Outcomes of a type 2 diabetes education program adapted to the cultural contexts of Saudi women. A pilot study.

OBJECTIVE: To explore the outcomes of a pilot intervention of a type 2 diabetes (T2D) education program, based on international standards, and adapted to the cultural and religious contexts of Saudi women. METHODS: This study is an experiment of a pilot intervention carried out between August 2011 and January 2012 at the primary health clinics in Dammam. Women at risk of or diagnosed with T2D (N=35 including dropouts) were assigned to one of 2 groups; an intervention group participated in a pilot intervention of T2D education program, based on international standards and tailored to their cultural and religious contexts; and a usual care group received the usual care for diabetes in Saudi Arabia. Outcomes included blood glucose, body composition, 6-minute walk distance, life satisfaction, quality of life, and diabetes knowledge. The intervention group participated in a focus group of their program experience. Data analysis was based on mixed methods. RESULTS: Based on 95% confidence interval comparisons, improvements were noted in blood sugar, 6-minute walk distance, quality of life, and diabetes knowledge in participants of the intervention group. They also reported improvements in lifestyle-related health behaviors after the education program. CONCLUSION: Saudi women may benefit from a T2D education program based on international standards and adapted to their cultural and religious contexts.

Stroke-related knowledge, beliefs, and behaviours of chinese and European canadians: implications for physical therapists.

PURPOSE: To improve cross-cultural health education on risk-reducing behaviour change by examining the stroke-related knowledge, beliefs, and behaviours of Chinese Canadians (CCs). METHODS: Participants (103 first-generation CCs and 101 European Canadians [ECs] representing the dominant cultural group in Canada) completed a cross-sectional questionnaire about knowledge, health behaviours, and beliefs related to stroke. RESULTS: Compared with ECs, CCs were less aware of risk factors, warning signs, and appropriate responses to stroke in others. Information sources about stroke included mass media, family, and friends. CCs were less likely to smoke and drink alcohol but were also less likely to be physically active or to participate in structured exercise, less likely to have a healthy diet, and more likely to report stress. CONCLUSIONS: Theoretical dimensions of culture may explain variations in stroke-related knowledge, behaviours, and beliefs between CCs and ECs. Awareness of cultural differences can help physical therapists evaluate clients and appropriately tailor lifestyle-related health education.

Objectif : Améliorer l'éducation en santé transculturelle portant sur le changement des comportements visant à réduire les risques en examinant les connaissances, les croyances ou les comportements des Sino-canadiens (SC) au sujet de l'accident vasculaire cérébral. Méthodes : Les participants (103 SC de première génération et 101 Euro-canadiens [EC] représentant le groupe culturel dominant au Canada) ont rempli un questionnaire transversal sur les connaissances, les comportements sanitaires et les croyances portant sur l'accident vasculaire cérébral. Résultats : Comparativement aux EC, les SC connaissaient moins les facteurs de risque, les signes avertisseurs et les façons appropriées de traiter les victimes d'un accident vasculaire cérébral. Les médias grand courant, les membres de la famille et les amis, notamment, constituaient les sources d'information. Les SC étaient moins susceptibles de fumer et de boire de l'alcool, mais aussi moins susceptibles de faire de l'activité physique ou de participer à des exercices structurés, moins susceptibles d'avoir une alimentation santé et plus susceptibles de signaler du stress. Conclusion : Des dimensions théoriques de la culture peuvent expliquer les variations, entre les SC et les EC, des connaissances, des comportements et des croyances portant sur l'accident vasculaire cérébral. La sensibilisation aux différences culturelles peut aider les physiothérapeutes à évaluer les clients et à personnaliser comme il se doit l'éducation en santé portant sur les habitudes de vie.

Ischaemic heart disease-related knowledge, behaviours, and beliefs of indo-canadians and euro-canadians: implications for physical therapists.

