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Haeme R, Felzien M, Kelly K, Lowe S, Martinez-Guijosa A, Mason K, Kaplan D, LeMaster J, Westfall JM, Pavilanis A, Templeton A, Haddad L, Ramsden VR. PaCE Builds on the Tradition of Responsible Research Within NAPCRG. Ann Fam Med 2023; 21:562-563. [PMID: 38012029 PMCID: PMC10681689 DOI: 10.1370/afm.3063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
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MacFarlane A, LeMaster J. Disrupting patterns of exclusion in participatory spaces: Involving people from vulnerable populations. Health Expect 2022; 25:2031-2033. [PMID: 35983897 DOI: 10.1111/hex.13578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Anne MacFarlane
- Public and Patient Involvement Reserach Unit, School of Medicine & Health Research Institute, University of Limerick, Limerick, Ireland
| | - Joseph LeMaster
- Department of Family Medicine and Community Health, University of Kansas School of Medicine, Kansas City, Kansas, USA
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Kahler L, LeMaster J. Understanding Medication Adherence in Patients with Limited English Proficiency. Kans J Med 2022; 15:31-36. [PMID: 35106121 PMCID: PMC8765509 DOI: 10.17161/kjm.vol15.15912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/12/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction. Approximately 41.6% of the US population who speak a language other than English (20% over all) and have limited English proficiency (LEP) status.1 Health outcomes for patients with LEP status or who are language discordant (speak a different language than their clinicians) have been studied in several settings, including the hospital and outpatient, with results widely demonstrating that these patients have worse outcomes when a professional interpreter is not used consistently. 2,3 The aim of this study was to investigate the impact of preferred language and language discordance on medication adherence.
Methods. Data were collected via review of pharmacy-acquired medication profiles for three primary language cohorts: Nepali, Spanish, and English. Total Days of Adherence, Adherence Ratio, and Maximum Days Non-adherent were calculated and compared between language groups. We examined these statistics for regular and long-acting insulin, metformin and ACE inhibitors, testing for differences between language groups and those who experienced greater vs less than the median value for language concordant clinical encounters.
Results. The most adherent group over all (highest adherence-ratio) were the Nepali-speaking, but the results showed high variability across outcomes and medications.
Conclusions. After adjustment and stratification for greater vs lesser language concordant patient visit experience, we found that language-spoken plays an important role in the clinical encounter, and that LEP patients could have improved outcomes in their adherence to medications by having providers who speak their language or use an interpreter.
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Affiliation(s)
- Luke Kahler
- Department of Family Medicine and Community Health, University of Kansas School of Medicine, Kansas City, KS
| | - Joseph LeMaster
- Department of Family Medicine and Community Health, University of Kansas School of Medicine, Kansas City, KS
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Alothman S, Alenazi AM, Alshehri MM, LeMaster J, Thyfault J, Rucker J, Kluding PM. Sedentary Behavior Counseling Intervention in Aging People With Type 2 Diabetes: A Feasibility Study. Clin Med Insights Endocrinol Diabetes 2021; 14:11795514211040540. [PMID: 34776731 PMCID: PMC8580491 DOI: 10.1177/11795514211040540] [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] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/23/2021] [Indexed: 11/26/2022]
Abstract
This study examined the feasibility and effect of sedentary behavior (SB) counseling on total sitting time (TST) and glycemic control in people with type 2 diabetes (T2D). Community-dwelling sedentary adults with T2D (n = 10; 8 women; age 65.6 ± 7.31) completed SB counseling (motivational interviewing-informed education about SB) aided by an activity monitor with a vibrotactile feature (activPAL3TM). The monitor was worn for 7 days, on weeks 1 and 13 (without the vibrotactile feature) and during weeks 5 and 9 (with the vibrotactile feature). Intervention feasibility was determined by study retention rates and activity monitor tolerability, and differences between pre- and post-intervention average daily TST. Paired t-test were performed. The effect size (ES) was calculated using Cohen d. All participants attended all study sessions with only 20% reporting moderate issues tolerating the activity monitor. TST time decreased from 11.8 hours ± 1.76 at baseline to 10.29 hours ± 1.84 at 3 months’ assessment (P < .05) with a large ES (Cohen d = .88). HbA1c was decreased by 0.51% (P < .05) at the end of the intervention. This study found that the intervention was feasible for sedentary adults with type 2 diabetes.
