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Akyirem S, Choa E, Poghosyan H. Investigating Racial and Ethnic Differences in Diabetes Self-Management Education Among Adults With Diabetes. Sci Diabetes Self Manag Care 2023; 49:206-216. [PMID: 37129292 DOI: 10.1177/26350106231169693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE The purpose of this study was to examine racial and ethnic differences in diabetes self-management education (DSME) participation among adults with diabetes. METHODS Population-based, cross-sectional data from the 2020 Behavioral Risk Factor Surveillance System diabetes module were analyzed. Study cohort included 9881 adults age 18 years or older with self-reported diabetes living in 11 US states, Washington, DC, and Puerto Rico. The outcome variable was participation in DSME. Weighted descriptive statistics and multivariable logistic regression were computed to investigate the association between race and ethnicity and participation in DSME, adjusting for self-reported social determinants of health factors (eg, sex, education, employment, health insurance). RESULTS Overall, 19.3% self-identified as non-Hispanic Black, 16.5% as Hispanic, and 59.9% as non-Hispanic White. Of participants, 44.3% were between 66 and 80 years old, and 50.4% were women. Half (50.1%) reported participating in DSME, and 78.5% had seen clinicians for diabetes-related care 1 to 5 times in the past year. Hispanic participants were less likely to report participation in DSME (28.5%) compared to non-Hispanic Black (60.3%) and non-Hispanic White (53.4%) participants (P < .001). Adults with diabetes who were less likely to participate in DSME tend to be unmarried, have high school or lower-level education, and not exercise regularly. CONCLUSIONS Racial and ethnic differences exist in DSME participation. Because DSME has been shown to improve diabetes outcomes, there is a need to develop strategies promoting equity in DSME participation, particularly among Hispanic populations, to reduce health disparities in diabetes care.
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Affiliation(s)
- Samuel Akyirem
- Yale School of Nursing, Yale University, Orange, Connecticut
| | - Elizabeth Choa
- Yale School of Nursing, Yale University, Orange, Connecticut
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Li Y, Zhong Q, Zhu S, Cheng H, Huang W, Wang HHX, Li YT. Frequency of Follow-Up Attendance and Blood Glucose Monitoring in Type 2 Diabetic Patients at Moderate to High Cardiovascular Risk: A Cross-Sectional Study in Primary Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192114175. [PMID: 36361055 PMCID: PMC9656430 DOI: 10.3390/ijerph192114175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/17/2022] [Accepted: 10/26/2022] [Indexed: 05/17/2023]
Abstract
Regular follow-up attendance in primary care and routine blood glucose monitoring are essential in diabetes management, particularly for patients at higher cardiovascular (CV) risk. We sought to examine the regularity of follow-up attendance and blood glucose monitoring in a primary care sample of type 2 diabetic patients at moderate-to-high CV risk, and to explore factors associated with poor engagement. Cross-sectional data were collected from 2130 patients enrolled in a diabetic retinopathy screening programme in Guangdong province, China. Approximately one-third of patients (35.9%) attended clinical follow-up <4 times in the past year. Over half of patients (56.9%) failed to have blood glucose monitored at least once per month. Multivariable logistic regression analysis showed that rural residents (adjusted odds ratio [aOR] = 0.420, 95% confidence interval [CI] = 0.338-0.522, p < 0.001, for follow-up attendance; aOR = 0.580, 95%CI: 0.472-0.712, p < 0.001, for blood glucose monitoring) and subjects with poor awareness of adverse consequences of diabetes complications (aOR = 0.648, 95%CI = 0.527-0.796, p < 0.001, for follow-up attendance; aOR = 0.770, 95%CI = 0.633-0.937, p = 0.009, for blood glucose monitoring) were both less likely to achieve active engagement. Our results revealed an urban-rural divide in patients' engagement in follow-up attendance and blood glucose monitoring, which suggested the need for different educational approaches tailored to the local context to enhance diabetes care.
