Predictors of adherence with self-care guidelines among persons with type 2 diabetes: results from a logistic regression tree analysis.

Type 2 diabetes is known to contribute to health disparities in the U.S. and failure to adhere to recommended self-care behaviors is a contributing factor. Intervention programs face difficulties as a result of patient diversity and limited resources. With data from the 2005 Behavioral Risk Factor Surveillance System, this study employs a logistic regression tree algorithm to identify characteristics of sub-populations with type 2 diabetes according to their reported frequency of adherence to four recommended diabetes self-care behaviors including blood glucose monitoring, foot examination, eye examination and HbA1c testing. Using Andersen's health behavior model, need factors appear to dominate the definition of which sub-groups were at greatest risk for low as well as high adherence. Findings demonstrate the utility of easily interpreted tree diagrams to design specific culturally appropriate intervention programs targeting sub-populations of diabetes patients who need to improve their self-care behaviors. Limitations and contributions of the study are discussed.

Is diabetes-specific health literacy associated with diabetes-related outcomes in older adults?

BACKGROUND: The present study examined the association between a measure of diabetes-specific health literacy and three different Type 2 diabetes outcome indicators in a national sample of older adults. METHODS: Data were taken from the Health and Retirement Study (HRS) 2003 Diabetes module and the HRS 2002 core wave. Analysis was performed on data from 1318 respondents aged 42-96 years [mean (±SD) 67.96 ± 8.65 years] who submitted responses on all relevant independent variable measures along with an HbA1c test kit. The index of diabetes-specific health literacy was constructed from responses to 10 diabetes self-care regimen items (α = 0.927). RESULTS: Using a multivariate regression strategy to analyze weighted data, the diabetes-specific health literacy index was significantly and positively associated with self-graded assessment of diabetes self-care (R2 = 0.231). However, diabetes-specific health literacy was not independently associated with the HbA1c level or the average number of days five recommended self-management behaviors were practiced each week. CONCLUSIONS: No previous single study has focused on the relationship between diabetes-specific health literacy and multiple diabetes-related outcomes. The direct association of diabetes-specific health literacy with patients' assessment of their self-care practice acumen is useful information for the design of effective patient intervention and/or communication strategies. Health literacy is a broad, multidimensional construct that bridges basic literacy skills and various health and illness contexts. Because it is so important to adults engaged in the self-management of chronic illness, indicators of disease-specific knowledge and/or understanding should be included in efforts to measure health literacy.

Promoting active engagement in health research: lessons from an undergraduate gerontology capstone course.

With National Institutes of Health/National Institute of Aging (NIH/NIA) (R15/AREA) funding, the authors offered a four-credit hour undergraduate research course that was cross-listed in gerontology and sociology. This capstone course was aimed at providing students with the opportunity to (1) gain knowledge about diabetes and racial/ethnic disparities in the management of the illness and (2) develop expertise in secondary data analysis, using the Behavioral Risk Factor Surveillance System (BRFSS) data set. Each student designed and conducted her or his own research project and, working in teams, created a team poster and presentation. The authors examine student pretest/posttest questionnaire data, rubric-based assessment of students' work, and mid- and end-of-the-semester student evaluations to highlight three distinct aspects of the course: (1) skills acquired by students, (2) students' evaluation of the course, and (3) successes and challenges of implementing the course.

Diabetes self-care among a multiethnic sample of older adults.

Type 2 diabetes constitutes a leading and increasing cause of morbidity and mortality among older adults, particularly African Americans, Native Americans, Mexican Americans, and rural dwellers. To understand diabetes self-care, an essential determinant of diabetic and overall health outcomes, 80 middle aged and older adults from these four disproportionately affected racial/ethnic/residential groups engaged in in-depth interviews, focusing on approaches to and explanations for diabetes self-care. Certain self-care activities (medication-taking, diet, foot care) were performed regularly while others (blood glucose monitoring, exercise) were practiced less frequently. Despite research suggestions to the contrary, only one in four elders used unconventional diabetes therapies, and only one-third listed someone other than a health care provider as a primary information source. Few self-care differences emerged according to race/ethnicity/residence, perhaps because of the influential and common circumstance of low income. Thematic analyses suggest that inadequate resources, perceived efficacy of medication, great respect for biomedical authority, and lack of familiarity with and concerns about unconventional therapies are influential in establishing these patterns of self-care. We discuss the similarity of self-care practices and perspectives irrespective of race/ethnicity/residence and the predominance of biomedical acceptability.

Lay explanations and self-management of diabetes in Kathmandu, Nepal.

