, Feldman N, Tamura K, Jiang N, Lim S, Wang C, Bubu OM, Schoenthaler A, Ogedegbe G, Sevick MA. A Social Media-Based Diabetes Intervention for Low-Income Mandarin-Speaking Chinese Immigrants in the United States: Feasibility Study. JMIR Form Res 2022; 6:e37737. [PMID: 35544298 PMCID: PMC9492091 DOI: 10.2196/37737] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/31/2022] [Accepted: 04/06/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Chinese immigrants bear a high diabetes burden and face significant barriers to accessing diabetes self-management education (DSME) and counseling programs. OBJECTIVE The goal of this study was to examine the feasibility and acceptability and to pilot test the potential efficacy of a social media-based DSME intervention among low-income Chinese immigrants with type 2 diabetes (T2D) in New York City. METHODS This was a single group pretest and posttest study in 30 Chinese immigrants with T2D. The intervention included 24 culturally and linguistically tailored DSME videos, focusing on diabetes education and behavioral counseling techniques. Over 12 weeks, participants received 2 brief videos each week via WeChat, a free social media app popular among Chinese immigrants. Primary outcomes included the feasibility and acceptability of the intervention. Feasibility was evaluated by recruitment processes, retention rates, and the video watch rate. Acceptability was assessed via a satisfaction survey at 3 months. Secondary outcomes, that is, hemoglobin A1c (HbA1c), self-efficacy, dietary intake, and physical activity, were measured at baseline, 3 months, and 6 months. Descriptive statistics and paired 2-sided t tests were used to summarize the baseline characteristics and changes before and after the intervention. RESULTS The sample population (N=30) consisted of mostly females (21/30, 70%) who were married (19/30, 63%), with limited English proficiency (30/30, 100%), and the mean age was 61 (SD 7) years. Most reported an annual household income of <US $25,000 (24/30, 80%) and a high school education or less (19/30, 63%). Thirty participants were recruited within 2 months (January and February 2020), and 97% (29/30) of the participants were retained at 6 months. A video watch rate of 92% (28/30) was achieved. The mean baseline HbA1c level was 7.3% (SD 1.3%), and this level declined by 0.5% (95% CI -0.8% to -0.2%; P=.003) at 6 months. The mean satisfaction score was 9.9 (SD 0.6) out of 10, indicating a high level of satisfaction with the program. All strongly agreed or agreed that they preferred this video-based DSME over face-to-face visits. Compared to baseline, there were significant improvements in self-efficacy, dietary, and physical activity behaviors at 6 months. CONCLUSIONS This pilot study demonstrated that a social media-based DSME intervention is feasible, acceptable, and potentially efficacious in a low-income Chinese immigrant population with T2D. Future studies need to examine the efficacy in an adequately powered clinical trial.
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Affiliation(s)
| | - Nadia Islam
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Chau Trinh-Shevrin
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Naumi Feldman
- Charles B Wang Community Health Center, New York, NY, United States
| | - Kosuke Tamura
- Socio-Spatial Determinants of Health (SSDH) Laboratory, Population and Community Health Sciences Branch, Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institute of Health, Bethesda, MD, United States
| | - Nan Jiang
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Sahnah Lim
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Chan Wang
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Omonigho M Bubu
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States.,Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, United States
| | - Antoinette Schoenthaler
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, New York, NY, United States.,Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States.,Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Gbenga Ogedegbe
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, New York, NY, United States.,Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States.,Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Mary Ann Sevick
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, New York, NY, United States.,Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States.,Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
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