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Martinez S, Nouryan CN, Williams MS, Patel VH, Barbero P, Correa Gomez V, Marino J, Goris N, Cigaran E, Granville D, Murray LF, Harris YT, Myers A, Guzman J, Makaryus AN, McFarlane SI, Zeltser R, Pena M, Sison C, Lesser ML, Kline M, DiClemente RJ, Pekmezaris R. Ensuring fidelity: key elements to consider in disseminating a diabetes telemanagement program for underserved Hispanic/Latinos living with type 2 diabetes. Front Clin Diabetes Healthc 2024; 5:1328993. [PMID: 38436046 PMCID: PMC10907990 DOI: 10.3389/fcdhc.2024.1328993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/30/2024] [Indexed: 03/05/2024]
Abstract
Background The Hispanic/Latino population has greater risk (estimated >50%) of developing type 2 diabetes (T2D) and developing it at a younger age. The American Diabetes Association estimates costs of diagnosed diabetes in 2017 was $327 billion; with medical costs 2.3x higher than patients without diabetes. The purpose of this manuscript is to describe the methodology utilized in a randomized controlled trial aimed at evaluating the efficacy of a diabetes telemanagement (DTM) program for Hispanic/Latino patients with T2D. The intent is to provide information for future investigators to ensure that this study can be accurately replicated. Methods This study was a randomized controlled trial with 240 participants. Eligible patients (Hispanic/Latino, aged 18+, living with T2D) were randomized to Comprehensive Outpatient Management (COM) or DTM. DTM was comprised of usual care, including routine clinic visits every three months, as well as: Biometrics (a tablet, blood glucose meter, blood pressure monitor, and scale); Weekly Video Visits (facilitated in the patient's preferred language); and Educational Videos (including culturally congruent diabetes self-management education and quizzes). COM consisted of usual care including routine clinic visits every three months. For this study, COM patients received a glucometer, glucose test strips, and lancets. Establishing a therapeutic nurse-patient relationship was a fundamental component of our study for both groups. First contact (post-enrollment) centered on ensuring that patients and caregivers understood the program, building trust and rapport, creating a non-judgmental environment, determining language preference, and establishing scheduling availability (including evenings and weekends). DTM were provided with a tablet which allowed for self-paced education through videos and weekly video visits. The research team and Community Advisory Board identified appropriate educational video content, which was incorporated in diabetes educational topics. Video visits allowed us to assess patient involvement, motivation, and nonverbal communication. Communicating in Spanish, and awareness of diverse Hispanic/Latino backgrounds was critical, as using relevant and commonly-used terms can increase adherence and improve outcomes. Shared decision-making was encouraged to make realistic health care choices. Conclusion Key elements discussed above provide a framework for future dissemination of an evidence-based DTM intervention to meet the needs of underserved Hispanic/Latino people living with T2D.
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Affiliation(s)
- Sabrina Martinez
- Northwell Health System, Department of Medicine, Manhasset, NY, United States
| | - Christian N. Nouryan
- Northwell Health System, Department of Medicine, Manhasset, NY, United States
- Zucker School of Medicine at Hofstra Northwell, Department of Medicine, Hempstead, NY, United States
- Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Myia S. Williams
- Northwell Health System, Department of Medicine, Manhasset, NY, United States
- Zucker School of Medicine at Hofstra Northwell, Department of Medicine, Hempstead, NY, United States
| | - Vidhi H. Patel
- Northwell Health System, Department of Medicine, Manhasset, NY, United States
- Zucker School of Medicine at Hofstra Northwell, Department of Medicine, Hempstead, NY, United States
| | - Paulina Barbero
- Northwell Health System, Department of Medicine, Manhasset, NY, United States
| | | | - Jose Marino
- Northwell Health System, Department of Medicine, Manhasset, NY, United States
| | - Nicole Goris
- Northwell Health System, Department of Medicine, Manhasset, NY, United States
| | - Edgardo Cigaran
- Northwell Health System, Department of Medicine, Manhasset, NY, United States
| | - Dilcia Granville
- Nassau University Medical Center, Department of Medicine, Uniondale, NY, United States
| | - Lawrence F. Murray
- Nassau University Medical Center, Department of Medicine, Uniondale, NY, United States
| | - Yael T. Harris
- Northwell Health System, Department of Medicine, Manhasset, NY, United States
- Zucker School of Medicine at Hofstra Northwell, Department of Medicine, Hempstead, NY, United States
| | - Alyson Myers
- Northwell Health System, Department of Medicine, Manhasset, NY, United States
- Zucker School of Medicine at Hofstra Northwell, Department of Medicine, Hempstead, NY, United States
| | - Josephine Guzman
- Northwell Health System, Department of Medicine, Manhasset, NY, United States
| | - Amgad N. Makaryus
- Northwell Health System, Department of Medicine, Manhasset, NY, United States
- Zucker School of Medicine at Hofstra Northwell, Department of Medicine, Hempstead, NY, United States
- Nassau University Medical Center, Department of Medicine, Uniondale, NY, United States
| | - Samy I. McFarlane
- SUNY Downstate Health Sciences University, Department of Medicine, Brooklyn, NY, United States
