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Smith-Miller CA, Berry DC, Miller CT. Gender Differences and Their Influences on T2DM Self-Management Among Spanish-Speaking Latinx Immigrants. HISPANIC HEALTH CARE INTERNATIONAL 2021; 20:44-55. [PMID: 33906459 DOI: 10.1177/15404153211011727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Evidence suggests that gender may influence many aspects of type 2 diabetes (T2DM) self-management (SM) and we posit that limited English language-proficient Latinx immigrants face additional challenges. METHODS Instruments and semi-structured interviews were used to examine gender differences on health literacy, diabetes knowledge, health-promoting behaviors, diabetes, eating and exercise self-efficacy (SE), and T2DM SM practices among a cohort of limited English language-proficient Latinx immigrants. Statistical and qualitative analysis procedures were performed comparing males and females. RESULTS Thirty persons participated. Males tended to be older, have higher educational achievement, and more financial security than females. Physiologic measures tended worse among female participants. Health literacy and exercise SE scores were similar, but females scored lower on Eating and Diabetes SE. Forty-seven percent (n= 9) of the women reported a history of gestational diabetes mellitus and a majority of men (n = 7) cited difficulty with excessive alcohol. CONSUMPTION Males appeared to receive more SM support compared to females. Females more frequently noted how family obligations and a lack of support impeded their SM. Work environments negatively influenced SM practices. CONCLUSION Men and women have unique SM challenges and as such require individualized strategies and support to improve T2DM management.
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Affiliation(s)
- Cheryl A Smith-Miller
- UNC Medical Center, Nursing Quality and Research, Chapel Hill, NC, USA.,Office of Human Research Ethics, University of North Carolina-Chapel Hill, NC, USA.,School of Nursing, University of North Carolina-Chapel Hill, NC, USA
| | - Diane C Berry
- Co-Director Interventions for Preventing and Managing Chronic Illness (T32-NIH/NINR); Optimizing Outcomes in Women with Gestational Diabetes and their Infants (NIH/NIDDK); Diabetes Group Visits (Kate B. Reynolds), School of Nursing, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Cass T Miller
- Environmental Sciences and Engineering, UNC Gillings School of Global Public Health, University of North Carolina-Chapel Hill, NC, USA
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Ho J, Bachman-Carter K, Thorkelson S, Anderson K, Jaggi J, Brown C, Nelson AK, Curley C, King C, Atwood S, Shin S. Glycemic control and healthcare utilization following pregnancy among women with pre-existing diabetes in Navajo Nation. BMC Health Serv Res 2018; 18:629. [PMID: 30097012 PMCID: PMC6086058 DOI: 10.1186/s12913-018-3434-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 07/30/2018] [Indexed: 11/13/2022] Open
Abstract
Background Native American communities experience greater burden of diabetes than the general population, including high rates of Type 2 diabetes among women of childbearing age. Diabetes in pregnancy is associated with risks to both the mother and offspring, and glycemic control surrounding the pregnancy period is of vital importance. Methods A retrospective chart review was conducted at a major Navajo Area Indian Health Service (IHS) hospital, tracking women with pre-existing diabetes who became pregnant between 2010 and 2012. Logistic regression was performed to find patient-level predictors of our desired primary outcome—having hemoglobin A1c (HbA1c) consistently < 8% within 2 years after pregnancy. Descriptive statistics were generated for other outcomes, including glycemic control and seeking timely IHS care. Results One hundred twenty-two pregnancies and 114 individuals were identified in the dataset. Baseline HbA1c was the only covariate which predicted our primary outcome (OR = 1.821, 95% CI = 1.184–2.801). Examining glycemic control among pregnancies with complete HbA1c data (n = 59), 59% were controlled before, 85% during, and 34% after pregnancy. While nearly all women received care in the immediate postpartum period, only 49% of women visited a primary care provider and 71% had HbA1c testing in the 2 years after pregnancy. Conclusions This is the first analysis of outcomes among women with diabetes in pregnancy in Navajo Nation, the largest reservation and tribal health system in the United States. Our findings demonstrate the positive impact of specialized prenatal care in achieving glycemic control during pregnancy, while highlighting the challenges in maintaining glycemic control and continuity of healthcare after pregnancy.
