Health equity in action: using community-engaged research to update an intervention promoting a healthy home food environment to Black/African American families.

PURPOSE: Describe the method for conducting community-engaged research to identify needed changes for an existing evidence-based intervention, and prepare it for implementation in a community setting within the Dan L Duncan Comprehensive Cancer Center catchment area in an effort to achieve more equitable outcomes in diet-related disease risk factors. METHODS: The intervention, Family Eats, was developed over 10 years ago. It works directly with parents of Black/African American 9-12 year old children to create a healthy home food environment to support prevention of obesity and related cancers. Data collection with community stakeholders occurred through a series of  Community Advisory Board (CAB) meetings guided by the Delphi Technique, an iterative approach for gaining group consensus on a topic. RESULTS: Key information on needed changes and potential implementation strategies were identified. Perceived level of engagement among CAB members was high overall and in terms of both quantity and quality. CONCLUSION: The Delphi Technique shows promise as a method for conducting community-engaged research that promotes engagement and identifies key information needed to adapt and implement an existing intervention in a community setting.

Self-Sampling for Human Papillomavirus Testing: Acceptability in a U.S. Safety Net Health System.

INTRODUCTION: Self-sampling for human papillomavirus testing is increasingly recognized as a strategy to expand cervical cancer screening access and utilization. Acceptability is a key determinant of uptake. This study assesses the acceptability of and experiences with mailed self-sampling kits for human papillomavirus testing among underscreened patients in a safety net health system. METHODS: A nested telephone survey was administered between 2021 and 2023 to a sample (n=272) of the 2,268 participants enrolled in the Prospective Evaluation of Self-Testing to Increase Screening trial. Trial participants include patients of a safety net health system aged 30-65 years who were not up to date on screening. Participants were asked about barriers to provider-performed screening. Kit users and nonusers were asked about their experiences. RESULTS: Prevalent barriers to provider-performed screening included perceived discomfort of pelvic examination (69.4%), being uncomfortable with male providers (65.4%), and embarrassment (57.0%). Among participants who reported using the mailed kit (n=164), most reported good experiences (84.8%). Most reported self-sampling as more/equally convenient (89.0%), less/equally embarrassing (99.4%), and less/equally stressful (95.7%) than provider-performed screening. Among kit nonusers (n=43), reasons for not using the kit included forgetting about it (76.7%), preferring provider-performed screening (76.7%), and fearing cancer (67.4%). CONCLUSIONS: Prospective Evaluation of Self-Testing to Increase Screening trial participants generally had a positive experience with self-sampling for human papillomavirus testing. Increased comfort and reduced embarrassment/anxiety with self-sampling are relevant attributes because these were the most prevalent reported barriers to provider-performed screening. High acceptability suggests potentially high uptake when self-sampling for human papillomavirus testing receives regulatory approval and is available in safety net health systems.

Gender Differences in Self-Efficacy for Diabetes Self-Management Among Hispanics: The Mediating Role of Perceived Support and Depressive Symptoms.

PURPOSE: The purpose of this study is to examine the extent to which perceived support and depressive symptoms might interfere with Hispanic patients' ability to manage their diabetes and whether these effects vary by gender. METHODS: Data were collected from a cohort of 232 Hispanic men and women with type 2 diabetes mellitus (T2DM). Conditional process analysis was used to test a moderated mediation model of the time-lagged processes associating gender, diabetes support, and depressive symptoms with reported self-efficacy after 3 months. RESULTS: Increased depressive symptoms were associated with lower self-efficacy, but the conditional effects varied among men and women. The index of moderated mediation was significant, indicating that among women, the indirect effect of depressive symptoms on self-efficacy was contingent on lower levels of perceived support. Among men, increased depressive symptoms were directly associated with declines in self-efficacy and were not conditional on perceived support. CONCLUSIONS: Results of the study have important implications for gender health equity. Mental health screening and an assessment of support needs may be important for determining appropriate complementary therapies when treating Hispanic women with chronic conditions such as diabetes. Attention to possible differences in gender-specific mental health needs could lead to improved self-management, better glycemic control, and more equitable health outcomes.

The Texas collaborative center for hepatocellular cancer: Reducing liver cancer mortality in Texas through coordination, collaboration and advocacy.