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Affiliation(s)
- Shaima Alothman
- Lifestyle and Health Research Center, Health Science Research Center, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia.,Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Aqeel M Alenazi
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | | | - Joseph LeMaster
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - John Thyfault
- Department of Molecular & Integrative Physiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jason Rucker
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Patricia M Kluding
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA
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Affiliation(s)
- Mary Chambers
- Faculty of Health, Social Care and Education, Kingston and St George's University of London, Cranmer Terrace, London, SW17 ORE, UK
| | - Joseph LeMaster
- Research Division, Department of Family Medicine, School of Medicine, University of Kansas, Kansas City, KS, 66160, USA
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Abstract
Abstract
Background
Migration has become one of the most politically pressing issues of the 21st century. Still, migrant health remains an under-researched area in global health. Participatory Health Research (PHR) can potentially contribute to a paradigm shift, from a pathogenic deficit model that sees migrants as passively affected by policies to their re-conceptualization as creative, inspiring, and actively engaged citizens in search of solutions. However, PHR is not a panacea and there are specific challenges in enacting meaningful and impactful projects in this field.
Methods
This literature review examines the opportunities and challenges posed by the use of this approach in migrant health research. We highlight critical issues for consideration and provide some examples of successful PHR with migrants.
Results
A number of successful initiatives illustrate the value of engaging migrants in the definition of the research agenda, the design and implementation of health interventions, the identification of health protective factors, and the operationalization and validation of indicators to monitor progress in this field. Still, within fragmented community landscapes that are not necessarily constructed along ethnicity traits, and real-world contexts that are far from the ideals of justice and equality, inadequate structures of representation and power dynamics can hamper a meaningful implementation of PHR with migrants.
Conclusions
For each particular research context it is essential to reflect on what is the “optimal” level and type of participation that is more likely to leverage migrants' empowerment so we can better advocate for our voices to be heard, and our rights to be addressed.
Key messages
Participatory Health research can potentially contribute to address migrant health challenges. The level and type of participation must be tailored to each research context.
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Affiliation(s)
- M Roura
- School of Public Health, University College Cork, Cork, Ireland
- International Collaboration for Participatory Health Research, Berlin, Germany
| | - S Dias
- Public Health Research Center, NOVA National School of Public Health, Universidade NOVA, Lisbon, Portugal
- International Collaboration for Participatory Health Research, Berlin, Germany
| | - J LeMaster
- Kansas University Medical School, The University of Kansas Medical Center, Kansas City, USA
- International Collaboration for Participatory Health Research, Berlin, Germany
| | - A MacFarlane
- GEMS, University of Limerick, Limerick, Ireland
- International Collaboration for Participatory Health Research, Berlin, Germany
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Hannigan A, Villarroel N, Roura M, LeMaster J, Basogomba A, Bradley C, MacFarlane A. Ethnicity recording in health and social care data collections in Ireland: where and how is it measured and what is it used for? Int J Equity Health 2019; 19:2. [PMID: 31892328 PMCID: PMC6938635 DOI: 10.1186/s12939-019-1107-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 12/09/2019] [Indexed: 12/25/2022] Open
Abstract
Background In the European Union (EU), discrimination based on racial and ethnic origin is prohibited under the Racial Equality Directive. Ireland is one of only three EU countries where a legal duty of equality data collection is placed on public bodies. It provides an important context in which to study ethnic equality monitoring; however no systematic mapping of where it occurs in health information systems has been carried out. The aim of this study is to identify all existing national health and social care data collections with information on ethnicity and to explore how this data has been collected and used. Methods An electronic search of a national catalogue of health and social care data collections (N = 97) was carried out to identify any collections which contained information on ethnicity. Data dictionaries were searched and key informants contacted. For each of the data collections that collected information on ethnicity, data was extracted on the ethnic categories used and how this data is collected; the completeness of ethnicity recording; and other measures related to ethnicity in the data collection. Relevant outputs for these data collections, related to ethnicity, were identified through key informants and electronic searches. Results Of the 97 data collections, 14 (14%) collected information on ethnic or cultural background. Country of birth was collected by 10 of these 14 data collections. Most used the ethnic categories in the Census and recommended that ethnicity should be self-identified and not assigned. Reported rates of identification were generally high (≥90%). Data collections which recorded ethnicity tended to be focused on potentially high-risk populations with no routine recording in primary care. There were some examples of where ethnic equality monitoring had informed targeted interventions e.g. vaccination awareness initiatives or cultural training for healthcare staff. Conclusions Despite strong policy and legal imperatives, there is limited data collection of ethnicity in health and social care data collections in Ireland. While there are some examples of where differences by ethnicity have been identified and acted upon, a more coordinated and comprehensive approach to the collection, quality and utilization of ethnicity data is needed to promote health equity.
