A Community-Academic Collaboration to Support Chronic Disease Self-Management among Individuals Living in Permanent Supportive Housing.

BACKGROUND: Individuals experiencing chronic homelessness with a chronic health condition may qualify for permanent supportive housing (PSH). Given limited PSH resources, it is important to identify priority programming with demonstrated effectiveness. OBJECTIVES: A community-academic partnership was formed to address the priority health needs of individuals living in PSH. METHODS: Community stakeholders identified diabetes self-management as a priority health need. Wisdom, Power, Control (WPC), an evidence-based diabetes self-management program, was piloted for seven weeks with diabetic (type 2) or prediabetic PSH residents. A survey was administered at baseline and program completion. HbA1c was assessed at baseline and 3-month follow-up. RESULTS: Those who completed the Program (N = 10), reported a significant increase in diabetes knowledge, self-efficacy and foot self-care. The average hemoglobin A1c (HbA1c) of the participants significantly decreased from 8.86 to 6.88. CONCLUSIONS: Pilot data from this study provides an example of a community-academic partnership that improved the health of individuals in PSH through evidence-based programming.

Development of a diabetes self-management + mHealth program: tailoring the intervention for a pilot study in a low-income setting in Mexico.

BACKGROUND: Type 2 diabetes (T2D) is a public health pandemic disproportionately affecting low- and middle-income countries. The purpose of this formative research was to adapt evidence-based diabetes self-management education programs to the context of Seguro Popular clinics in Mexico. A theory-based mHealth (pictorial text messaging) component was developed. METHOD: Our formative research and development of the program protocol consisted of six phases: (1) interviews and focus groups with stakeholders on the challenges to T2D management, curriculum content needs, and the use of mHealth as a supplement to a DSME program; (2) review of the theoretical underpinning, curriculum, and interactive strategies of four evidence-based DSME programs and modification to meet the needs of adults with T2D and systems of care in Mexico City; (3) development of theory-based illustrated text messages; (4) evaluation of text messaging acceptability and access in adults with T2D via focus groups; (5) development of program manual; and (6) development of a training program for health care providers. RESULTS: The ¡Sí, Yo Puedo Vivir Sano Con Diabetes! included 7 group-based weekly lessons; simple, interactive content; weekly empowerment messages; video novellas; group activities; and goal setting. Adaptations to the cultural context of Mexico included content/activities on diabetes etiology (addressing cultural misconceptions), nutrition (indigenous foods and plate method), self-blood glucose monitoring, and diabetes-related stress/coping. We used the Health Action Process Approach to guide the text message development, which posits that adoption, initiation, and maintenance of health behaviors require the development of intentions, plans, coping, and self-efficacy. Our final text message bank consisted of 181 messages. There were approximately 20-30 messages for each process of behavior change (e.g., action planning, maintenance self-efficacy) and 30 messages for each content topic (e.g., eating healthy, physical activity). There were 96 messages that were illustrated. Training materials were also developed. DISCUSSION: We used a systematic approach, collaboration with stakeholders, and a well-established behavior change theory to develop an evidence-based intervention to an international context and system of care. Collectively, this process has the potential to enhance the feasibility, acceptability, and efficacy of the program.

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.

Impact of Diabetes Self-Management Education on Psychological Distress and Health Outcomes Among African Americans and Hispanics/Latinos With Diabetes.

PURPOSE: Diabetes self-management education and support (DSME/S) is an effective strategy to improve health outcomes. However, little is known about the impact of formal DSME/S on psychological distress among minority populations. The study purposes were to 1) explore the impact of a culturally tailored DSME/S intervention on psychological distress and diabetes-related outcomes among African-American and Hispanic/Latino participants and 2) examine differences across groups in self-care, self-efficacy, diabetes knowledge, and psychological distress. METHODS: Using a pre- and post-test research design, baseline and post-test assessments were conducted at weeks 1 and 7 of the intervention, respectively. Statistical analyses included descriptive statistics for demographic variables and four outcomes (self-care, self-efficacy, knowledge, and psychological distress score), general linear regression analysis of the post-test outcomes, and the Spearman correlation between psychological distress score and the outcomes. RESULTS: Compared to African-American participants (n = 122), Hispanic/Latino participants (n = 137) were significantly younger and less educated. The two groups were comparable in sex, income, and health status. Significant pre- to post-test improvements were seen in each group for self-care, self-efficacy, and psychological distress. Diabetes knowledge had moderate improvement. Hispanics/Latinos had significantly greater post-test self-efficacy and self-care scores compared to African Americans. For both African-American and Hispanic/Latino participants, lower psychological distress scores were generally associated with greater self-efficacy and self-care. Psychological distress scores were not significantly associated with knowledge in African-Amerian or Hispanic/Latino participants. For African Americans only, better health status was significantly associated with less psychological distress. CONCLUSION: DSME/S programs have the potential to improve psychological health among African Americans and Hispanics/Latinos, which can lead to better diabetes outcomes.

"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.

Extending cancer prevention to improve fruit and vegetable consumption.

Consuming a diet that is rich in fruits and vegetables is critical for preventing cancer and cancer-related disparities. Food systems approaches that increase spatial-temporal, economic, and social access to fruits and vegetables may ultimately result in improved consumption patterns among Americans. Engaging the triad of Cooperative Extension Services, public health systems, and community health centers may yield maximal public health benefits from food systems interventions. These entities have a mutual interest in promoting health equity and community and economic vitality that provides common ground to (a) implement solutions through the dissemination of evidence-based programs and (b) share resources to foster grassroots support for sustained change. Working together, these systems have an unprecedented opportunity to build on their common ground to implement, evaluate, and disseminate evidence-based food systems interventions in communities and with populations experiencing disparate risk for cancer and cancer-related diseases.

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.

Hispanics' use of Internet health information: an exploratory study.

PURPOSE: The research examined use of the Internet to seek health information among Hispanics in the United States. METHODS: A secondary analysis used the Impact of the Internet and Advertising on Patients and Physicians, 2000-2001, survey data. Pearson's chi(2) test, multivariate analysis of variance (MANOVA), analysis of variance (ANOVA), and independent samples t tests were conducted to test for relationships and differences between facets of Hispanic and non-Hispanic white online health information seeking. RESULTS: Findings indicated lower Internet health information seeking among Hispanics (28.9%, n=72) than non-Hispanic whites (35.6%, n=883). On a scale of 1 (strongly agree) to 4 (strongly disagree), Hispanics were likely to agree that Internet health information improves understanding of medical conditions and treatments (M=1.65), gives patients confidence to talk to doctors about health concerns (M=1.67), and helps patients get treatment they would not otherwise receive (M=2.23). Hispanics viewed their skills in assessing Internet health information as good. Overall ratings were also positive for items related to sharing Internet health information with a doctor. Conflicting with these findings, Hispanics (M=3.33) and non-Hispanic whites (M=3.46) reported that physician-patient relationships worsened as a result of bringing online health information to a visit (scale 1=a lot better to 5=a lot worse). CONCLUSION: This study provides further evidence of differences in Internet health information seeking among Hispanics and non-Hispanic whites. Cultural discordance may be a possible explanation for Hispanics' view that the Internet negatively impacts physician-patient relationships. Strategies to increase Hispanics' access to Internet health information will likely help them become empowered and educated consumers, potentially having a favorable impact on health outcomes.