Behavioral reactivity to acute stress among Black and White women with type 2 diabetes: The roles of income and racial discrimination.

This study investigated relationships of income and self-reported racial discrimination to diabetes health behaviors following an acute stressor. A total of 77 diabetic women (51% Black, 49% White) completed a laboratory public speaking stressor. That evening, participants reported same-day eating, alcohol consumption, and medication adherence; physical activity was measured with actigraphy, and the next morning participants reported sleep quality. Measures were repeated on a counterbalanced control day. There was no mean level difference in health behaviors between stressor and control days. On stressor day, lower income predicted lower physical activity, sleep quality, and medication adherence, and higher racial discrimination predicted more eating and alcohol consumed, even after accounting confounders including race and control day behaviors.

Medication Use and Metabolic Syndrome Among Overweight/Obese Patients With and Without Binge-Eating Disorder in a Primary Care Sample.

OBJECTIVE: To examine metabolic factors among overweight/obese individuals with binge-eating disorder (BED) and non-binge-eating overweight/obese (NBO) patients recruited from primary care and to examine and compare medication use by these groups. METHOD: Participants were 102 adults recruited for a weight loss study within primary care centers who were assessed for BED (28 [38%] met DSM-5 BED criteria). Participants completed a medication log, had physiologic measurements taken, and were evaluated for the presence of metabolic syndrome using 2 methods. Data were collected between February 2012 and October 2012. RESULTS: The BED group had a higher mean body mass index (BMI), a higher pulse, and a larger waist circumference than the NBO group. Of the sample, 65% reported current medication use (prescription and/or over-the-counter medications): 19.6% took 3 to 4 medications and 15.7% took ≥ 5 medications. Aside from vitamin and over-the-counter allergy pill use, there were no differences in medication use between BED and NBO patients. Full metabolic syndrome (≥ 3 criteria met) was present in 31.5% of the sample when using objective measurement alone, and 39.1% of the sample when defined by objective measurement and pharmacologic management. No significant differences were observed regardless of definition. CONCLUSIONS: Despite higher BMI, pulse, and waist circumference, the current sample of BED patients in primary care did not present with poorer metabolic health than NBO patients.

Differential item functioning on the Schedule of Racist Events: exploring a modified scale for samples with black and white participants.

OBJECTIVE: Although both Black and White individuals report racial discrimination, self-report measures of exposure to racial discrimination that can be used across races/ethnicities are rare. The primary aim of our study was to determine if the Schedule of Racist Events (SRE), which was designed for use in Black samples, should also be used in White samples, and if so, what modifications to the scale are necessary. METHODS: In a sample of 302 adults, approximately equally divided by race, we investigated whether item endorsement differed between Black and White respondents. RESULTS: Results of confirmatory factor analysis and differential item functioning (DIF) analysis suggest that changing the item stem (from 'because you are Black' to 'because of your race/ethnicity') and removing four items that show differential item functioning and/or do not load on the first factor, results in a psychometrically sound scale with no evidence of measurement bias. CONCLUSION: Researchers interested in measuring racial discrimination in samples that include both Black and White respondents may consider using this version of the SRE. Future studies should investigate other forms of validity in Black and White samples.

Problem solving interventions for diabetes self-management and control: a systematic review of the literature.

AIMS: Problem solving is deemed a core skill for patient diabetes self-management education. The purpose of this systematic review is to examine the published literature on the effect of problem-solving interventions on diabetes self-management and disease control. DATA SOURCES: We searched PubMed and PsychINFO electronic databases for English language articles published between November 2006 and September 2012. Reference lists from included studies were reviewed to capture additional studies. STUDY SELECTION: Studies reporting problem-solving intervention or problem solving as an intervention component for diabetes self-management training and disease control were included. Twenty-four studies met inclusion criteria. DATA EXTRACTION: Study design, sample characteristics, measures, and results were reviewed. DATA SYNTHESIS: Sixteen intervention studies (11 adult, 5 children/adolescents) were randomized controlled trials, and 8 intervention studies (6 adult, 2 children/adolescents) were quasi-experimental designs. CONCLUSIONS: Studies varied greatly in their approaches to problem-solving use in patient education. To date, 36% of adult problem-solving interventions and 42% of children/adolescent problem-solving interventions have demonstrated significant improvement in HbA1c, while psychosocial outcomes have been more promising. The next phase of problem-solving intervention research should employ intervention characteristics found to have sufficient potency and intensity to reach therapeutic levels needed to demonstrate change.