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Affiliation(s)
- Ailish Hannigan
- Public and Patient Involvement Research Unit, Graduate Entry Medical School, University of Limerick, Limerick, V94 T9PX, Ireland. .,Health Research Institute, University of Limerick, Limerick, Ireland.
| | - Nazmy Villarroel
- Public and Patient Involvement Research Unit, Graduate Entry Medical School, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Maria Roura
- Public and Patient Involvement Research Unit, Graduate Entry Medical School, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Joseph LeMaster
- Department of Family Medicine and Community Health, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Alphonse Basogomba
- Intercultural and Diversity Education Centre - Ireland (IDEC-Ireland), Ennis, Co. Clare, Ireland
| | | | - Anne MacFarlane
- Public and Patient Involvement Research Unit, Graduate Entry Medical School, University of Limerick, Limerick, V94 T9PX, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
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Hannigan A, Basogomba A, LeMaster J, Nurse D, O’Reilly F, Roura M, Villarroel N, MacFarlane A. Ethnic Minority Health in Ireland-Co-creating knowledge (EMH-IC): a participatory health research protocol. BMJ Open 2018; 8:e026335. [PMID: 30385450 PMCID: PMC6252715 DOI: 10.1136/bmjopen-2018-026335] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION International policy recommends continuous, cost-effective monitoring of health data to enable health services to identify and respond to health inequities as experienced by different ethnic groups. However, there is a lack of routinely collected ethnicity data, particularly in primary care, and very little implementation research internationally to understand how ethnic identifiers are introduced, embedded and used in healthcare settings. This paper describes a protocol for a novel participatory health research project with the objective of building the evidence base on ethnic minority health in Ireland. Findings on the participatory appraisal of ethnic identifiers as an intervention to generate useful data about minority and majority ethnic groups will have relevance in other settings and countries. METHODS AND ANALYSIS This multidisciplinary project is designed as a participatory health research study where all stakeholders, including ethnic minority communities, participate in co-design of the research protocol, project governance, collaborative data interpretation and disseminating findings. A national catalogue of all routinely collected health data repositories will be electronically searched for any repositories that contain information on ethnicity. A secondary quantitative analysis of a population-representative cohort study, Growing Up in Ireland, will be carried out to compare the health of ethnic minority and majority groups. A qualitative case study informed by normalisation process theory will be carried out at three primary care sites to monitor the implementation of an ethnic identifier and identify barriers and levers to implementation. ETHICS AND DISSEMINATION Ethical approval for the qualitative case study has been granted by the Irish Council for General Practitioners (06/09/17). Permission to access data from Growing Up in Ireland has been granted by the Director General of the Central Statistics Office. Dissemination will be carried out at community events and academic conferences, in peer-reviewed journal publications, and through academic and healthcare provider networks.