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Affiliation(s)
- Yunyi Li
- School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou 510060, China
| | - Qiya Zhong
- School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou 510060, China
| | - Sufen Zhu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Hui Cheng
- School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou 510060, China
| | - Wenyong Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou 510060, China
| | - Harry H. X. Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou 510060, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou 510060, China
- Correspondence: (H.H.X.W.); (Y.-T.L.)
| | - Yu-Ting Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou 510060, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou 510060, China
- Correspondence: (H.H.X.W.); (Y.-T.L.)
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White Perkins D, Milan P, Miazek K, Havstad S, Wegienka G. Identifying factors affecting diabetes education program participation within a metro Detroit integrated health system. Prev Med Rep 2021; 24:101646. [PMID: 34976695 PMCID: PMC8683990 DOI: 10.1016/j.pmedr.2021.101646] [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: 05/04/2021] [Revised: 11/14/2021] [Accepted: 11/17/2021] [Indexed: 11/29/2022] Open
Abstract
Classification and regression tree analysis identified patterns in participation. White people, >43 years old, with A1c > 8.9 and with Medicaid had lowest contact. People with Medicaid, <48 years, and A1C > 8.1 had lowest intake session attendance. Older males with A1c ≤ 8.3% had the highest rate (66.0%) of completing their plan.
Diabetes self-management education and support (DSMES) can help people achieve optimal disease control, yet these services often remain underutilized. People referred to these programs by their provider can become disengaged in the program at several key steps. This study applies Classification and Regression Tree analysis to 3796 people with diabetes at a single health system based in the Detroit metropolitan area who were referred for DSMES provided by the health system to determine demographic patterns of those who were successfully contacted to schedule program intake appointments, those who did not attend their intake appointment, and those who began but did not complete their personalized DSMES program. White people > 43 years of age, those with a prior A1C value > 8.9 and those with Medicaid insurance had the highest rate of not being successfully contacted for their intake appointment. Those who did not attend their intake appointment tended to have Medicaid insurance, be younger than 48 years, and have A1C > 8.1. Within the Medicare or private insurance groups, those who did not attend were more likely to be female, of Black race and not partnered. Older males with a lower A1C (≤8.3%) had the lowest rate (34.0%) of failing to complete their DSMES plan. The data showed that almost half of those referred were not successfully contacted. The overall low completion rate of 13.2% confirms the need to examine factors predictive of participation and completion. This study highlights process improvement changes to improve personalization of outreach and engagement.
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Affiliation(s)
- Denise White Perkins
- Department of Family Medicine, Henry Ford Health System, One Ford Place, Detroit, MI 48202, USA
- Corresponding author at: One Ford Place, 3E, Detroit, MI 48202, USA.
| | - Pam Milan
- Department of Population Health Sciences, Henry Ford Health System, One Ford Place, Detroit, MI 48202, USA
| | - Kimberly Miazek
- Department of Population Health Sciences, Henry Ford Health System, One Ford Place, Detroit, MI 48202, USA
| | - Suzanne Havstad
- Department of Public Health Sciences, Henry Ford Health System, One Ford Place, Detroit, MI 48202, USA
| | - Ganesa Wegienka
- Department of Public Health Sciences, Henry Ford Health System, One Ford Place, Detroit, MI 48202, USA
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Khan MM, Roberson S, Reid K, Jordan M, Odoi A. Geographic disparities and temporal changes of diabetes prevalence and diabetes self-management education program participation in Florida. PLoS One 2021; 16:e0254579. [PMID: 34270601 PMCID: PMC8284795 DOI: 10.1371/journal.pone.0254579] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 06/30/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although Diabetes Self-Management Education (DSME) programs are recommended to help reduce the burden of diabetes and diabetes-related complications, Florida is one of the states with the lowest DSME participation rates. Moreover, there is evidence of geographic disparities of not only DSME participation rates but the burden of diabetes as well. Understanding these disparities is critical for guiding control programs geared at improving participation rates and diabetes outcomes. Therefore, the objectives of this study were to: (a) investigate geographic disparities of diabetes prevalence and DSME participation rates; and (b) identify predictors of the observed disparities in DSME participation rates. METHODS Behavioral Risk Factor Surveillance System (BRFSS) data for 2007 and 2010 were obtained from the Florida Department of Health. Age-adjusted diabetes prevalence and DSME participation rates were computed at the county level and their