Impact of Gaming (Gamification) on Diabetes Self-Care Behaviors and Glycemic Outcomes Among Adults With Type 2 Diabetes.

PURPOSE: The purpose of this systematic review was to determine if the use of gaming (gamification) among persons with type 2 diabetes improves diabetes self-management behaviors and diabetes outcomes. METHODS: A systematic review was conducted using electronic databases including MEDLINE, Embase, Web of Science, and CINAHL. Studies reporting on the impact of gaming on at least 1 of the Association of Diabetes Care and Education Specialists self-care behaviors (ADCES7) were included. RESULTS: The review included 9 studies, 8 of which were of strong/high quality. Five of the self-care behaviors were addressed in at least 1 of the included studies. However, taking medications and problem solving were not reported in any of the studies. Physical activity and self-efficacy or quality of life (healthy coping) were the most frequently reported ADCES7 behaviors. Six of the studies used A1C as an outcome measure, with a reduction reported in all the studies except 1. CONCLUSION: Type 2 diabetes affects a person holistically, necessitating a range of self-care behaviors to effectively manage the chronic condition. Novel gaming interventions may improve coping mechanisms, lifestyle behaviors, medication engagement, and monitoring of risks and problems, all of which are essential in facilitating optimal diabetes self-management.

Recommendations to improve maternal health equity among Black women in "The South": A position paper from the SNRS minority health research interest & implementation group.

Black women in the United States experience a higher maternal mortality rate compared to other racial groups. The maternal mortality rate among non-Hispanic Black women is 3.5 times that of non-Hispanic White women and is higher in the South compared to other regions. The majority of pregnancy-related deaths in Black women are deemed to be preventable. Healthy People 2030 directs healthcare providers to advance health equity through societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and healthcare disparities. The Southern Nursing Research Society has put forward this position paper to provide recommendations to improve maternal health equity among Black women. Recommendations for nurses, multidisciplinary healthcare providers, policymakers, and researchers are discussed.

Implementation of an Online Affirmation Discussion for RN-to-BSN Students.

This article describes a quality improvement project that studied students' perceptions about how writing affirmations on an online discussion board helped them transition into the first semester of an RN-to-BSN online program. Analysis of students' responses revealed themes (Transition to a New Group, Enhanced Critical Thinking, and Focus on Client-Centered Care) that aligned with holistic nursing practice and nursing role development.

Changes in Patient-Reported Outcome Measures With a Technology-Supported Behavioral Lifestyle Intervention Among Patients With Type 2 Diabetes: Pilot Randomized Controlled Clinical Trial.

BACKGROUND: In the United States, more than one-third of the adult population is obese, and approximately 25.2% of those aged ≥65 years have type 2 diabetes (T2D), which is the seventh leading cause of death. It is important to measure patient-reported outcomes and monitor progress or challenges over time when managing T2D to understand patients' perception of health and quantify the impact of disease processes or intervention effects. The evaluation of patient-reported outcome measures (PROMs) is especially important among patients with multiple chronic conditions in which clinical measures do not provide a complete picture of health. OBJECTIVE: This study examined the feasibility of collecting Patient-Reported Outcome Measurement Information System (PROMIS) measures, and preliminarily evaluated changes in PROMIS scores and compared the scores with standard scores of the general US population. The parent study is a pilot randomized controlled clinical trial testing three different modes (mobile health [mHealth], paper diary, and control) of self-monitoring in a behavioral lifestyle intervention among overweight or obese patients with T2D. METHODS: Patients with comorbid overweight or obesity and a diagnosis of T2D for at least 6 months were recruited from a diabetes education program. Participants were randomized to the following three groups: mHealth, paper diary, and control (standard of care) groups. Paper diary and mHealth experimental groups received additional behavioral lifestyle intervention education sessions, as well as tools to self-monitor weight, physical activity, diet, and blood glucose. All participants completed PROMIS-57 and PROMIS-Global Health (GH) version 1.0 questionnaires during visits at baseline, 3 months, and 6 months. The PROMIS-57 includes the following seven domains: anxiety, depression, fatigue, pain interference, physical function, satisfaction with participation in social roles, and sleep disturbance. The PROMIS-GH is composed of the following two domains: global mental health and global physical health. RESULTS: A total of 26 patients (mHealth, 11; paper diary, 9; control, 6) were included in our analysis. The study sample was predominantly African American (68%) and female (57%), with a mean age of 54.7 years and a mean BMI of 37.5 kg/m2. All patients completed the PROMIS-57 and PROMIS-GH questionnaires, and we compared the mean scores of the three groups to investigate potential differences. No relevant differences were noted across the groups. However, positive trends were noted in both intervention (mHealth and paper diary) groups in the middle (month 3) and end (month 6) of the study. CONCLUSIONS: Our pilot study provides evidence for the feasibility of using PROMIS questionnaires to record important components of T2D-related symptoms among overweight or obese individuals. The results from our study support the use of PROMIS questionnaires to provide clinicians and researchers with a benchmark for assessing the overall need for symptom management and determining the success or challenges of an intervention. TRIAL REGISTRATION: ClinicalTrials.gov NCT02858648; https://clinicaltrials.gov/ct2/show/NCT02858648.