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Affiliation(s)
- Ailish Hannigan
- Public and Patient Involvement Research Unit, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Alphonse Basogomba
- Intercultural and Diversity Education Centre - Ireland (IDEC-Ireland), Ennis, Ireland
| | - Joseph LeMaster
- Department of Family Medicine, University of Kansas School of Medicine, Kansas City, USA
| | - Diane Nurse
- National Office for Social Inclusion, Health Service Executive, Dublin, Ireland
| | | | - Maria Roura
- Public and Patient Involvement Research Unit, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Nazmy Villarroel
- Public and Patient Involvement Research Unit, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Anne MacFarlane
- Public and Patient Involvement Research Unit, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
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Villarroel-Williams N, MacFarlane A, Roura M, Nurse D, LeMaster J, Basogomba A, Adshead M, Hannigan A. 3.11-P2A mapping of ethnicity recording in routinely collected health and social care data in Ireland. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky048.124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - A MacFarlane
- Graduate Entry Medical School (GEMS), University of Limerick, Ireland
| | - M Roura
- Graduate Entry Medical School (GEMS), University of Limerick, Ireland
| | - D Nurse
- Social Inclusion, Health Service Executive, Ireland
| | - J LeMaster
- University of Kansas Medical Centre, United States
| | - A Basogomba
- Intercultural and Diversity Education Centre (IDEC-Ireland), Ireland
| | - M Adshead
- Graduate Entry Medical School (GEMS), University of Limerick, Ireland
| | - A Hannigan
- Graduate Entry Medical School (GEMS), University of Limerick, Ireland
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Roura M, Bradley C, Hannigan A, Basogomba A, Adshead M, LeMaster J, Villarroel N, Romer A, Papyan A, McCarthy S, Nurse D, MacFarlane A. 2.3-O3Unveiling participation of ethnic minorities and other stakeholders in heath research decision-making in Ireland. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky047.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Roura
- University of Limerick, Ireland
| | - C Bradley
- Shannon Family Resource Centre, Dublin, Ireland
| | | | - A Basogomba
- Intercultural and Diversity Education Centre, Dublin, Ireland
| | | | - J LeMaster
- Kansas University Medical Centre, United States
| | | | - A Romer
- Shannon Family Resource Centre, Dublin, Ireland
| | - A Papyan
- Shannon Family Resource Centre, Dublin, Ireland
| | - S McCarthy
- Shannon Family Resource Centre, Dublin, Ireland
| | - D Nurse
- Health Service Executive, Dublin, Ireland
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Alothman S, Alenazi A, Waitman LR, LeMaster J, Kluding P. Neuropathy and Other Risk Factors for Lower Extremity Amputation in People with Diabetes Using a Clinical Data Repository System. J Allied Health 2018; 47:217-221. [PMID: 30194829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 09/25/2017] [Indexed: 06/08/2023]
Abstract
AIMS The purpose of the study was to identify the frequency of a prior diagnosis of neuropathy, peripheral vascular disease (PVD), and foot ulceration in patients with diabetes who subsequently underwent lower extremity amputation (LEA). METHODS We performed a retrospective electronic review of de-identified charts from a tertiary medical health center of patients who had the diagnosis codes of diabetes and the procedure codes of LEA. For this query, neuropathy, PVD, and foot ulcer diagnosis codes were selected as the variables of interest. The timeline of events was defined as the first-ever diagnosis of diabetes, followed by the first-ever diagnosis of any of the risk factors, followed by the first-ever procedure of LEA. The frequency of each risk factor was counted individually and the different combinations of risk factors were calculated. RESULTS The search yielded 844 patients who had a diabetes diagnosis prior to LEA. We found that 669 (79.3%) of the patients had one or more of the risk factors before LEA. From the 844 patients, 414 (49.1%) had neuropathy, 402 (47.6%) had a foot ulcer, and 495 (58%) had a PVD diagnosis. Investigating the frequency of patients who have multiple risk factors, we found that 28.9% had two risk factors and 23.6% had three risk factors. CONCLUSIONS The majority of LEA procedures were done for patients with at least one diabetic LEA risk factor. Our findings provide recent quantitative support of known risk factors' association with amputation, and the presence of risk factors war¬rants escalation in prevention strategies.
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Affiliation(s)
- Shaima Alothman
- Dep. of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, 3901 Rainbow Blvd., MS 2002, Kansas City, KS 66160, USA. Tel 913-945-6630.
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Daley CM, Hale JW, Berryhill K, Bointy S, Clark L, Chase B, LeMaster J, He J. Diabetes Self-Management Behaviors among American Indians in the Midwestern United States. ACTA ACUST UNITED AC 2017; 3:34-41. [PMID: 30637353 PMCID: PMC6329453 DOI: 10.20431/2455-5983.0301005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to understand if American Indian adults with diabetes in the Midwest are similar to American Indian adults nationally in their self-management behaviors. This cross-sectional survey was conducted from May 2009 to April 2010 at powwows, health fairs, and other community events. The convenience sample self-selected into the study and answered questions via touch screen computer about diabetes self-management. Participants were significantly below the national average for American Indians in their adherence to self-management recommendations in daily foot checks (p=0.0035) and having had a dilated eye exam in the previous year (p=0.0002), despite being significantly more likely to have taken a diabetes self-management class (p<0.0001). They were similar to the national average for daily glucose checks and having had one or more hemoglobin A1C tests in the previous year. Participants were less likely to eat 5 or more servings of fruits or vegetables per day (p=0.0001), but more likely to achieve 150 minutes or more of physical activity per week (p=0.0001). Programs addressing self-care issues should be developed to help improve the self-management habits of American Indian adults with diabetes, with particular attention to activities outside of monitoring blood glucose and hemoglobin A1C levels.
