Impact of a Behavioral Intervention on Diet, Eating Patterns, Self-Efficacy, and Social Support.

OBJECTIVE: To examine the effectiveness of a structured multimodal behavioral intervention to change dietary behaviors, as well as self-efficacy and social support for engaging in healthier diets. METHODS: A quasi-experimental design was used to assign sites into intervention and comparison groups. Data were collected at baseline, 3 months, and 6 months. The intervention group participated in Texercise Select, a 12-week lifestyle enhancement program. Multiple mixed-effects models were used to examine nutrition-related changes over time. RESULTS: For the intervention group, significant improvements were observed for fast food consumption (P = .011), fruit/vegetable consumption (P = .008), water consumption (P = .009), and social support (P < .001) from baseline to 3 months. The magnitude of these improvements was significantly greater than changes in the comparison group. CONCLUSIONS AND IMPLICATIONS: Findings suggest the intervention's ability to improve diet-related outcomes among older adults; however, additional efforts are needed to maintain changes over longer periods.

"You've Got to Love Yourself": Photovoice Stories From African Americans and Hispanic/Latinos Living With Diabetes.

INTRODUCTION: Health disparities persist among African Americans (AAs) and Latino adults with type 2 diabetes. The purpose of this research was to use PhotoVoice to examine AAs and Latinos' daily experiences of managing diabetes. METHOD: An exploratory, descriptive study using PhotoVoice and focus groups was conducted over a 3-week period: Week 1 orientation session, Week 2 photo taking and returning cameras, and Week 3 focus group to share and discuss photos. RESULTS: Ten AAs and nine Latino adults were enrolled, forming four focus groups. Four categories emerged: (1) daily life living with type 2 diabetes mellitus, (2) negative and positive emotions, (3) supports and barriers, and (4) needs. The social determinants of health influencing diabetes self-care were observed in discussions and photos-this included the built environment to promote a healthy lifestyle, social support, and education. IMPLICATIONS: PhotoVoice promotes culturally congruent care to better understand AA and Latinos' experience living with type 2 diabetes mellitus.

Translating an evidence-based diabetes education approach into rural african-american communities: the "wisdom, power, control" program.

Purpose. The aim of this exploratory study was to assess the efficacy of the "Wisdom, Power, Control" diabetes self-management education (DSME) program with regard to diabetes knowledge, self-efficacy, self-care, distress level, and A1C in an African-American population. Methods. A prospective, quasi-experimental, repeated-measure design was employed to measure these outcomes. Study participants were assessed at baseline, 6 weeks post-intervention, and at a 3-month A1C follow-up. Results. A total of 103 participants were recruited from the intervention counties, and 14 were identified from the control counties. At the post-test, participants in the intervention group reported a significantly higher level of diabetes knowledge (Δ = 9.2%, P <0.0001), higher self-efficacy (Δ = 0.60, P <0.0001), more self-care behaviors (Δ = 0.48, P <0.0001), lower distress level (Δ = -0.15, P = 0.05), and higher health status (Δ = 0.49, P = <0.0001). About 56% of the intervention group completed all six classes, and 25% attended five classes. Conclusions. Findings from this study demonstrate the initial success of translating a culturally adapted DSME program into rural African-American communities. The study highlights important lessons learned in the process of implementing this type of program in a real-world setting with a minority population.

An application of a diabetes knowledge scale for low-literate Hispanic/Latinos.

PURPOSE: The threefold purpose of this study is to assess diabetes knowledge among Hispanic/Latinos attending a culturally sensitive, empowerment-based, diabetes self-management education program; second, to examine the utility of the Spoken Knowledge in Low Literacy in Diabetes (SKILLD) scale as an assessment tool for this population; and third, to assess the relationship between hemoglobin A1C and knowledge improvement in the intervention group. METHOD: A prospective, quasi-experimental, repeated-measure design tested pre- and post-A1C and diabetes knowledge using the SKILLD scale. The sample consisted of 71 in the intervention group and 64 controls. RESULTS: Most participants were female, marginally acculturated, and, on average, 60 years of age. Both groups were similar in baseline diabetes knowledge score (median 6 out of 10), and higher literacy was significantly related to increased baseline knowledge. The intervention group significantly improved at follow-up compared with the controls: Participants in the intervention with low baseline knowledge scores had a mean follow-up score of 5.6; those with a high baseline score had a mean score of 7.6. The intervention cohort scored significantly better in knowing why to see an eye doctor, what are normal fasting blood glucose and A1C, and understanding long-term diabetes complications. Increased knowledge of a normal fasting blood glucose level had a significant effect on follow-up A1C in the intervention group. CONCLUSION: The intervention favorably affects diabetes knowledge, and the SKILLD scale has utility with low-literate Hispanic/Latinos. The significant impact on A1C by diabetes knowledge gain shows that the empowerment-based diabetes self-management education was successful for this ethnic population.

Outcomes of online support and resources for cancer survivors: a systematic literature review.

OBJECTIVE: This study aims to review systematically the available literature on health outcomes of online cancer support and resources. METHODS: We searched major databases with the following selection criteria: (1) empirical study on use of online support or resources by cancer survivors, (2) reporting effects or outcomes of online support or resources, (3) focusing on adult cancer survivors, and (4) peer-reviewed articles published by 2010. RESULTS: A total of 24 studies (37 articles) were included in the review. Most studies were focused on breast cancer survivors and had small sample sizes. Fifteen studies employed a cross-sectional design including eight qualitative studies. Only five studies used pre-post design, and four employed RCT design. The outcome measures have focused on psychosocial effects; most studies reported positive effects, although none of the RCT studies reported significant outcomes. CONCLUSION: Existing studies of online cancer support and resources have demonstrated preliminary but inconclusive evidence for positive outcomes. We call for additional studies with rigorous study designs and the inclusion of more diverse participants and cancer conditions. PRACTICE IMPLICATIONS: Connecting diverse cancer survivors to culturally appropriate, evidence-based online support and resources is a strategy to enhance health outcomes.

An empowerment-based diabetes self-management education program for Hispanic/Latinos: a quasi-experimental pilot study.

PURPOSE: The purpose of this pilot study was to evaluate the effects of a culturally sensitive, empowerment-based diabetes self-management education program for Spanish-speaking Hispanic/Latinos. METHODS: A prospective quasi-experimental repeated measures design tested the effectiveness of the ¡Si, Yo Puedo Controlar Mi Diabetes! diabetes self-management education program. In sum, 144 persons residing in 2 Texas counties at the Texas-Mexico border (Starr and Hidalgo) served as participants. Two groups were formed, an intervention and a control (wait list). Clinical (A1C), cognitive, attitudinal, behavioral, and cultural assessments were collected at baseline and 3 months. RESULTS: Demographic characteristics for the intervention and control groups were similar. Both groups were predominately female, low income, older than 40 years, and minimally acculturated. Baseline and posttest findings showed that the intervention group had a significant reduction in A1C values; median difference was 0.3 (n = 45), especially for those with higher baseline values. Participants in the intervention group also improved in their self-efficacy and self-care scores. CONCLUSIONS: Findings from the study suggest that additional dissemination of a diabetes self-management education program for Spanish-speaking Hispanic/Latinos is warranted to improve clinical outcomes and associated diabetes self-efficacy and self-care behaviors.