Introduction: Latinas are among the groups most affected by diabetes health disparities, yet they often benefit less from diabetes interventions even when these are culturally adapted. The purpose of this qualitative study was to explore readiness of Latinas enrolled in a diabetes prevention program to adopt recommended preventive behaviors, and to identify factors associated with the adoption and maintenance of these recommended lifestyle changes. Insights gained will be used to inform future efforts at reducing diabetes disparities and the burden of chronic diseases among Latinas. Methods: Nine focus group discussions (FGDs) and 3 key informant interviews (KIIs) were conducted after the completion of a culturally adapted diabetes prevention program led by Latino community health workers. A grounded theory approach by Charmaz informed by the transtheoretical model guided the questions. Discussions and interviews were audio-taped with participants’ permission, transcribed, coded, and themed. Results: Forty low-income Latinas contributed to FGDs and KIIs. Baseline readiness to engage in new behaviors varied. Negative personal and family health events and physician referral impacted most readiness to enroll and to adopt preventive behaviors. Built environment, financial constraints, and threat of social alienation constituted major barriers to behavior adoption and maintenance, while physician involvement, awareness of diabetes complications, and social support partially mitigated these impediments. Conclusions: Our results suggest that timing of enrollment, physician-patient dynamics, and the emotional personal/family cost of behavior modification should all be considered when planning diabetes prevention programs for low-income Latinas. Besides appropriately timing referrals to accessible culturally informed prevention programs, health educators and health care providers should be aware of the potentially negative impact of behavior modification on family dynamics and be prepared to address resulting repercussions. Future research on Latinas should also include and report data on physician involvement, family context, and social determinants of health for more consistent program comparisons.

Background Despite nationwide efforts to address the diabetes epidemic and reduce prevalence disparities, higher rates persist among the poor, especially those with limited literacy. Currently, individuals with abnormal glycemia who have pre-diabetes and diabetes qualify for different programs. However, evidence suggests that, for low-income Hispanic/Latinos, offering a single intervention to all those with abnormal glycemia may provide a more culturally acceptable and effective approach. Our objective was to explore the feasibility of such an intervention led by community health workers (CHWs) among low-income Hispanic/Latinos with diabetes and at risk for diabetes. Methods Using a quasi-experimental mixed method design, we assessed weight, glycosylated hemoglobin, diabetes knowledge, and behavior changes of Hispanic/Latinos participants with pre-diabetes and diabetes living in Southern California. Biometric measurements, blood tests, and surveys were collected at baseline and 3 months post-intervention. Interviews and focus group discussions provided qualitative data. Results Although the program was less costly, results exceeded those reported for low-income H/L attending the National Diabetes Prevention Program and did not differ between pre-diabetes and diabetes groups. Instead, including individuals at different stages of the dysglycemic spectrum seemed to have enhanced the intervention. Physician referral and attendance of family/friends were associated with better outcomes. Conclusion Our findings indicate that a joint prevention/self-management intervention led by CHWs for low-income Hispanic/Latinos with diabetes and with pre-diabetes is feasible and cost-effective, providing results that could help reduce the success gap. Incorporating suggestions and replicating this study on a larger scale could help determine whether or not results are reproducible.

BackgroundThe aim of this study was to understand the perceptions and experiences of health education and self-management practices on Malamulo Adventist Hospital type 2 diabetic patients. MethodsIn this qualitative study, key informant interviews (KIIs; n=4) and focus group discussions (3 FGDs; n=16) were conducted amongst type 2 diabetes patients who had been treated at Malamulo Adventist Hospital in southern Malawi at least once. Key informant interviews and focus group discussions were audio recorded, transcribed verbatim and translated for analysis. Grounded theory methods were used to identify line-by-line emerging codes and were categorized and examined in Atlas.ti. The data was analyzed for emergent themes and supported by critical quotes. Results Content analysis revealed participants had a positive regard for the diabetes education classes and had satisfactory health literacy. Participants expressed their ability to integrate diabetes education, such as exercise into their lifestyle. Due to financial constraints subjects experienced trouble maintaining their medication regimen, and had difficulty adopting healthier nutritional alternatives. Although patients expressed efficacy in controlling their blood sugar they subsequently expressed having limited knowledge when dealing with diabetes complications. Conclusions Diabetes self-management is comprised of a complex set of processes. Patients with type 2 diabetes at Malamulo Adventist Hospital are deeply impacted by these processes which includes their understanding of the disease process, effects of medication, economic challenges to acquiring health care services and medications, and one's unique life experience. For all patients with type 2 diabetes to successfully manage their condition, support from their family, the medical community, and health policies must be readily available.

There is a rising demand to expand the successful roles community health workers (CHW) offer into clinical settings (cCHW) to support patient services. Using survey data, we evaluated patient and CHW readiness and intent to adopt cCHW clinical care integration. We found CHW and patient readiness to become or utilize a cCHW significantly predicted CHW and patient intent to become or utilize a cCHW; however, in our study CHWs experienced greater readiness to serve as cCHWs than did patients to utilize cCHWs.

Purpose The purpose of this paper is to assess perceptions of organizational readiness to integrate clinic-based community health workers (cCHWs) between traditional CHWs and potential cCHW employers and their staff in order to inform training and implementation models. Design/methodology/approach A cross-sectional mixed-methods approach evaluated readiness to change perceptions of traditional CHWs and potential employers and their staff. Quantitative methods included a printed survey for CHWs and online surveys in Qualtrics for employers/staff. Data were analyzed using SPSS software. Qualitative data were collected via focus groups and key informant interviews. Data were analyzed with NVIVO 11 Plus software. Findings CHWs and employers and staff were statistically different in their perceptions on appropriateness, management support and change efficacy (p<0.0001, 0.0134 and 0.0020, respectively). Yet, their differences lay within the general range of agreement for cCHW integration (4=somewhat agree to 6=strongly agree). Three themes emerged from the interviews which provided greater insight into their differences and commonalities: perspectives on patient-centered care, organizational systems and scope of practice, and training, experiences and expectations. Originality/value Community health workers serve to fill the gaps in the social and health care systems. They are an innovation as an emerging workforce in health care settings. Health care organizations need to learn how to integrate paraprofessionals such as cCHWs. Understanding readiness to adopt the integration of cCHWs into clinical settings will help prepare systems through trainings and adapting organizational processes that help build capacity for successful and sustainable integration.