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Affiliation(s)
- Christine M Daley
- Professor of Family Medicine and Preventive Medicine & Public Health Director, Center for American Indian Community Health, USA
| | - Jason W Hale
- Research Instructor of Family Medicine, Assistant Director, Center for American Indian Community Health, USA
| | - Kelly Berryhill
- Research Associate, Center for American Indian Community Health, USA
| | - Shelley Bointy
- Project Director, Center for American Indian Community Health, USA
| | - Lauren Clark
- Graduate Research Associate, Department of Biostatistics Member, Center for American Indian Community Health, USA
| | - Brian Chase
- Graduate Research Associate, Department of Biostatistics Member, Center for American Indian Community Health, USA
| | - Joseph LeMaster
- Associate Professor of Family Medicine Member, Center for American Indian Community Health, USA
| | - Jianghua He
- Associate Professor of Biostatistics Member, Center for American Indian Community Health, USA
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Ramsden VR, Salsberg J, Herbert CP, Westfall JM, LeMaster J, Macaulay AC. Patient- and community-oriented research: How is authentic engagement identified in grant applications? Can Fam Physician 2017; 63:74-76. [PMID: 28115445 PMCID: PMC5257224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Vivian R Ramsden
- Professor and Director of the Research Division in the Department of Academic Family Medicine at the University of Saskatchewan in Saskatoon
| | - Jon Salsberg
- Associated with Participatory Research at McGill University in Montreal, Que, and is Associate Director of Family Medicine at McGill University
| | - Carol P Herbert
- Professor Emerita at the University of Western Ontario in London
| | - John M Westfall
- Professor of Family Medicine at the University of Colorado in Aurora
| | - Joseph LeMaster
- Associate Professor of Family Medicine at the University of Kansas in Kansas City
| | - Ann C Macaulay
- Founding Director of Participatory Research at McGill and Professor of Family Medicine at McGill University
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Greiner KA, Daley CM, Epp A, James A, Yeh HW, Geana M, Born W, Engelman KK, Shellhorn J, Hester CM, LeMaster J, Buckles DC, Ellerbeck EF. Implementation intentions and colorectal screening: a randomized trial in safety-net clinics. Am J Prev Med 2014; 47:703-14. [PMID: 25455115 PMCID: PMC4311575 DOI: 10.1016/j.amepre.2014.08.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 07/08/2014] [Accepted: 08/05/2014] [Indexed: 02/06/2023]
Abstract
CONTEXT Low-income and racial/ethnic minority populations experience disproportionate colorectal cancer (CRC) burden and poorer survival. Novel behavioral strategies are needed to improve screening rates in these groups. BACKGROUND The study aimed to test a theoretically based "implementation intentions" intervention for improving CRC screening among unscreened adults in urban safety-net clinics. DESIGN Randomized controlled trial. SETTING/PARTICIPANTS Adults (N=470) aged ≥50 years, due for CRC screening, from urban safety-net clinics were recruited. INTERVENTION The intervention (conducted in 2009-2011) was delivered via touchscreen computers that tailored informational messages to decisional stage and screening barriers. The computer then randomized participants to generic health information on diet and exercise (Comparison group) or "implementation intentions" questions and planning (Experimental group) specific to the CRC screening test chosen (fecal immunochemical test or colonoscopy). MAIN OUTCOME MEASURES The primary study outcome was completion of CRC screening at 26 weeks based on test reports (analysis conducted in 2012-2013). RESULTS The study population had a mean age of 57 years and was 42% non-Hispanic African American, 28% non-Hispanic white, and 27% Hispanic. Those receiving the implementation intentions-based intervention had higher odds (AOR=1.83, 95% CI=1.23, 2.73) of completing CRC screening than the Comparison group. Those with higher self-efficacy for screening (AOR=1.57, 95% CI=1.03, 2.39), history of asthma (AOR=2.20, 95% CI=1.26, 3.84), no history of diabetes (AOR=1.86, 95% CI=1.21, 2.86), and reporting they had never heard that "cutting on cancer" makes it spread (AOR=1.78, 95% CI=1.16, 2.72) were more likely to complete CRC screening. CONCLUSIONS The results of this study suggest that programs incorporating an implementation intentions approach can contribute to successful completion of CRC screening even among very low-income and diverse primary care populations. Future initiatives to reduce CRC incidence and mortality disparities may be able to employ implementation intentions in large-scale efforts to encourage screening and prevention behaviors.