Development and evaluation of the DECIDE to move! Physical activity educational video.

PURPOSE: To develop a video that provides accessible and usable information about the importance of physical activity to type 2 diabetes self-management and ways of incorporating physical activity into everyday life. CONCLUSION: A 15-minute physical activity educational video narrated by US Surgeon General Dr Regina Benjamin was developed and evaluated. The video addresses the following topics: the effects of exercise on diabetes, preparations for beginning physical activity, types of physical activity, safety considerations (eg, awareness of symptoms of hypoglycemia during activity), and goal setting. Two patient screening groups were held for evaluation and revision of the video. Patient satisfaction ratings ranged 4.6 to 4.9 out of a possible 5.0 on dimensions of overall satisfaction, how informative they found the video to be, how well the video held their interest and attention, how easy the video was to understand, and how easy the video was to see and hear. Patients reported the educational video effective in empowering them to take strides toward increasing and maintaining physical activity in their lives. The tool is currently used in a clinical research trial, Project DECIDE, as one component of a diabetes and cardiovascular disease self-management program.

Five-step methodology for evaluation and adaptation of print patient health information to meet the < 5th grade readability criterion.

BACKGROUND: In the setting of declining U.S. literacy, new policies include use of clear communication and low-literacy accessibility practices with all patients. Reliable methods for adapting health information to meet such criteria remain a pressing need. OBJECTIVES: To report method validation (study 1) and method replication (study 2) procedures and outcomes for a 5-step method for evaluating and adapting print health information to meet the current low-literacy criterion of <5th grade readability. MATERIALS: Sets of 18 and 11 publicly disseminated patient education documents developed by a university affiliated medical center. MEASURES: Three low-literacy criteria were strategically targeted for efficient, systematic evaluation, and text modification to meet a <5th grade reading level: sentence length <15 words, writing in active voice, and use of common words with multisyllabic words (>2-3 syllables) minimized or avoided. Interrater reliability for the document evaluations was determined. RESULTS: Training in the methodology resulted in interrater reliability of 0.99-1.00 in study 1 and 0.98-1.00 in study 2. Original documents met none of the targeted low literacy criteria. In study 1, following low-literacy adaptation, mean reading grade level decreased from 10.4±1.8 to 3.8±0.6 (P<0.0001), with consistent achievement of criteria for words per sentence, passive voice, and syllables per word. Study 2 demonstrated similar achievement of all target criteria, with a resulting decrease in mean reading grade level from 11.0±1.8 to 4.6±0.3 (P<0.0001). CONCLUSIONS: The 5-step methodology proved teachable and efficient. Targeting a limited set of modifiable criteria was effective and reliable in achieving <5th grade readability.

Inpatient rehabilitation diabetes consult service: a rehabilitation psychology approach to assessment and intervention.

PROBLEM: Diabetes clinical practice recommendations call for assessment and intervention on diabetes self-management during inpatient hospitalization. Although diabetes is prevalent in inpatient rehabilitation settings, diabetes self-management has not traditionally been a focus of inpatient rehabilitation psychology care. This is because diabetes is often a secondary diagnosis when an individual is admitted to rehabilitation for an acute event. OBJECTIVES: The authors provide a rationale for a role for rehabilitation psychologists in assessing and intervening on the psychosocial, behavioral, and functional self-management needs of individuals with diabetes within the rehabilitation setting. The development of a rehabilitation psychology Inpatient Rehabilitation Diabetes Consultation Service is described. Theoretical and empirical bases for compilation of the assessment and intervention materials are provided. Format and implementation of the service on a university-affiliated inpatient rehabilitation unit is described, with special consideration given to professional issues faced by rehabilitation psychologists and teams. RESULTS: A flexible consultation model was implemented using a guided diabetes psychosocial assessment with brief educational handouts addressing selected key topics (i.e., hyperglycemia, hypoglycemia, blood sugar monitoring, nutrition, physical activity, medication, and, A1C and average blood sugar). The consultation service was feasible and well-accepted by treated individuals and the rehabilitation team. CONCLUSIONS: Rehabilitation psychologists are uniquely positioned to address the functional, psychosocial, and behavioral needs of individuals with diabetes. With further research to assess clinical outcomes, this approach may further address practice recommendations for inpatient diabetes care. Moreover, such a diabetes consultation model may be useful on an outpatient rehabilitation basis as well.