Texas has the highest age-adjusted incidence rate of hepatocellular carcinoma (HCC) in the United States. To address cancer prevention and early detection through research, Cancer Prevention and Research Institute of Texas (CPRIT) has funded the Texas Collaborative Center for Hepatocellular Cancer (TeCH) to facilitate liver cancer research, education and advocacy activities. This paper describes the organizational structure, program measures, the actions completed and future plans of TeCH. This center is comprised of several cores and committees including the Administrative Core, Steering Committee, Data and Biospecimen Core, Scientific Committee, Clinical Network Committee, and the Community Outreach Committee. Each core and committee provide its own level of connectivity and necessary research support. We have developed and published a TeCH Framework, a conceptual model designed for improving primary and secondary prevention of HCC. TeCH and its committees facilitate connections and collaborations among HCC researchers and clinicians, healthcare leaders, biotechnology companies and the public to reduce liver cancer mortality in Texas by 2030.

Human Papillomavirus Vaccinations During the COVID-19 Pandemic in Middle Schools in the Rio Grande Valley of Texas.

This quasi-experimental study (a community-based, physician-led human papillomavirus [HPV] education campaign and school-based vaccination program) followed 6481 students at eight Pharr-San Juan-Alamo Independent School District (Rio Grande Valley, Texas) middle schools between August 2016 and March 2021. We describe the successes and challenges experienced during the COVID-19 pandemic. HPV vaccine initiation and completion rates increased 1.29-fold and 1.47-fold, respectively, between June 2019 and March 2021. Between March 2020 and March 2021, 268 HPV vaccine doses were provided through 24 school-based interventions. Our program continued successes seen in increasing HPV vaccination rates and reducing possible HPV-associated cancers. (Am J Public Health. 2022;112(9):1269-1272. https://doi.org/10.2105/AJPH.2022.306970).

Preferred Strategies for Delivering Health Information to Patients With Musculoskeletal Disorders: A Qualitative Study.

BACKGROUND: Patients' information needs may differ from what their care providers may perceive to be the patients' needs. This discordance needs to be recognized and addressed. OBJECTIVE: We conducted a qualitative study to explore the perceptions of patients with selected musculoskeletal disorders and those of rheumatologists, on their preferred strategies for delivery of disease management information. METHODS: Fifty-two patients diagnosed with either rheumatoid arthritis, knee osteoarthritis, or osteoporosis took part in 6 focus groups and 18 individual semistructured interviews. In addition, 11 rheumatologists participated in 2 focus groups and 4 semistructured individual interviews. Data were explored by thematic content analysis. Perceived preferences were identified and compared between patients and rheumatologists regarding (a) media, (b) setting, (c) messengers, and (d) key message content. RESULTS: Patients' preferred media for disease management information were electronic (television and videos delivered as digital optical discs or the Internet), group instruction, and printed material. Patients preferred the information to be delivered in the setting of their homes, doctor's offices, or clinic waiting areas by the rheumatologists and patients with disease experience, addressing healthy lifestyle changes, medication adherence, and consequences of noncompliance. For rheumatologists, the perceived preference for information delivery was through printed material (brochures, booklets, and pamphlets) delivered in waiting areas by nurses and physicians, addressing nature of the disease, complications, and treatment adverse effects. CONCLUSIONS: Provider perspectives on strategies for education may differ from those of patients. Our findings highlight the need for considering different stakeholder perspectives in designing educational tools and decision support materials for patients with chronic diseases. TAKEHOME MESSAGE: Rheumatologists' preferences on strategies for education (mode of delivery, delivery setting, messengers, and topics) differ from those of patients. For example, patients want to learn about lifestyle changes and consequences of compliance versus noncompliance, whereas rheumatologists considered more important for patients to understand their disease, treatment adverse effects, and consequences of noncompliance.

Psychosocial Contributors to Depressive Symptoms in Hispanic Patients With Type 2 Diabetes.