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Affiliation(s)
- K Allen Greiner
- Department of Family Medicine; University of Kansas Cancer Center.
| | - Christine M Daley
- Department of Family Medicine; Center for American Indian Community Health; Department of Preventive Medicine; University of Kansas Cancer Center
| | | | - Aimee James
- Siteman Cancer Center, Washington University, St. Louis, Missouri
| | - Hung-Wen Yeh
- Department of Biostatistics; University of Kansas Cancer Center
| | - Mugur Geana
- Department of Family Medicine; University of Kansas Cancer Center; Center of Excellence for Health Communications to Underserved Populations, William Allen White School of Journalism and Mass Communications
| | | | | | - Jeremy Shellhorn
- School of Architecture Design and Planning, University of Kansas, Kansas City, Kansas
| | | | | | - Daniel C Buckles
- Department of Internal Medicine, University of Kansas Medical Center
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Vetter-Smith M, LeMaster J, Olsberg J, Kruse R, Day T, Mehr D. Providing Diabetes Self-Management Support in Rural Primary Care Clinics With Nurse Partners. West J Nurs Res 2012; 34:1023-42. [DOI: 10.1177/0193945911436106] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study examined the roles and effectiveness of nurse partner–provided diabetes self-management (DSM) support in five rural primary care clinics. There were two to nine providers and one nurse partner in each clinic; nurses were licensed practical nurses (LPNs) in all but one clinic. Interviews with providers and observations of patient interactions assessed nurse roles, clinic processes, and communication patterns. Using immersion-crystallization methods, three major themes explained nurse partner role variation: “gatekeeper” role of providers, compression of time and space within clinic work flow, and nurses’ educational background and experience. While nurses’ education and experience were important, clinics where providers facilitated nurse participation in DSM support through focused communication and commitment of time and space most effectively integrated DSM support into their practice. Some quantitative measures improved; notably glycated hemoglobin level and patients’ frequency of blood glucose measurement. Study findings provide guidance on using nurses in primary care clinics to provide DSM.
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Abstract
PURPOSE Diabetes self-management is essential for diabetes control, yet little is known about patient preferences for sources of health information or about the extent to which information is sought directly or received passively through various media sources. The aim of this qualitative study was to identify how individuals with diabetes seek and use health care information. METHODS Using a health information model to guide our research, we conducted 9 focus groups with 46 adults with a diagnosis of diabetes and then analyzed the transcripts and notes from these focus groups. RESULTS Five themes emerged: (1) passive receipt of health information about diabetes is an important aspect of health information behavior; (2) patients weave their own information web depending on their disease trajectory; (3) patients' personal relationships help them understand and use this information; (4) a relationship with a health care professional is needed to cope with complicated and sometimes conflicting information; and (5) health literacy makes a difference in patients' ability to understand and use information. CONCLUSIONS Patients make decisions about diabetes self-management depending on their current needs, seeking and incorporating diverse information sources not traditionally viewed as providing health information. Based on our findings, we have developed a new health information model that reflects both the nonlinear nature of health information-seeking behavior and the interplay of both active information seeking and passive receipt of information.
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Affiliation(s)
- Daniel R Longo
- Department of Family Medicine, Virginia Commonwealth University School of Medicine, West Hospital, Richmond, Virginia 23298-0251, USA.
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Abstract
OBJECTIVE Many persons with HIV do not receive needed behavioral health services. This study examined the impact of medical clinic characteristics on access to mental health and substance abuse care for persons with HIV. METHODS This was a longitudinal survey of patients and clinic directors participating in the HIV Cost and Services Utilization Study, a national probability sample of persons in care for HIV between 1996 and 1998 (N=2,031). Primary outcomes were receipt of outpatient mental health specialist care, outpatient substance abuse care, and abstinence from substance use in the past 30 days. RESULTS After adjustment for patient characteristics, the likelihood of care by a mental health specialist was higher for patients in HIV specialty clinics (odds ratio [OR]=2.1, 95% confidence interval [CI]=1.2-3.5) and clinics with a combination of on-site case management and affiliated mental health care (OR=2.3, CI 1.3-4.4, for off-site affiliated care; OR=2.1, CI=1.2-3.7, for on-site care). Outpatient substance abuse care also was more likely for patients in clinics with on-site case management and affiliated substance abuse care (OR=4.3, CI=1.5-12.2, for off-site affiliated care; OR=3.2, CI=1.3-8.0, for on-site care). In a subgroup of persons reporting active substance use, care in clinics with on-site case management predicted 30-day abstinence from substances at follow-up (OR=1.7, CI=1.1-2.5). CONCLUSIONS The organizational structure of medical clinics can have an important effect on use of mental health and substance abuse specialist care.