PURPOSE: To examine knowledge, behaviours, and beliefs related to ischaemic heart disease (IHD) of Indo-Canadians (ICs), thereby helping target health education strategies. METHODS: In a cross-sectional descriptive/comparative study, 102 Indian-born Indo-Canadians (ICs) and 102 Canadian-born Euro-Canadians (ECs) completed a standardized questionnaire on IHD knowledge and lifestyle-related behaviours and beliefs. RESULTS: Compared with ECs, ICs were less aware of IHD-risk factors. ICs' lifestyle practices and beliefs were consistent with having less perceived control over health than ECs. ICs reported more stress from various sources and resorted less to exercise for stress relief and more to religious/spiritual activities. CONCLUSIONS: In accordance with health belief theory, approaches to educating immigrants from collectivistic cultures such as India to assume responsibility for their personal health may need to be different from those used with ECs, which stress self-management. Such programmes may need to emphasize lifestyle-related health knowledge and beliefs as bases for health behaviour change.

Objectif : Étudier les connaissances, les comportements et les croyances qui ont trait à la cardiopathie ischémique (CPI) chez les Indo-Canadiens (IC) pour aider ainsi à cibler des stratégies d'éducation en santé. Méthodes : Lors d'une étude descriptive/comparative transversale, 102 Indo-Canadiens (IC) d'origine indienne et 102 Euro-Canadiens (EC) d'origine canadienne ont rempli un questionnaire normalisé sur leurs connaissances relatives à la CPI et leurs comportements et croyances portant sur les habitudes de vie. Résultats : Comparativement aux EC, les IC connaissaient moins les facteurs de risque de CPI. Les pratiques et les croyances des IC au sujet des habitudes de vie correspondaient au fait qu'ils croyaient avoir moins de contrôle de leur santé que les EC. Ils ont signalé plus de stress provenant de diverses sources. Ils faisaient moins d'exercice pour soulager le stress et s'en remettaient davantage aux activités religieuses ou spirituelles. Conclusions : Conformément à la théorie des croyances en santé, il faudra peut-être aborder l'éducation des immigrants de cultures collectivistes comme l'Inde, qui vise à les amener à assumer la responsabilité de leur santé personnelle de façon distincte de celle des EC, qui met l'accent sur l'autoprise en charge. Ces programmes devront peut-être mettre l'accent sur les connaissances et les croyances relatives aux habitudes de vie dans le domaine de la santé comme base des changements de comportement en santé.

Getting it "right": how collaborative relationships between people with disabilities and professionals can lead to the acquisition of needed assistive technology.

PURPOSE: The purpose of this study was to examine the impact of a consumer-led equipment and device program [Equipment and Assistive Technology Initiative (EATI) in British Columbia, Canada] from the perspective of program participants. The importance of collaborative assessments for obtaining the right assistive technology (AT) for meeting an individual's needs is discussed in light of the program's participant-centered "Participation Model", or philosophy by which the program is structured. METHOD: A cross-sectional survey with participants and semi-structured interviews were conducted with participants (≥ 18 years) who held a range of disabilities. The survey asked participants to rank their AT and to identify the method by which they obtained the technology [by self, prescribed by a health professional or collaborative (self and professional)]. Interviews addressed participants' opinions about obtaining and using AT. RESULTS: In total, 357 people responded to the survey (17% response rate) and 16 people participated in the interviews. The highest ranking AT was assigned to devices assessed via a collaborative method (self = 31%, practitioner = 26%, collaborative = 43%; χ(2) (16,180) = 39.604, p < 0.001). CONCLUSIONS: Shared decision-making between health professionals and people with disabilities within the assessment process for assistive technology leads to what participants perceive as the right AT. IMPLICATIONS FOR REHABILITATION: Collaborative decision-making can lead to the selection of assistive technology that is considered needed and right for the individual. Person-centered philosophy associated with assistive technology assessment is contributing to attaining "the right" AT.

Culture as a variable in health research: perspectives and caveats.