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Affiliation(s)
- Julius Ho
- Department of Medicine, Johns Hopkins School of Medicine, 1800 Orleans St, Baltimore, MD, 21298, USA
| | | | - Shelley Thorkelson
- Northern Navajo Medical Center, Indian Health Service, Shiprock, NM, USA
| | - Kristi Anderson
- Northern Navajo Medical Center, Indian Health Service, Shiprock, NM, USA
| | - Jennifer Jaggi
- Gallup Indian Medical Center, Indian Health Service, Gallup, NM, USA
| | - Chris Brown
- Division of Global Health Equity, Brigham and Women's Hospital, 210 East Aztec Avenue, Gallup, NM, 87301, USA.,Community Outreach and Patient Empowerment, 210 East Aztec Avenue, Gallup, NM, 87301, USA
| | - Adrianne Katrina Nelson
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave., Boston, MA, 02115, USA
| | - Cameron Curley
- Division of Global Health Equity, Brigham and Women's Hospital, 210 East Aztec Avenue, Gallup, NM, 87301, USA.,Community Outreach and Patient Empowerment, 210 East Aztec Avenue, Gallup, NM, 87301, USA
| | - Caroline King
- Division of Global Health Equity, Brigham and Women's Hospital, 210 East Aztec Avenue, Gallup, NM, 87301, USA.,Community Outreach and Patient Empowerment, 210 East Aztec Avenue, Gallup, NM, 87301, USA
| | - Sid Atwood
- Division of Global Health Equity, Brigham and Women's Hospital, 210 East Aztec Avenue, Gallup, NM, 87301, USA
| | - Sonya Shin
- Division of Global Health Equity, Brigham and Women's Hospital, 210 East Aztec Avenue, Gallup, NM, 87301, USA. .,Community Outreach and Patient Empowerment, 210 East Aztec Avenue, Gallup, NM, 87301, USA. .,Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave., Boston, MA, 02115, USA.
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Barnacle M, Strand MA, Werremeyer A, Maack B, Petry N. Depression Screening in Diabetes Care to Improve Outcomes. DIABETES EDUCATOR 2016; 42:646-51. [DOI: 10.1177/0145721716662917] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Purpose Evidence-based guidelines recommend regular depression screening among individuals with type 2 diabetes mellitus (T2DM). The purpose of this study is to examine depression screening patterns among a primary care population with T2DM, through use of the Patient Health Questionnaire-9 (PHQ-9). Methods In total, 1817 patients with T2DM were analyzed through a retrospective observational study at 2 sites, a regional health center and a federally qualified health center (FQHC). The T2DM sample was divided into those with and without a major depressive disorder (MDD) diagnosis. Depression screening rates and depression severity were assessed through the PHQ-9. Results Both sites had higher rates of PHQ-9 screening among individuals with a history of MDD (64.82%) vs those without MDD (11.39%). Individuals from the FQHC without a history of depression had a higher mean PHQ-9 score (10.11) than those with a previous MDD diagnosis at both RHS and FQHC (7.16 and 9.85, respectively). Conclusions Depression screening rates among individuals with diabetes and no history of MDD were remarkably low. Patients with diabetes but no MDD diagnosis who sought health care at a FQHC clinic had more depressive symptoms than those with a history of MDD at both sites. Individuals with diabetes and who have a MDD diagnosis are much more likely to receive regular depression screening than those without MDD, which leaves a substantial proportion of patients with undetected depression. Depression screening must be enhanced for all individuals with diabetes, particularly for low-income individuals and those without a previous diagnosis of MDD.
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Affiliation(s)
- Mykell Barnacle
- School of Nursing, North Dakota State University, Fargo, North Dakota, USA (Dr Barnacle)
- Department of Pharmacy Practice and Masters in Public Health Program, North Dakota State University, Fargo, North Dakota, USA (Dr Strand)
- Department of Pharmacy Practice, North Dakota State University, Fargo, North Dakota, USA (Dr Werremeyer, Dr Maack, Dr Petry)
| | - Mark A. Strand
- School of Nursing, North Dakota State University, Fargo, North Dakota, USA (Dr Barnacle)
- Department of Pharmacy Practice and Masters in Public Health Program, North Dakota State University, Fargo, North Dakota, USA (Dr Strand)
- Department of Pharmacy Practice, North Dakota State University, Fargo, North Dakota, USA (Dr Werremeyer, Dr Maack, Dr Petry)
| | - Amy Werremeyer
- School of Nursing, North Dakota State University, Fargo, North Dakota, USA (Dr Barnacle)
- Department of Pharmacy Practice and Masters in Public Health Program, North Dakota State University, Fargo, North Dakota, USA (Dr Strand)
- Department of Pharmacy Practice, North Dakota State University, Fargo, North Dakota, USA (Dr Werremeyer, Dr Maack, Dr Petry)
| | - Brody Maack
- School of Nursing, North Dakota State University, Fargo, North Dakota, USA (Dr Barnacle)
- Department of Pharmacy Practice and Masters in Public Health Program, North Dakota State University, Fargo, North Dakota, USA (Dr Strand)
- Department of Pharmacy Practice, North Dakota State University, Fargo, North Dakota, USA (Dr Werremeyer, Dr Maack, Dr Petry)
| | - Natasha Petry
- School of Nursing, North Dakota State University, Fargo, North Dakota, USA (Dr Barnacle)
- Department of Pharmacy Practice and Masters in Public Health Program, North Dakota State University, Fargo, North Dakota, USA (Dr Strand)
- Department of Pharmacy Practice, North Dakota State University, Fargo, North Dakota, USA (Dr Werremeyer, Dr Maack, Dr Petry)
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