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Affiliation(s)
- Michael E Ohl
- Department of Internal Medicine, University of Missouri--Columbia, Missouri, USA.
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18
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Kapp JM, Boren SA, Yun S, LeMaster J. Diabetes and tooth loss in a national sample of dentate adults reporting annual dental visits. Prev Chronic Dis 2007; 4:A59. [PMID: 17572963 PMCID: PMC1955413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Periodontal disease has been associated with tooth loss and reported as more prevalent among people with diabetes than among those without diabetes. Having an annual dental examination is a national goal of Healthy People 2010. Our objective was to examine whether an association exists between diabetes and tooth loss among a population reporting an annual dental visit. METHODS We used data from the 2004 Behavioral Risk Factor Surveillance System to examine the association between self-reported diabetes and tooth removal due to decay or periodontal disease among 155,280 respondents reporting a dental visit within the past year. We calculated prevalence estimates, odds ratios, and 95% confidence intervals. Multiple logistic regression allowed for adjustment. RESULTS The overall prevalence of tooth removal among the people in the study was 38.3%. People with diabetes had a significantly higher prevalence of tooth removal. In a multivariable model adjusting for selected covariates, respondents with diabetes were 1.46 times as likely (95% CI, 1.30-1.64) to have at least one tooth removed than respondents without diabetes. A stronger association between diabetes and tooth loss was observed among people in the younger age groups than among those in the older age groups. CONCLUSION Even among people reporting a recent dental visit, diabetes was independently associated with tooth loss. Multidisciplinary efforts are needed to raise awareness of the risk of tooth loss among younger people with diabetes. Good oral hygiene as well as annual dental examinations are important for preventing tooth loss.
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Affiliation(s)
- Julie M Kapp
- Department of Health Management and Informatics, University of Missouri-Columbia, Columbia, MO 65211-3737, USA.
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19
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Smith DG, Assal M, Reiber GE, Vath C, LeMaster J, Wallace C. Minor environmental trauma and lower extremity amputation in high-risk patients with diabetes: incidence, pivotal events, etiology, and amputation level in a prospectively followed cohort. Foot Ankle Int 2003; 24:690-5. [PMID: 14524519 DOI: 10.1177/107110070302400907] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This study determined the incidence, pivotal events, etiology, and levels of amputation in a prospectively followed cohort of 400 people with diabetes and a prior healed foot ulcer who participated in a randomized footwear trial. Participants were seen every 17 weeks for 2 years. Subjects with foot lesions were referred to their healthcare provider for treatment. In this cohort, 11 participants required lower limb amputation (rate 13.8 per 1000 person-years). Pivotal event analysis revealed that only one amputation was related to footwear, six amputations were due to non-footwear-related minor environmental trauma, two were due to progression of vascular disease (dry gangrene from critical ischemia), one was due to a self-care injury while cutting the toenails, and one was due to a decubitus ulcer. Previously proposed strategies to reduce the amputation rates in individuals with diabetes have focused heavily on footwear and education. However, even with this emphasis, amputation rates in the United States are still high. This study suggests that the prevention of minor environmental trauma, including household accidents, merits additional attention. We believe that further efforts to reduce amputation rates for individuals with diabetes will need to emphasize the prevention of minor trauma, especially in those already compromised with neuropathy and vascular disease.
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Affiliation(s)
- Douglas G Smith
- Department of Orthopaedic Surgery, University of Washington, Seattle, WA, USA.
