Abstract:Purpose
The purpose of this study was to investigate how an intergenerational legacy of type 2 diabetes affected the knowledge, attitudes, and treatment strategies of Hispanic young adults with diabetes.
Methods
Eight Hispanic young adults (ages 18-30 years) participated in a series of in-home longitudinal qualitative interviews, and 11 of their family members completed single in-home interviews, regarding their diabetes management practices. Interview transcripts were analyzed thematically by a team of rese… Show more
“…Most studies were excluded because none relevant outcomes were reported ( n =453), and/or type of care was not integrated ( n =257). After the title, abstract and full text screening, 27 studies were included (Groeneveld et al ., 2001; Ostgren et al ., 2002; El-Kebbi et al ., 2003; Rothman et al ., 2003; Rothman et al ., 2004; Uitewaal et al ., 2004; Benoit et al ., 2005; Sperl-Hillen and O’Connor, 2005; Uitewaal et al ., 2005; De Alba Garcia et al ., 2006; Nielsen et al ., 2006; Taweepolcharoen et al ., 2006; Trief et al ., 2006; Wahba and Chang, 2007; Mold et al ., 2008; Al Omari et al ., 2009; De Fine Olivarius et al ., 2009; Robinson et al ., 2009; Kellow et al ., 2011; Cardenas-Valladolid et al ., 2012; Elissen et al ., 2012; Liu et al ., 2013; Quah et al ., 2013; LeBlanc et al ., 2015; Luijks et al ., 2015; Moreira et al ., 2015; Quinn et al ., 2016). Figure 1Flow diagram of the study selection.…”
AimTo identify which patient-related effect modifiers influence the outcomes of integrated care programs for type 2 diabetes in primary care.BackgroundIntegrated care is a widespread management strategy for the treatment of type 2 diabetes. However, most integrated care programs are not tailored to patients’ needs, preferences and abilities. There is increasing consensus that such a patient-centered approach could improve the management of type 2 diabetes. Thus far, it remains unclear which patient-related effect modifiers should guide such an approach.MethodsPubMed, CINAHL and EMBASE were searched for empirical studies published after 1998. A systematic literature review was conducted according to the PRISMA guidelines.FindingsIn total, 23 out of 1015 studies were included. A total of 21 studies measured the effects of integrated diabetes care programs on hemoglobin A1c (HbA1c) and three on low-density lipoprotein cholesterol, systolic blood pressure and health-care utilization. In total, 49 patient characteristics were assessed as potential effect modifiers with HbA1c as an outcome, of which 46 were person or health-related and only three were context-related. Younger age, insulin therapy and longer disease duration were associated with higher HbA1c levels in cross-sectional and longitudinal studies. Higher baseline HbA1c was associated with higher HbA1c at follow-up in longitudinal studies. Information on context- and person-related characteristics was limited, but is necessary to help identify the care needs of individual patients and implement an effective integrated type 2 diabetes tailored care program.
“…Most studies were excluded because none relevant outcomes were reported ( n =453), and/or type of care was not integrated ( n =257). After the title, abstract and full text screening, 27 studies were included (Groeneveld et al ., 2001; Ostgren et al ., 2002; El-Kebbi et al ., 2003; Rothman et al ., 2003; Rothman et al ., 2004; Uitewaal et al ., 2004; Benoit et al ., 2005; Sperl-Hillen and O’Connor, 2005; Uitewaal et al ., 2005; De Alba Garcia et al ., 2006; Nielsen et al ., 2006; Taweepolcharoen et al ., 2006; Trief et al ., 2006; Wahba and Chang, 2007; Mold et al ., 2008; Al Omari et al ., 2009; De Fine Olivarius et al ., 2009; Robinson et al ., 2009; Kellow et al ., 2011; Cardenas-Valladolid et al ., 2012; Elissen et al ., 2012; Liu et al ., 2013; Quah et al ., 2013; LeBlanc et al ., 2015; Luijks et al ., 2015; Moreira et al ., 2015; Quinn et al ., 2016). Figure 1Flow diagram of the study selection.…”
AimTo identify which patient-related effect modifiers influence the outcomes of integrated care programs for type 2 diabetes in primary care.BackgroundIntegrated care is a widespread management strategy for the treatment of type 2 diabetes. However, most integrated care programs are not tailored to patients’ needs, preferences and abilities. There is increasing consensus that such a patient-centered approach could improve the management of type 2 diabetes. Thus far, it remains unclear which patient-related effect modifiers should guide such an approach.MethodsPubMed, CINAHL and EMBASE were searched for empirical studies published after 1998. A systematic literature review was conducted according to the PRISMA guidelines.FindingsIn total, 23 out of 1015 studies were included. A total of 21 studies measured the effects of integrated diabetes care programs on hemoglobin A1c (HbA1c) and three on low-density lipoprotein cholesterol, systolic blood pressure and health-care utilization. In total, 49 patient characteristics were assessed as potential effect modifiers with HbA1c as an outcome, of which 46 were person or health-related and only three were context-related. Younger age, insulin therapy and longer disease duration were associated with higher HbA1c levels in cross-sectional and longitudinal studies. Higher baseline HbA1c was associated with higher HbA1c at follow-up in longitudinal studies. Information on context- and person-related characteristics was limited, but is necessary to help identify the care needs of individual patients and implement an effective integrated type 2 diabetes tailored care program.