OBJECTIVE: This research explores the lay explanations and self-management of diabetes among residents in greater Kathmandu, Nepal. METHODS: Interviews were done with 300 respondents drawn from diabetes patient listings and members of a national diabetes club. Sociodemographic and health-related data were collected with two standardized instruments: the Illness Perception Questionnaire and the Summary of Diabetes Self-Care Activities. Hierarchical ordinary least squares regression analyses were employed to examine predictors of self-management of diabetes. RESULTS: Across seven equations, R(2) values ranged from .020 to .221, and with the exception of one domain of self-management (blood sugar testing), one or more lay explanatory factors entered each equation. DISCUSSION: Respondents from this sample appear to hold lay explanations of diabetes that are similar to those of their peers in developed nations. Findings are discussed, including the caveat that these mostly male, relatively educated, and urban-residing adults with diabetes are not necessarily representative of Nepali society.

Situating stress: lessons from lay discourses on diabetes.

In response to the serious toll diabetes takes on health and resources, researchers increasingly are examining physical and psychological pathways that affect and are affected by diabetes, including stress. Although biomedical researchers and practitioners are beginning to recognize the association between stress and diabetes onset and management, laypersons have long-standing and extensive insights into the multiple ways in which stress is associated with the diabetes disease process. In this article, we examine lay perspectives on stress and diabetes among a multiethnic sample of 80 adults. Participants suggest varying arenas in which stress intersects with diabetes, including stress as implicated in the origin of diabetes, as a threat to maintaining glycemic control, as a challenge to self-management, and as a precursor to and a consequence of diabetes complications. An improved understanding of such perspectives may enhance appropriate disease management and develop a more valid conceptualization of stress in research efforts.

Complementary and alternative medicine use among a multiethnic sample of older adults with diabetes.

OBJECTIVE: This study describes complementary and alternative medicine (CAM) use for diabetes self-management among a multiethnic sample with an aim of better understanding lay perspectives on CAM's utility and determining whether CAM practices undermine conventional diabetes self-management. DESIGN: During in-depth interviews with 80 older adults, data were collected on sociodemographics, the full range of self-management practices, and attitudes toward CAM. Analysis included descriptive measures of association and line-by-line coding. SETTING/LOCATION: Trained interviewers recruited respondents from four health or social service sites. Sites were selected because they contained a large clientele of the targeted ethnic group and had been involved successfully in previous research studies. SUBJECTS: Twenty (20) adults age 50 and older from each of the groups most adversely affected by diabetes (African Americans, Hispanics, Native Americans, rural whites) participated in the study. OUTCOME MEASURES: Self-management strategies (included CAM) were assessed through a semistructured interview guide. Structured instruments obtained data on sociodemographics and health history. The 15-item Summary of Diabetes Self-Care Activities Questionnaire (SDSCA) assessed the frequency of completing recommended self-management activities. RESULTS: One in four elders reported using CAM, with respondents' cultural background associated with the CAM modality. We found no relationship between standard biomedical regimens and CAM use, supporting respondents' suggestion that CAM supplements rather than substitutes for biomedical self-management. Respondents suggested that use of CAM was limited by CAM's inaccessibility, and, underlying all, the dominance of conventional biomedical therapies that undermines belief in CAM's effectiveness. CONCLUSION: Older adults with diabetes use a flexible configuration of diabetes-self-management techniques, including culturally specific CAM modalities. CAM use, however, occupies a limited role in diabetes self-management, largely because of the predominance of conventional biomedical regimens.

Exploring the factorial structure of the EORTC QLQ-C30: Racial differences in measuring health-related quality of life in a sample of urban, older adults.

OBJECTIVES: To assess the European Organization for Research and Treatment of Cancer's 30-item Quality of Life Questionnaire (QLQ-C30) for use with a multiracial study population of adults. METHODS: Adults aged 50 and older were randomly selected from patients who made at least one visit to the Henry Ford Health System in Detroit, Michigan in 1998. RESULTS: African American (n = 255) and White (n = 234) subsamples were separately subjected to exploratory factor analysis; each yielded seven factors with eigenvalues above 1.00, accounting for approximately 65% of the variance, although the factorial structures of the subsamples were different. DISCUSSION: Participants were not screened for cancer or other illnesses, which may contribute to differences between the known scoring model and these results. Researchers are advised to conduct separate analyses on racial/ethnic groups and to supplement the QLQ-C30 with additional items pertinent to the populations being studied and/or the conceptual/theoretical paradigm being tested.