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20
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Wallace C, Reiber GE, LeMaster J, Smith DG, Sullivan K, Hayes S, Vath C. Incidence of falls, risk factors for falls, and fall-related fractures in individuals with diabetes and a prior foot ulcer. Diabetes Care 2002; 25:1983-6. [PMID: 12401743 DOI: 10.2337/diacare.25.11.1983] [Citation(s) in RCA: 158] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To describe the incidence of falls, risk factors for falls, and the frequency of fall-related fractures in a cohort of individuals with diabetes and a prior foot ulcer. RESEARCH DESIGN AND METHODS A total of 400 individuals with diabetes and a prior foot ulcer were recruited from two western Washington State health care organizations and followed prospectively for 2 years. Diabetes, demographic, and health information was collected at baseline, 1 year, and 2 years. Data on falls were collected at baseline, 4 weeks, and every 17 weeks thereafter. Medical records were abstracted to confirm fall-related morbidity. RESULTS The average age of the study population was 62 years, with 77% male and 23% female. Approximately 32% had fixed foot deformities, 58% had insensate feet, and 76% had comorbid conditions. Of the participants, 252 (64%) reported at least one fall during the 2-year study period. The overall incidence of falls in this cohort was 1.25 falls/person-year (95% CI 1.17-1.33). For the 164 participants (41%) who reported two or more falls, a BMI >/=30 kg/m(2), the presence of one or more comorbid conditions, and insensate feet increased the risk. Two or more falls of any type were associated with a higher fracture risk. Although women were not at significantly greater risk for falls than men, their fracture incidence was 3.6 times higher. CONCLUSIONS Falls are very common in individuals with diabetes and prior foot ulcers. A small percentage of falls resulted in fractures. The risk of a fall-related fracture was significantly higher in women than in men. Increased attention to falls and fall prevention is indicated for diabetes care providers.
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Affiliation(s)
- Carolyn Wallace
- Health Services and Rehabilitation Research and Development, VA Puget Sound Health Care System, Department of Veterans Affairs, Seattle, Washington 98108, USA.
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21
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Reiber GE, Smith DG, Wallace C, Sullivan K, Hayes S, Vath C, Maciejewski ML, Yu O, Heagerty PJ, LeMaster J. Effect of therapeutic footwear on foot reulceration in patients with diabetes: a randomized controlled trial. JAMA 2002; 287:2552-8. [PMID: 12020336 DOI: 10.1001/jama.287.19.2552] [Citation(s) in RCA: 168] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Many people with diabetes experience lower-limb ulcers. Footwear has been implicated as a primary cause of foot ulcers, yet research is limited on the efficacy of shoe and insert combinations to prevent reulceration. OBJECTIVE To determine whether extra-depth and -width therapeutic shoes used with 2 types of inserts reduce reulceration in diabetic individuals with a history of foot ulcer. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial of 400 diabetes patients with history of foot ulcer in 2 Washington State health care organizations who did not require custom shoes for foot deformity and were enrolled between August 1997 and December 1998 and followed up for 2 years. Data collected at regular intervals documented physical, foot, and diabetes characteristics; footwear use; foot lesions; and ulcers. INTERVENTIONS Participants were randomly assigned to receive 3 pairs of therapeutic shoes and 3 pairs of customized medium-density cork inserts with a neoprene closed-cell cover (n = 121); to receive 3 pairs of therapeutic shoes and 3 pairs of prefabricated, tapered polyurethane inserts with a brushed nylon cover (n = 119); or to wear their usual footwear (controls; n = 160). MAIN OUTCOME MEASURE Foot reulceration, compared among the 3 groups. RESULTS Two-year cumulative reulceration incidence across the 3 groups was low: 15% in the cork-insert group, 14% in the prefabricated-insert group, and 17% in controls. In the intent-to-treat analysis, patients assigned to therapeutic shoes did not have a significantly lower risk of reulceration compared with controls (risk ratio [RR] for the cork-insert group, 0.88; 95% confidence interval [CI], 0.51-1.52 and RR the for prefabricated-insert group, 0.85; 95% CI, 0.48-1.48). All ulcer episodes in patients assigned to therapeutic shoes and 88% wearing nonstudy shoes occurred in patients with foot insensitivity. CONCLUSIONS This study of persons without severe foot deformity does not provide evidence to support widespread dispensing of therapeutic shoes and inserts to diabetic patients with a history of foot ulcer. Study shoes and custom cork or preformed polyurethane inserts conferred no significant ulcer reduction compared with control footwear. This study suggests that careful attention to foot care by health care professionals may be more important than therapeutic footwear but does not negate the possibility that special footwear is beneficial in persons with diabetes who do not receive such close attention to foot care by their health care providers or in individuals with severe foot deformities.
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Affiliation(s)
- Gayle E Reiber
- VA Puget Sound Health Care System (152), 1660 S Columbian Way, Seattle, WA 98108, USA.
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