| | - Roman Zeltser
- Northwell Health System, Department of Medicine, Manhasset, NY, United States
- Zucker School of Medicine at Hofstra Northwell, Department of Medicine, Hempstead, NY, United States
- Nassau University Medical Center, Department of Medicine, Uniondale, NY, United States
| | - Maria Pena
- Mount Sinai Hospital, Department of Medicine, NY, Rego Park, NY, United States
| | - Cristina Sison
- Northwell Health System, Department of Medicine, Manhasset, NY, United States
- Zucker School of Medicine at Hofstra Northwell, Department of Medicine, Hempstead, NY, United States
| | - Martin L. Lesser
- Northwell Health System, Department of Medicine, Manhasset, NY, United States
- Zucker School of Medicine at Hofstra Northwell, Department of Medicine, Hempstead, NY, United States
| | - Myriam Kline
- Northwell Health System, Department of Medicine, Manhasset, NY, United States
| | | | - Renee Pekmezaris
- Northwell Health System, Department of Medicine, Manhasset, NY, United States
- Zucker School of Medicine at Hofstra Northwell, Department of Medicine, Hempstead, NY, United States
- Feinstein Institutes for Medical Research, Manhasset, NY, United States
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Pekmezaris R, Cigaran E, Patel V, Clement D, Sardo Molmenti CL, Molmenti E. Randomized intervention to assess the effectiveness of an educational video on organ donation intent among Hispanics in the New York metropolitan area. World J Transplant 2023; 13:190-200. [PMID: 37388392 PMCID: PMC10303414 DOI: 10.5500/wjt.v13.i4.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/04/2023] [Accepted: 05/23/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND The Hispanic community has a high demand for organ donation but a shortage of donors. Studies investigating factors that could promote or hinder organ donation have examined emotional video interventions. Factors acting as barriers to organ donation registration have been classified as: (1) Bodily integrity; (2) medical mistrust; (3) “ick”-feelings of disgust towards organ donation; and (4) “jinx”-fear that registration may result in one dying due to premeditated plans. We predict that by providing necessary information and education about the donation process via a short video, individuals will be more willing to register as organ donors.
AIM To determine perceptions and attitudes regarding barriers and facilitators to organ donation intention among Hispanic residents in the New York metropolitan area.
METHODS This study was approved by the Institutional Review Board at Northwell Health. The approval reference number is No. 19-0009 (as presented in Supplementary material). Eligible participants included Hispanic New York City (NYC) residents, 18 years of age and above, who were recruited voluntarily through Cloud Research and participated in a larger randomized survey study of NYC residents. The survey an 85-item Redcap survey measured participant demographics, attitudes, and knowledge of organ donation as well as the intention to register as an organ donor. Attention checks were implemented throughout the survey, and responses were excluded for those who did fail. Participants were randomly assigned two-between subject conditions: To view a short video on organ donation and then proceed to complete the survey (i.e., video first) and view the same video at the end of the survey (video last). No intra-group activities were conducted. This study utilized an evidenced-based emotive educational intervention (video) which was previously utilized and was shown to increase organ donation registration rates at the Ohio Department of Motor Vehicles. Results were analyzed using Jamovi statistical software. Three hundred sixty-five Hispanic individuals were included in the analysis. Once consent was obtained and participants entered the survey (the survey sample is presented in Supplementary material), participants were asked to report on demographic variables and their general impression of organ donation after death. The video depicted stories regarding organ donation after death from various viewpoints, including from the loved ones of a deceased person who died waiting for a transplant; from the loved ones of a deceased person whose organs were donated upon death; and, from those who were currently waiting for a transplant.
RESULTS Using a binomial logistic regression, the analysis provides information about the relationship between the effects of an emotive video and the intention to donate among Hispanic participants who were not already registered as donors. The willingness to go back and register was found to be significantly more probable for those who watched the emotive video before being asked about their organ donation opinions (odds ratio: 2.05, 95% confidence interval: 1.06-3.97). Motivations for participation in organ donation were also captured with many stating the importance of messages coming from “people like me” and a message that highlights “the welfare of those in need”. Overall, the findings suggest that using an emotive video that addresses organ donation barriers to prompt organ donation intentions can be effective among the Hispanic populous. Future studies should explore using targeted messaging that resonates with specific cultural groups, highlighting the welfare of others.
CONCLUSION This study suggests that an emotive educational intervention is likely to be effective in improving organ donation registration intent among the Hispanic population residing in NYC.