geographic distributions visualized using choropleth maps. Significant changes in diabetes prevalence and DSME participation rates between 2007 and 2010 were assessed and counties showing significant changes were mapped. Clusters of high diabetes prevalence before and after adjusting for common risk factors and DSME participation rates were identified, using Tango's flexible spatial scan statistics, and their geographic distribution displayed in maps. Determinants of the geographic distribution of DSME participation rates and predictors of the identified high rate clusters were identified using ordinary least squares and logistic regression models, respectively. RESULTS County level age-adjusted diabetes prevalence varied from 4.7% to 17.8% while DSME participation rates varied from 26.6% to 81.2%. There were significant (p≤0.05) increases in both overall age-adjusted diabetes prevalence and DSME participation rates from 2007 to 2010 with diabetes prevalence increasing from 7.7% in 2007 to 8.6% in 2010 while DSME participation rates increased from 51.4% in 2007 to 55.1% in 2010. Generally, DSME participation rates decreased in rural areas while they increased in urban areas. High prevalence clusters of diabetes (both adjusted and unadjusted) were identified in northern and central Florida, while clusters of high DSME participation rates were identified in central Florida. Rural counties and those with high proportion of Hispanics tended to have low DSME participation rates. CONCLUSIONS The findings confirm that geographic disparities in both diabetes prevalence and DSME participation rates exist. Specific attention is required to address these disparities especially in areas that have high diabetes prevalence but low DSME participation rates. Study findings are useful for guiding resource allocation geared at reducing disparities and improving diabetes outcomes.
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Affiliation(s)
- Md Marufuzzaman Khan
- Department of Public Health, College of Education, Health, and Human Sciences, The University of Tennessee, Knoxville, Tennessee, United States of America
| | - Shamarial Roberson
- Florida Department of Health, Tallahassee, Florida, United States of America
| | - Keshia Reid
- Florida Department of Health, Tallahassee, Florida, United States of America
| | - Melissa Jordan
- Florida Department of Health, Tallahassee, Florida, United States of America
| | - Agricola Odoi
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, Tennessee, United States of America
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Yazdani F, Abazari P, Haghani F, Iraj B. Restrictors of the effectiveness of diabetes self-management education: A qualitative content analysis. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:18. [PMID: 33688527 PMCID: PMC7933700 DOI: 10.4103/jehp.jehp_914_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/11/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND A key step for improving the effectiveness of diabetes self-management education (DSME) is to identify its restrictors. OBJECTIVES The aim of this study was to explore the restrictors of the effectiveness of DSME. METHODS This descriptive qualitative study was conducted in March 2016-2017. Participants were 16 DSME providers (viz., physicians, nurses, nutritionists, and psychologists) and nine DSME receivers (viz., patients and their family members) - 25 in total. Semi-structured interviews were held for data collection. Interviews were transcribed word by word and analyzed through conventional content analysis approach proposed by Graneheim and Lundman. RESULTS The restrictors of the effectiveness of DSME were categorized into three main categories and 11 subcategories, namely patients' limited welcoming of DSME classes (allocating limited time for participation in DSME classes, inadequate knowledge about diabetes mellitus [DM] importance, inappropriate educational environment, and financial problems), unfavorable adherence to treatments: serious challenge (inattention to educations, poor motivation for adherence to medical recommendations, and inattention to the psychological aspects of DM), and the difficulty of adult education (the difficulty of changing health-related attitudes and behaviors, mere information delivery during education, adults' physical and perceptual limitations, and diabetes educators' limited competence in adult education). CONCLUSION The findings of the present study provide an in-depth understanding about the restrictors of the effectiveness of DSME. DM management authorities and policymakers can use these findings to develop strategies for improving the effectiveness of DSME.
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Affiliation(s)
- Faridokht Yazdani
- Student Research Committee, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
- Nursing and Midwifery Sciences Development Research Center, Najafabad Branch, Islamic Azad University, Najafabad, Iran
| | - Parvaneh Abazari
- Nursing and Midwifery Sciences Development Research Center, Najafabad Branch, Islamic Azad University, Najafabad, Iran
- Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fariba Haghani
- Department of Medical Education, Medical Education Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bijan Iraj
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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