To augment the rigor of health promotion research, this perspective article describes how cultural factors impact the outcomes of health promotion studies either intentionally or unintentionally. It proposes ways in which these factors can be addressed or controlled in designing studies and interpreting their results. We describe how variation within and across cultures can be considered within a study, e.g. the conceptualization of research questions or hypotheses, and the methodology including sampling, surveys and interviews. We provide multiple examples of how culture influences the interpretation of study findings. Inadequately accounting or controlling for cultural variations in health promotion studies, whether they are planned or unplanned, can lead to incomplete research questions, incomplete data gathering, spurious results and limited generalizability of the findings. In health promotion research, factors related to culture and cultural variations need to be considered, acknowledged or controlled irrespective of the purpose of the study, to maximize the reliability, validity and generalizability of study findings. These issues are particularly relevant in contemporary health promotion research focusing on global lifestyle-related conditions where cultural factors have a pivotal role and warrant being understood.

Associations between social participation and subjective quality of life for adults with moderate to severe traumatic brain injury.

PURPOSE: To examine the association between social participation and subjective quality of life (SQOL) for non-employed, community-dwelling adults with moderate to severe traumatic brain injury (TBI) at 1 year or greater post-injury. METHOD: A correlational study was conducted involving 46 participants. Social participation was measured using the Community Integration Questionnaire, Social Provisions Scale and the Adult Subjective Assessment of Participation. SQOL was measured using the Quality of Life and Health Questionnaire, Abdel-Khalek Happiness Scale and UCLA Loneliness Scale. RESULTS: Higher levels of happiness and global quality of life were each associated with higher levels of enjoyment, satisfaction with performance and higher proportion of activities performed with others. Lower levels of loneliness were associated with higher levels of general social integration and higher levels of perceived social supports. There were no associations found between SQOL and the objective social participation measures of diversity, frequency (intensity) or proportion of activities performed outside of home. CONCLUSIONS: Findings contribute to the TBI literature in showing that it is: (a) the more subjective and not objectively measured nature of participation that is associated with SQOL and (b) positive and negative aspects of quality of life show different relationships with social participation variables. Implications for Rehabilitation A high proportion of individuals with traumatic brain injury (TBI) experiences reduced involvement in social participation (involvement in social and leisure activities and within a social network) and low subjective quality of life (SQOL). This study suggests that, by simply increasing the variety and frequency of social and leisure activities, there may be no positive influences on SQOL. Instead, this study suggests that, to increase SQOL, it is important to increase opportunities for individuals to participate with others and also to enhance their subjective experience of social and leisure activities. The large variance obtained of scores for social participation and SQOL provide a reminder to clinicians to maintain an individualized approach when working with individuals with TBI.

Occupational therapy for patients with problems in personal activities of daily living after stroke: systematic review of randomised trials.

OBJECTIVE: To determine whether occupational therapy focused specifically on personal activities of daily living improves recovery for patients after stroke. DESIGN: Systematic review and meta-analysis. DATA SOURCES: The Cochrane stroke group trials register, the Cochrane central register of controlled trials, Medline, Embase, CINAHL, PsycLIT, AMED, Wilson Social Sciences Abstracts, Science Citation Index, Social Science Citation, Arts and Humanities Citation Index, Dissertations Abstracts register, Occupational Therapy Research Index, scanning reference lists, personal communication with authors, and hand searching. REVIEW METHODS: Trials were included if they evaluated the effect of occupational therapy focused on practice of personal activities of daily living or where performance in such activities was the target of the occupational therapy intervention in a stroke population. Original data were sought from trialists. Two reviewers independently reviewed each trial for methodological quality. Disagreements were resolved by consensus. RESULTS: Nine randomised controlled trials including 1258 participants met the inclusion criteria. Occupational therapy delivered to patients after stroke and targeted towards personal activities of daily living increased performance scores (standardised mean difference 0.18, 95% confidence interval 0.04 to 0.32, P=0.01) and reduced the risk of poor outcome (death, deterioration or dependency in personal activities of daily living) (odds ratio 0.67, 95% confidence interval 0.51 to 0.87, P=0.003). For every 100 people who received occupational therapy focused on personal activities of daily living, 11 (95% confidence interval 7 to 30) would be spared a poor outcome. CONCLUSIONS: Occupational therapy focused on improving personal activities of daily living after stroke can improve performance and reduce the risk of deterioration in these abilities. Focused occupational therapy should be available to everyone who has had a stroke.