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Affiliation(s)
- Renee Pekmezaris
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY 11030, United States
| | - Edgardo Cigaran
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY 11030, United States
| | - Vidhi Patel
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY 11030, United States
| | - Damian Clement
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY 11030, United States
| | | | - Ernesto Molmenti
- Department of Nephrology, Northwell Health/Zucker School of Medicine at Hosftra, Manhasset, NY 11030, United States
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Williams MS, Cigaran E, Martinez S, Marino J, Barbero P, Myers AK, DiClemente RJ, Goris N, Gomez VC, Granville D, Guzman J, Harris YT, Kline M, Lesser ML, Makaryus AN, Murray LM, McFarlane SI, Patel VH, Polo J, Zeltser R, Pekmezaris R. COVID-19 stressors for Hispanic/Latino patients living with type 2 diabetes: a qualitative study. Front Clin Diabetes Healthc 2023; 4:1070547. [PMID: 37187937 PMCID: PMC10175775 DOI: 10.3389/fcdhc.2023.1070547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 03/16/2023] [Indexed: 05/17/2023]
Abstract
Background and aim During the early stages of the COVID-19 pandemic, nationwide lockdowns caused disruption in the diets, physical activities, and lifestyles of patients with type 2 diabetes. Previous reports on the possible association between race/ethnicity, COVID-19, and mortality have shown that Hispanic/Latino patients with type 2 diabetes who are socioeconomically disadvantaged are disproportionately affected by this novel virus. The aim of this study was to explore stressors associated with changes in diabetes self-management behaviors. Our goal was to highlight the health disparities in these vulnerable racial/ethnic minority communities and underscore the need for effective interventions. Methods and participants Participants were enrolled in part of a larger randomized controlled trial to compare diabetes telehealth management (DTM) with comprehensive outpatient management (COM) in terms of critical patient-centered outcomes among Hispanic/Latino patients with type 2 diabetes. We conducted a thematic analysis using patient notes collected from two research nurses between March 2020 and March 2021. Two authors read through the transcripts independently to identify overarching themes. Once the themes had been identified, both authors convened to compare themes and ensure that similar themes were identified within the transcripts. Any discrepancies were discussed by the larger study team until a consensus was reached. Results Six themes emerged, each of which can be categorized as either a source or an outcome of stress. Sources of stress associated with the COVID-19 pandemic were (1) fear of contracting COVID-19, (2) disruptions from lockdowns, and (3) financial stressors (e.g., loss of income). Outcomes of COVID-19 stressors were (1) reduced diabetes management (e.g., reduced diabetes monitoring and physical activity), (2) suboptimal mental health outcomes (e.g., anxiety and depression), and (3) outcomes of financial stressors. Conclusion The findings indicated that underserved Hispanic/Latino patients with type 2 diabetes encountered a number of stressors that led to the deterioration of diabetes self-management behaviors during the pandemic.
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Affiliation(s)
- Myia S. Williams
- Department of Medicine, Division of Health Services Research, Northwell Health, Manhasset, NY, United States
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, United States
- *Correspondence: Myia S. Williams,
| | - Edgardo Cigaran
- Department of Medicine, Division of Health Services Research, Northwell Health, Manhasset, NY, United States
| | - Sabrina Martinez
- Department of Medicine, Division of Health Services Research, Northwell Health, Manhasset, NY, United States
| | - Jose Marino
- Department of Medicine, Division of Health Services Research, Northwell Health, Manhasset, NY, United States
| | | | - Alyson K. Myers
- Department of Medicine, Division of Endocrinology, Albert Einstein/Montefiore, Bronx, NY, United States
| | - Ralph J. DiClemente
- Department of Social and Behavioral Sciences, New York University (NYU) School of Global Public Health, New York, NY, United States
- Hispanic Counseling Center, Hempstead, NY, United States
| | - Nicole Goris
- Department of Medicine, Division of Health Services Research, Northwell Health, Manhasset, NY, United States
| | - Valeria Correa Gomez
- Department of Medicine, Division of Health Services Research, Northwell Health, Manhasset, NY, United States
| | - Dilcia Granville
- Department of Social and Behavioral Sciences, New York University (NYU) School of Global Public Health, New York, NY, United States
- Hispanic Counseling Center, Hempstead, NY, United States
| | | | - Yael T. Harris
- Department of Medicine, Division of Endocrinology, North Shore University Hospital, Manhasset, NY, United States
| | - Myriam Kline
- Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Martin L. Lesser
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Amgad N. Makaryus
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY, United States
| | - Lawrence M. Murray
- Annie E. Casey Foundation Children and Family Fellowship, Baltimore, MD, United States
| | - Samy I. McFarlane
- Division of Infectious Disease, College of Medicine, SUNY-Downstate Health Sciences University, Brooklyn, NY, United States
| | - Vidhi H. Patel
- Department of Medicine, Division of Health Services Research, Northwell Health, Manhasset, NY, United States
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Jennifer Polo
- Department of Medicine, Division of Health Services Research, Northwell Health, Manhasset, NY, United States
| | - Roman Zeltser
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY, United States
| | - Renee Pekmezaris
- Department of Medicine, Division of Health Services Research, Northwell Health, Manhasset, NY, United States
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, United States
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