“…A sense of inevitability about developing diabetes is prevalent among other marginalized populations, including American Indians, 48–50 African Americans, 51,52 and Hispanics. 53,54 The perception that diabetes is inevitable is influenced in part by family history and the belief that diabetes is hereditary, 49–51 as well as fatalistic beliefs that diabetes is beyond one's control and may be the will of God, nature, or the universe. 48,53 It is imperative to navigate ways to increase self-efficacy while respecting culturally-based fatalistic beliefs regarding developing diabetes.…”
Objectives
The Marshallese population suffers from disproportionate rates of type 2 diabetes. This study identifies the underlying beliefs and perceptions that affect diabetes self-management behavior among the US Marshallese population living in Arkansas.
Methods
The study uses qualitative focus groups with a semi-structured interview guide developed using a community-based participatory research (CBPR) approach and the Health Belief Model. Data was collected from a total of N = 41 participants and bilingual community co-investigators provided translation as needed.
Results
The results show high-perceived threat, with most participants describing diabetes as inevitable and a death sentence. Participants are generally unaware of the benefits of diabetes self-management behaviors, and the Marshallese population faces significant policy, environmental, and systems barriers to diabetes self-management. The primary cue to action is a diagnosis of diabetes, and there are varying levels of self-efficacy.
Conclusions
The research grounded in the Health Belief Model provides important contributions that can help advance diabetes self-management efforts within Pacific Islander communities.
“…This definition was later expanded to include the following: (1) the participant qualified for income-restricted government entitlement programs (e.g., MediCal/Medicaid, Supplemental Nutrition Assistance Program); (2) the participant had a household income of 250% of Federal Poverty Level or lower; or (3) neither of the participant’s parents had attained a four-year college degree. Participants were excluded if they had cognitive disabilities or severe impairments that limited life expectancy; were pregnant or planned a pregnancy within the next 6 months; had participated in a diabetes management intervention beyond diabetes education offered in usual clinic visits totaling ≥6 hours within the past year; or if they had participated in qualitative research used to inform the development of the REAL Diabetes intervention (23, 24). …”
Section: Methodsmentioning
confidence: 99%
“…The Lifestyle Redesign intervention framework has been shown in two large-scale randomized controlled trials (RCTs) to cost-effectively improve physical and mental well-being, and facilitate maintenance of therapeutic gains over the long term (17, 18, 21, 22). To adapt this framework to address the needs of the targeted population, our research team conducted a qualitative needs assessment amongst young adults with both T1D and T2D (23, 24), and developed and validated an intervention manual among a small sample of young adults with diabetes (25). After completing intervention development and validation, our research team initiated a pilot RCT, described herein, to evaluate the efficacy of the intervention and further optimize its implementation in preparation for a large-scale RCT.…”
Overview
This paper describes the study protocol used to evaluate the Resilient, Empowered, Active Living with Diabetes (REAL Diabetes) intervention and reports on baseline characteristics of recruited participants. REAL Diabetes is an activity-based intervention designed to address the needs of young adults diagnosed with type 1 (T1D) or type 2 diabetes (T2D) from low socioeconomic status or racial/ethnic minority backgrounds. The REAL intervention incorporates tailored delivery of seven content modules addressing various dimensions of health and well-being as they relate to diabetes, delivered by a licensed occupational therapist.
Methods
In this pilot randomized controlled trial, participants are assigned to the REAL Diabetes intervention or an attention control condition. The study’s primary recruitment strategies included in-person recruitment at diabetes clinics, mass mailings to clinic patients, and social media advertising. Data collection includes baseline and 6-month assessments of primary outcomes, secondary outcomes, and hypothesized mediators of intervention effects, as well as ongoing process evaluation assessment to ensure study protocol adherence and intervention fidelity.
Results
At baseline, participants (n=81) were 51% female, 78% Latino, and on average 22.6 years old with an average HbA1c of 10.8%. A majority of participants (61.7%) demonstrate clinically significant diabetes distress and 27.2% report symptoms consistent with major depressive disorder. Compared to participants with T1D, participants with T2D had lower diabetes-related self-efficacy and problem-solving skills. Compared to participants recruited at clinics, participants recruited through other strategies had greater diabetes knowledge but weaker medication adherence.
Discussion
Participants in the REAL study demonstrate clinically significant medical and psychosocial needs.
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