PURPOSE: The purpose of this study is to identify psychosocial factors associated with depressive symptoms in Hispanic patients with diabetes and explore the extent to which their effects may vary by gender and acculturation. METHODS: The authors completed a secondary analysis of data from 247 Hispanic adults with type 2 diabetes. Gender and language groups were compared using chi-square and t tests. Hierarchical multiple regression was used to examine associations of depressive symptoms with perceived support, diabetes-related distress, and social and personal factors. RESULTS: Women reported less support than men. English speakers reported more depressive symptoms than Spanish speakers. When adjusting for age, gender, and acculturation, psychosocial factors significantly associated with depressive symptoms included less support received, greater emotional burden, and less ability to socialize or pursue normal activities because of diabetes. CONCLUSIONS: Social support provided by family among less acculturated Hispanics may play an important role in reducing emotional burden and lowering the risk of comorbid depression. The quality of interpersonal relationships and the ability to continue normal activities may also be important. More acculturated Hispanic women with diabetes may be at greater risk for comorbid depression and worse health outcomes. Screening for depression and assessment of support needs is warranted for Hispanic women.

Human papillomavirus awareness among foreign- and US-born Hispanics, United States, 2017-2018.

INTRODUCTION: Human papillomavirus (HPV) and HPV vaccine knowledge and awareness are known to be lower among Hispanics compared to non-Hispanic whites. However, Hispanics in the US are a non-homogenous population, with significant differences by nativity, particularly between the US-and foreign-born individuals. We examined HPV and HPV vaccine awareness among foreign-born Hispanics, US-born Hispanics, and US-born non-Hispanic whites. METHODS: We analyzed data from the Health Information National Trends Survey (HINTS) 5, cycles 1 (2017) and 2 (2018), the most recent HINTS datasets including nativity information. We used descriptive statistics and multivariable regression to compare awareness of HPV and the HPV vaccine among ethnicity/nativity subgroups. RESULTS: Over 50% of foreign-born Hispanics had not heard of HPV, compared to 32% of US-born Hispanics (P < 0.01) and 33% of non-Hispanic whites (p < 0.01). Lack of HPV vaccine awareness among foreign-born Hispanics was not significantly different from US-born Hispanics (52% vs. 44%, p = 0.12), but was significantly lower compared to non-Hispanic whites (52% vs. 32%, p < 0.01). In multivariable analyses, non-Hispanic whites had over twice the odds of having heard of HPV than foreign-born Hispanics (p < 0.05), while US-born Hispanics had 75% higher odds (p < 0.05). Regarding HPV awareness, non-Hispanic whites had 95% higher odds of having heard of the HPV vaccine than foreign-born Hispanics (p < 0.05), while differences between US and foreign-born Hispanics were not significant. CONCLUSION: There are significant nativity-related differences in HPV and HPV vaccine awareness and knowledge among US-born Hispanics. Over 50% of foreign-born Hispanic adults are unaware of HPV and the HPV vaccine.

Adolescent electronic cigarette counselling: knowledge, attitudes and perceived barriers among clinical staff in a primary care setting.

OBJECTIVE: To assess knowledge, attitudes, and perceived barriers (KAP) regarding e-cigarette use counselling among adolescent healthcare clinical staff in an urban system, and to compare results between providers and rooming staff. METHODS: Primary care clinical staff (n = 169) completed an anonymous survey. Descriptive statistics and Chi-square tests were used to summarize data and compare KAP between medical providers and rooming staff. RESULTS: Staff wanted to learn more about e-cigarettes (87.6%). The most common knowledge deficits were how to use the 5As + 5Rs model for tobacco cessation counselling (66.7%) and the chemical content of e-liquids (55.4%), with no differences across groups. Overall, 58% of providers expressed confidence in their ability to talk with adolescent patients about e-cigarette use. The most common barriers to counselling were low knowledge about e-cigarettes (74.0%) and how to refer adolescent patients for cessation support (43.8%). CONCLUSIONS: Provider and rooming staff expressed similar educational needs surrounding e-cigarettes, counselling, and treatment for adolescent patients. Clinical staff expressed confidence in their ability to affect change. There were no differences in the identified knowledge gaps or barriers to care between rooming staff and providers, suggesting that the same educational format can be used to target both groups.

Incomplete Records as a Leading Cause of Missed Opportunity for Human Papillomavirus Vaccine Initiation in a Safety Net Health System.