Health Beliefs Regarding Cardiovascular Disease Risk and Risk Reduction in South Asian Immigrants: An Integrative Review.

Introduction: The risk for cardiovascular disease (CVD) is higher in South Asians (SAs) than in other ethnic groups. The purpose of this review is to explore SAs' health beliefs regarding CVD risk and risk reduction behaviors including physical activity and healthy diet. Methodology: An integrative review was conducted to examine the peer-reviewed literature published before May 2017. Searches from PubMed, Scopus, and CINAHL yielded 1 mixed-method, 4 quantitative, and 14 qualitative studies. Results: Stress, lack of exercise, and high-fat diet were perceived as causes of CVD in most studies. Lack of time, sociocultural norms, and insufficient guidance from health care providers were perceived barriers to CVD risk reduction. Exercise and healthy diet were perceived to be beneficial in a few studies. Cues to action included information from community leaders and health care providers. Discussion: Understanding the unique health beliefs of SAs regarding CVD is important in planning and delivering culturally competent preventive and educational services.

Mediating Role of Acculturation and Lifestyle Behaviors on Cardiometabolic Risk Among a National Sample of U.S. Asian Indians.

Asian Indians are the third largest and fastest growing Asian subgroup in the U.S. and have high risks for diabetes and cardiovascular disease. This study explored the mediating role of lifestyle behaviors on the relationship between acculturation and cardiometabolic risk factors among Asian Indians using the Diabetes in Indian Americans national study. The cross-sectional study sample comprised 1038 randomly selected adult Asian Indians in seven U.S. sites. Acculturation was assessed using the Acculturation Scale for Southeast Asians. Diet and lifestyle behaviors were measured using the Health-Promoting Lifestyle Profile II subscales. Path analyses with bootstrap methods were conducted. Dietary behavior significantly mediated the relationship between acculturation and HbA1C (ß = 0.004, p = 0.047), and physical activity mediated the relationship between acculturation and HDL (ß = 0.08, p = 0.011). Other mediation models were not significant (p > 0.05). Mediating factors besides lifestyle behaviors should be explored in future studies.

Cultural factors associated with physical activity among U.S. adults: An integrative review.

AIM: The purpose of this integrative review is to identify the cultural factors associated with physical activity (PA) among United States (U.S.) adults. BACKGROUND: Physical inactivity is a significant public health problem that requires comprehensive community-based efforts. Cultural factors influence behavior and attitudes towards PA. Therefore, identifying the cultural factors is a key requirement for the planning of specific measures to enhance the level of PA and are more promising than campaigns aimed at the general population. This integrative review examined existing research on cultural factors influencing adult PA to inform the development of culturally adapted PA interventions in adults. METHODS: Literature searches were conducted in key scientific databases (PubMed, Cumulative Index to Nursing and Allied Health, and PsycINFO) using several key words related to both culture and PA. Fifteen peer-reviewed articles were identified, reviewed, synthesized, and critically analyzed. RESULTS: Eight major categories of cultural factors were identified: 1) collectivism and cultural identity; 2) religiosity; 3) cultural attitudes and gender norms in regards to PA; 4) cultural perspectives on health in regards to PA; 5) cultural expectations of familism and lack of time; 6) lack of role models and lack of motivation; 7) lack of culturally appropriate exercise facilities; and 8) cultural expectations of body image and physical appearance. CONCLUSIONS: Review findings emphasize the need for health promotion targeted toward improving cultural barriers to PA among U.S. Adults.