Self-reported outcomes of a randomized trial comparing three community health worker interventions for diabetes prevention among Cambodian Americans with depression

Wagner, Julie; Bermúdez‐Millán, Angela; Buckley, Thomas; Buxton, Orfeu M.; Feinn, Richard; Kong, Sengly; Kuoch, Theanvy; Nye, Lindsay Master; Scully, Mary

doi:10.1016/j.pec.2022.09.011

Cited by 1 publication

(1 citation statement)

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“…For example, among traumatized Cambodians, common clinical complaints include nightmares, visitations by ghosts, sleep paralysis, and dreams of the dead [ 42 – 44 ]. We previously reported improved self-reported sleep quality among our intervention groups [ 45 ]. That we were not also able to improve objective sleep indicators suggests that more intensive cognitive behavioral treatments and/or medications may be indicated.…”

Section: Discussionmentioning

confidence: 99%

Secondary analysis of a randomized trial testing community health educator interventions for diabetes prevention among refugees with depression: effects on nutrition, physical activity and sleep

Wagner,

Bermúdez-Millán,

Buckley

et al. 2023

Int J Behav Nutr Phys Act

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Background Refugees have high levels of psychological distress that hamper lifestyle change efforts. We previously reported that community health educator (CHE) diabetes prevention interventions decreased HbA1c and depressive symptoms among Cambodian-American refugees with depression; this paper reports health behavior outcomes of those interventions. Methods Participants were aged 35–75, Khmer speaking, at risk for diabetes, and met study criteria for likely depression by either a) antidepressant medication and/or b) prolonged elevated depressive symptoms. Participants were randomized to one of three CHE interventions: 1) lifestyle intervention called Eat, Walk, Sleep (EWS), 2) EWS plus medication therapy management with a pharmacist/CHE team (EWS + MTM), or, 3) social services (SS; control). Physical activity and sleep were measured with 7 days of actigraphy. Nutrition was measured as carbohydrates as reported in a culturally tailored food frequency questionnaire. Assessments were at baseline, end point (12 months), and follow-up (15 months). Results The n = 188 participants were 78% female, average age of 55 years, half had a household income < $20,000, and modal education was 7.0 years. Individuals in the two treatment groups that received the EWS intervention significantly increased their brown rice consumption (p < .001, Cohen’s d = 0.76) and their moderate-to-vigorous activity (p = .039, d = 0.32). No intervention changed sleep duration, timing, efficiency or wake after sleep onset. Across groups, individuals who increased brown rice consumption, increased vigorous activity and decreased total sleep time variability showed decreased HbA1c, with small effect sizes. Conclusions CHEs may improve nutrition and physical activity in refugees with depression but more intensive interventions may be required to impact sleep. Improvements in all three behaviors appear to be associated with HbA1c lowering Trial registration ClinicalTrials.gov identifier NCT02502929.

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Section: Discussionmentioning

confidence: 99%