OBJECTIVE: The goal of this study was to categorize reasons behind missed opportunities for human papillomavirus (HPV) vaccine initiation in an under-resourced population and to identify associated patient and clinic characteristics. METHODS: Manual chart review was performed for patients aged 11 to 18 years who visited a primary care clinic in a health system in Texas, USA between 06/01/18 and 08/31/18 and were due for an initial HPV vaccine dose but did not receive it. Reasons for HPV vaccine noninitiation were categorized as follows: incomplete immunization record, no documentation of discussion (no documentation that the HPV vaccine was offered or ordered), refusal, staff/provider error, and medical. Multinomial logistic regression was used to examine factors associated with each category. RESULTS: Of 4467 adolescents seen in the study period, 575 (12.9%) were due for the first dose of HPV vaccine but did not receive it. The most common reason for noninitiation was incomplete immunization record (37%), followed by no documentation of discussion (24%), refusal (20%), staff/provider error (15%), and medical (4%). The highest odds of incomplete immunization were among older adolescents. The highest odds of no documentation of discussion were during sick visits. The highest odds of staff/provider error were among patients with commercial insurance. The lowest odds of refusal were in patients with county/indigent insurance. CONCLUSIONS: The most common reason for missed opportunity visits for HPV vaccine initiation was lack of adequate immunization records. Our study highlights the importance of immunization record access and bidirectional reporting as important targets for future interventions.

Randomized Controlled Trial of Patient Education Tools for Patients With Rheumatoid Arthritis.

OBJECTIVE: The present study was undertaken to evaluate the efficacy of 2 educational tools for patients with rheumatoid arthritis (RA) by comparing a newly developed video tool, including storylines and testimonials, combined with a written booklet to the same written booklet alone. METHODS: We conducted a randomized controlled trial. Our primary outcome was disease knowledge. Secondary outcomes were decisional conflict, self-efficacy, effective health care management, and satisfaction. Outcomes were measured before and after reviewing the materials, and 3 and 6 months later. Linear mixed-effects models were performed to evaluate changes over time. RESULTS: In total, 221 participants received an educational video and booklet (n = 111) or a booklet alone (n = 110). The mean age was 50.8 years, mean disease duration was 4.8 years, 85% were female, and 24% had limited health literacy levels. Within groups, most outcomes improved between baseline and follow-up, but there were no statistically significant differences across groups. Patients receiving the video and booklet were more likely than those receiving the booklet alone to rate the presentation as excellent for providing information about the impact of RA, medication options, evidence about medications, benefits of medication, and self-care options. Factors significantly associated with greater improvements in knowledge and decisional conflict from baseline to 6 months included limited health literacy, lower educational level, and shorter disease duration. CONCLUSION: Regardless of the delivery method, outcomes were improved up to 6 months after educational materials were delivered. Our findings support the implementation of self-administered educational materials in clinical settings, as they can result in sustained improvements in disease knowledge and decisional conflict.

Mailed self-sample HPV testing kits to improve cervical cancer screening in a safety net health system: protocol for a hybrid effectiveness-implementation randomized controlled trial.

BACKGROUND: Almost 20% of U.S. women remain at risk for cervical cancer due to their inability or unwillingness to participate in periodic clinic-based screening. Self-sampling has been shown to be an effective strategy for screening women for high-risk human papillomavirus (HR-HPV) infection in specific contexts. However, its effectiveness among medically underserved women in safety net health systems has not been evaluated. Furthermore, it is also unclear whether implementation strategies such as patient navigation can be used to improve the success of self-sample screening programs by addressing patient-level barriers to participation. METHODS/DESIGN: The Prospective Evaluation of Self-Testing to Increase Screening (PRESTIS) trial is a hybrid type 2 effectiveness-implementation pragmatic randomized controlled trial of mailed self-sample HPV testing. The aim is to assess the effectiveness of mailed self-sample HPV testing kits to improve cervical cancer screening participation among patients in a safety net health system who are overdue for clinic-based screening, while simultaneously assessing patient navigation as an implementation strategy. Its setting is a large, urban safety net health system that serves a predominantly racial/ethnic minority patient population. The trial targets recruitment of 2268 participants randomized to telephone recall (enhanced usual care, n = 756), telephone recall with mailed self-sample HPV testing kit (intervention, n = 756), or telephone recall with mailed self-sample HPV testing kit and patient navigation (intervention + implementation strategy, n = 756). The primary effectiveness outcome is completion of primary screening, defined as completion and return of mailed self-sample kit or completion of a clinic-based Pap test. Secondary effectiveness outcomes are predictors of screening and attendance for clinical follow-up among women with a positive screening test. Implementation outcomes are reach, acceptability, fidelity, adaptations, and cost-effectiveness. DISCUSSION: Hybrid designs are needed to evaluate the clinical effectiveness of self-sample HPV testing in specific populations and settings, while incorporating and evaluating methods to optimize its real-world implementation. The current manuscript describes the rationale and design of a hybrid type 2 trial of self-sample HPV testing in a safety net health system. Trial findings are expected to provide meaningful data to inform screening strategies to ultimately realize the global goal of eliminating cervical cancer. TRIAL REGISTRATION: ClinicalTrials.gov NCT03898167 . Registered on 01 April 2019. TRIAL STATUS: Study start data: February 13, 2020. Recruitment status: Enrolling by invitation. Estimated primary completion date: February 15, 2023. Estimated study completion date: May 31, 2024. Protocol version 1.6 (February 25, 2020).