Employment after spinal cord injury: the impact of government policies in Canada.

The British Columbia Paraplegic Association (BCPA) sought a research partnership to evaluate where its activities should be focused. A survey of members with disabilities of the BCPA included questions on employment and identified three priorities related to employment. These were the need for assistance in finding appropriate work, the impact of policies of government and insurance agencies, and attitudes of employers. This paper examines the social and political environment related to employment following spinal cord injury in British Columbia, Canada. There is no coherent set of goals underlying government employment and income programs in Canada. Incremental development of particular employment and income programs during the 20th century led to a patchwork of policies and programs, which deal with people differently according to the cause of their disability. Federal and provincial governments have attempted to educate employers and reduce barriers to employment of those with disabilities by focusing on anti-discrimination legislation and individual rights (e.g. the Employment Equity Act and the Canadian Human Rights Act). However, people with disabilities face non-accommodating environments, inadequate income support, lack of opportunities and little political influence which stem from an unfair distribution of societal resources, not from discrimination. Joint efforts of the BCPA and other disability organizations are likely to have the most impact on legislative changes.

Community participation after spinal cord injury.

OBJECTIVES: To describe participation among a community-based sample of adults with spinal cord injury (SCI) and to explore the relationship between participation and life satisfaction. DESIGN: Survey. SETTING: Community. PARTICIPANTS: A sample of 357 people (response rate, 44%) with SCI recruited through the British Columbia Paraplegic Association. The mean age +/- standard deviation was 46.0+/-14.7 years, mean time since SCI was 13.0+/-11.0 years, and 68% of the respondents were men. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Descriptive survey data on community participation specifically related to social involvement, physical activity and relationship with others, transportation, and community access. Life satisfaction and happiness assessed using the Satisfaction With Life Scale and Happiness Scale. RESULTS: No limitations to participation were experienced by 18.5% of the respondents. Satisfaction with transportation was associated with owning one's own vehicle (P<.001). There was overall satisfaction with access to community buildings (mean score range, 6.9-8.5; where 10 is most satisfied). Being physically active was important to a majority and 75% were currently engaged in physical activity. Those living alone were less satisfied (mean, 7.3+/-2.7; where 10 is most satisfied) with the support they received than those living with others (8.5+/-1.7). Respondents were generally happy (5.0+/-1.4) and satisfied with life (18.6+/-7.6). CONCLUSIONS: This study provides a rich description of the multifaceted nature of participation and its association with life satisfaction as identified by people with SCI living in the community.

The impact of reimbursement systems on occupational therapy practice in Canada and the United States of America.

Different funding and cost-control mechanisms in Canada and the United States of America (USA) have a powerful influence on occupational therapy practice in each country. Canada's public health insurance system emphasizes access to health care services based on medical need. Costs are controlled at the provincial government level by limiting the capacity of facilities and personnel. Occupational therapists in publicly-funded settings have considerable professional autonomy to use occupational therapy theoretical models and to be client-centred. The measurement of outcomes is not always required and the interventions of individual occupational therapists are infrequently scrutinized. The USA has no universal, publicly-funded, comprehensive health insurance. Health care policies are driven by financial priorities and cost control occurs at the service delivery level. Insurance companies define the scope of occupational therapy practice by identifying what services they will pay for and they scrutinize occupational therapy interventions. The emphasis on effectiveness and efficiency leads to critical examination of interventions by therapists. Canadian occupational therapists can learn much from their colleagues in the USA in this area.