Impact of Colonoscopy Preparation Video on Boston Bowel Preparation Scale Score.

Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States and the third most common cancer in men and the second most common cancer among women. Early detection of localized adenocarcinoma and adenomatous polyps helps reduce the mortality related to colon cancer. According to the American Gastroenterological Association, colonoscopy (CSPY) is the gold standard in screening for CRC. To improve the results of screening, the CSPY preparation (prep) needs to be optimal. This study was undertaken to determine whether a supplemental standardized educational video on bowel preparation in the viewer's native language would improve bowel preparation at the time of CSPY. After institutional review board approval, the records of adult patients who presented to the gastroenterology clinic were reviewed. Patients who underwent a CSPY were assigned according to whether they watched a supplemental educational video on CSPY bowel preparation in their native language. This video reflects the same information provided in written and verbal form at the time of CSPY scheduling. Bowel prep was rated by the endoscopist using the Boston Bowel Preparation Scale (BBPS) and quantifies the adequacy of the preprocedure bowel prep. Participant characteristics and BBPS scores were statistically assessed for significant differences. We identified a total of 186 patients, 91 in March 2015 (pre-video intervention) and 95 in March 2016 (post-video intervention). Mean BBPS score was 7.9 and 8.54 for the March 2015 and 2016 group, respectively (p value of .0039). Although there was no statistical difference between the 2 groups with concern to gender and age, the racial makeup and BBPS score were statistically different. Multivariate analysis was performed. There was no interaction between gender or race and year effect to account for any difference in that factors' performance. Thus, it can be implied that there is not a consistent race effect but there is a consistent gender effect with females having higher success rates, regardless of video intervention (p value of .003). After controlling for both gender and race, the year effect is modestly significant (p value of .025), with the post-video subjects having higher prep success rates. A supplemental educational video incorporated into precolonoscopy teaching may provide a standardized method of effectively conveying simple bowel prep instructions in an efficient manner. This study demonstrated that using such a video produced significant results in improving the quality of bowel preparation.

The effects of culturally targeted patient decision aids on medical consultation preparation for Hispanic women in the U.S.: Results from four randomized experiments.

RATIONALE: Do culturally targeted patient decision aids (DAs) better prepare lower-middle and middle-class Hispanic American women for medical decision making compared to DAs designed for the general population? Health promotion evidence indicates that inclusion of cultural values, imagery, linguistics, and health data in a DA will improve ethnic patients' preparation relative to a generic DA; yet, this hypothesis remains untested. METHOD: Four experiments examined consultation preparation effects of culturally targeted versus generic DAs for Hispanic women living in the United States. Drawing on highly rated online DAs, an experienced Hispanic content developer and Hispanic focus groups worked with researchers to develop culturally targeted digital DAs. Online panels of self-identified Hispanic women in the U.S. were randomly assigned to a targeted or generic DA as part of a scenario-based physician consultation for advanced diabetes (Study 1) or early stage breast cancer (Studies 2-4). RESULTS: Manipulation checks showed high awareness of cultural information in the targeted DA group. Despite efforts to rule out confounds that could account for null effects, DA cultural targeting did not increase knowledge, decision preparedness, or empowerment or reduce decision conflict in the four randomized experiments. Only individual difference variables (e.g., group interdependence) consistently predicted enhanced DA consultation preparation effects. Related research indicates that culture at the group level may exert less influence when individuals think deliberatively, feel less constrained by limited resources such as time, understand processing objectives, and/or are primed with task-specific schema/norms. CONCLUSION: Given deeper deliberation and clearly primed processing objectives, personal experiences and task-related schema/norms may have significantly reduced the effects of cultural targeting. Consistent findings from four studies suggest that culturally targeted DAs may not better prepare Hispanic women in the U.S. for medical decision making than generic versions designed for the broader population.

Development and Pilot Testing of Multimedia Patient Education Tools for Patients With Knee Osteoarthritis, Osteoporosis, and Rheumatoid Arthritis.

OBJECTIVE: We developed and tested multimedia patient education tools (video tools) for patients with knee osteoarthritis (OA), osteoporosis (OP), and rheumatoid arthritis (RA). METHODS: We followed an "edutainment" model, incorporating educational patient story lines. The goals were designed to make the programs both didactic and entertaining, with navigation and graphic user interfaces as simple as possible. We created both English and Spanish language versions. Once the video tool was finalized, 60 patients, 20 per disease, were shown the tool and interviewed. Disease knowledge was our primary outcome, and decision conflict, disease management, and acceptability were secondary outcomes. RESULTS: We observed statistically significant differences in pre- to postintervention knowledge questionnaire scores (before and after viewing the video tool) (OA: P = 0.03, OP: P = 0.01, and RA: P < 0.0001). Most participants felt they gained "clarity" on disease duration, symptoms, and the time medication takes to start acting; were "encouraged to see their doctor regularly"; and were more aware about taking their medications. In terms of acceptability, most patients in all disease groups found the length and amount of information presented in the video tools to be "just right," and the presentation to be "balanced." In terms of comprehension, all participants provided a favorable evaluation of the video tool; all found the video easy to use, the vocabulary easy to understand, and the materials to be well organized. CONCLUSION: Multimedia tools that incorporate videos may help patients better understand and manage their disease. Patient involvement in the development process is essential to ensure relevant content and usability.

An entertainment-education colorectal cancer screening decision aid for African American patients: A randomized controlled trial.

BACKGROUND: Colorectal cancer screening rates for African American patients remain suboptimal. Patient decision aids designed with an entertainment-education approach have been shown to improve saliency and foster informed decision making. The purpose of this study was to assess whether an entertainment-education decision aid tailored for African American patients improved patients' decision making, attitudes, intentions, or colorectal cancer screening behavior. METHODS: Eighty-nine participants were randomized to view 1) a patient decision aid video containing culturally tailored information about colorectal cancer screening options and theory-based support in decision making presented in an entertainment-education format or 2) an attention control video about hypertension that contained similarly detailed information. Participants met with their clinician and then completed follow-up questionnaires assessing their knowledge, decisional conflict, self-advocacy, attitudes, perceived social norms, and intentions. At 3 months, completion of screening was assessed by chart review. RESULTS: Viewing the culturally tailored decision aid significantly increased African American patients' knowledge of colorectal cancer screening recommendations and options. It also significantly reduced their decisional conflict and improved their self-advocacy. No significant differences were observed in participants' attitudes, norms, or intentions. At three months, 23% of all patients had completed a colonoscopy. CONCLUSIONS: Designing targeted, engaging patient decision aids for groups that receive suboptimal screening holds promise for improving patient decision making and self-advocacy. Additional research is warranted to investigate the effectiveness of such aids in clinical practices with suboptimal screening rates and on downstream behaviors (such as repeat testing). Cancer 2017;123:1401-1408. © 2016 American Cancer Society.

Development of a Nutrition Education Intervention for Food Bank Clients.

The focus of this article is the development of a nutrition education intervention for food bank clients. Formative research using mixed-methods (qualitative and quantitative) and community-based participatory research principles was conducted to assess the nutrition education needs of clients obtaining service from the Houston Food Bank (HFB). Participants were HFB and pantry staff and clients. Interview data were coded and analyzed using grounded theory approach. Themes were then identified. Quantitative data were analyzed for frequencies and descriptives. Data were used to tailor the curriculum to the target population. Six HFB staff, 49 pantry staff from 17 pantries, and 54 clients from 10 pantries participated in interviews and focus groups and completed questionnaires. The participants provided opinion on the current nutrition education provided via the food bank and made suggestions on strategies for development of an intervention. Their feedback was used to develop the six-session intervention curriculum to be delivered over 6 months. This research provides evidence that it is critical for members of the target audience be included in formative research to develop behavior change programs that are relevant and appealing and target their needs and interests.

Incorporating Cultural Sensitivity into Interactive Entertainment-Education for Diabetes Self-Management Designed for Hispanic Audiences.

Diabetes self-management education can improve outcomes in adults with Type 2 diabetes mellitus (T2DM). However, Hispanics, a group that carries a large burden of disease, may not participate in diabetes education programs. Audience engagement with entertainment-education has been associated with improved health education outcomes and may engage and empower Hispanic users to active self-care. Successful use of entertainment-education relies on the use of characters and situations with whom the viewers can feel some sense of involvement and for Hispanic audiences is encouraged when storylines and characters are culturally sensitive. In this study, we used a mixed methods approach that included descriptive statistics of closed-ended and content analysis of open-ended questions to measure the cultural sensitivity of the telenovela portion of a novel technology-based application called Sugar, Heart, and Life (SHL). Specifically, we analyzed the responses of 123 male and female patients diagnosed with uncontrolled T2DM to determine viewer involvement with characters and situations in the telenovela, viewer perceived self-efficacy in following recommendations, as well as viewer satisfaction with the program. Our findings indicate that the SHL application achieved its goal of creating a user-friendly program that depicted realistic, culturally sensitive characters and storylines that resonated with Hispanic audiences and ultimately fostered perceived self-efficacy related to following recommendations given about healthy lifestyle changes for diabetes self-management. These findings suggest that the SHL application is a culturally sensitive health education intervention for use by Hispanic male and female individuals that may empower them in self-management of T2DM.

Hispanic Acculturation and Gender Differences in Support and Self-Efficacy for Managing Diabetes.

PURPOSE: The purpose of this study was to determine whether perceived support, social norms, and their association with self-efficacy varied by gender and language-based acculturation in Hispanic men and women with uncontrolled type 2 diabetes mellitus (T2DM). METHODS: A cross-sectional, secondary analysis of baseline survey data from a randomized control trial. Participants were 248 Hispanic patients from 4 community health centers who participated in a culturally targeted intervention for diabetes management. Quantitative statistical methods were used, including chi-square analyses, one-way ANOVA, and multiple regression. RESULTS: Gender and language both moderated the relationship between social factors and self-efficacy. Regardless of language, better perceived support was associated with improved self-efficacy in women but not men. Dietary norms were associated with self-efficacy in English-speaking men and women, while physical activity norms were associated with self-efficacy for Spanish-speaking women only. CONCLUSIONS: This study builds on previous research by exploring the extent to which the social context of diabetes self-management may vary in its effects depending on gender and acculturation. The findings revealed potentially important differences based on both gender and language, suggesting that interventions must be designed with these differences in mind. Diabetes-specific support from family members, especially spouses, may be especially important for Hispanic women. For both men and women, it may be effective to find creative ways of involving the family in creating healthier social norms and expectations.

Non-utilization of the Pap Test Among Women with Frequent Health System Contact.

Despite improvements in health access, many underserved women abstain from cervical cancer screening. A self-administered questionnaire was used to identify factors determining whether medically underserved women attending a safety net health system regularly are screened for cervical cancer. Approximately 11 % of study subjects had never received a Pap test despite an average of nearly four clinic visits in the preceding 12 months. Never screeners were significantly younger, more likely to be Hispanic, non-U.S. born and less likely to have healthcare continuity. In multivariable analysis, odds for never screening were independently lower among women with male partner support (aOR 0.29) and physician's recommendation for screening (aOR 0.34) and higher among women who believed screening visits are too long (aOR 2.53). Educating male partners of Hispanic and immigrant women in addition to addressing recognized situational barriers may help to improve cervical cancer screening rates.