Insights into Chinese Canadian culture: enablers and barriers for fruit and vegetable intake.

Background: Fruits and vegetables (F&V) play a vital role in promoting health and preventing diseases. Numerous studies have demonstrated the association between F&V consumption and reduced risks of cardiovascular disease, cancer, and mortality. Despite the high priority of public health in promoting F&V intake, Chinese immigrants in Canada often fall below national guidelines in their consumption. Understanding the factors influencing F&V intake in this community is crucial for developing effective interventions. Methods: This study used an applied ethnographic research approach to gain insight into the enablers and barriers that influence F&V intake among Chinese-Canadian adults in Richmond, BC. Semi-structured interviews and 'photovoice' group sessions were conducted to gather qualitative data from community participants and health care providers (HCPs). Results: The research identified four key themes: (1) Cultural differences around how vegetables are perceived, consumed and prepared; (2) Motivators and strategies for increasing vegetable and fruit intake; (3) Lack of culturally relevant dietary education and resources; and (4) Importance of value in vegetable/fruit-related decisions. Participants showed a strong preference for the traditional Eastern diet, with cost of food and lack of knowledge about Western vegetables acting as barriers to dietary diversity. The study also highlighted the need for culturally tailored educational resources to effectively promote F&V consumption. Conclusion: By adopting a multi-modal approach, incorporating both interviews and 'photovoice' sessions, this research provided comprehensive insights into the participants' perspectives and experiences related to F&V intake. Understanding these factors can guide the development of culturally appropriate interventions to increase F&V consumption among Chinese-Canadian adults in Richmond, BC, and potentially improve their overall health and well-being. Future studies should consider the heterogeneity within the Chinese immigrant population and target a more balanced representation of age groups to further enhance our understanding of F&V intake patterns in this community.

Testing 3 Digital Health Platforms to Improve Mental Health Outcomes in Adults With Type 1 Diabetes: A Pilot Trial.

OBJECTIVE: Our aim in this study was to examine the potential impact of a 3-pronged digital health pilot intervention (TRIFECTA) on diabetes distress and depressive symptoms among adults with type 1 diabetes (T1D) in British Columbia. METHODS: We recruited 60 adults with T1D (mean age 38.9±15.1 years, 75% female, 77% Caucasian) who participated in the 6-month pilot intervention involving 3 digital health platforms: monthly, provider-led, group-based sessions over Zoom (virtual huddles); a WhatsApp peer texting group; and a web-based "Ask-the-expert" portal. Assessments were conducted at baseline and 6 months and measured diabetes distress (T1D Diabetes Distress Scale), depressive symptoms (9-item Personal Health Questionnaire), and TRIFECTA engagement metrics. RESULTS: Participation in TRIFECTA was associated with significant reductions in Overall Distress (p=0.011) and 4 distress subscales: Powerlessness (p=0.006), Management Distress (p=0.001), Hypoglycemia Distress (p=0.029), and Eating Distress (p<0.001). A higher number of virtual huddles attended predicted lower Overall Distress (p=0.019) and Family/Friends Distress (p=0.023). A higher number of "Ask-the-expert" posts viewed predicted lower Overall Distress (p=0.046), whereas a higher number of WhatsApp messages posted predicted lower Management Distress (p=0.006). Furthermore, engagement in all 3 metrics was a predictor for lower Negative Social Perceptions Distress (p<0.05). No associations were seen in other distress subscales or for depressive symptoms. CONCLUSIONS: Participation in TRIFECTA was linked to reduced diabetes distress levels, but not depressive symptoms, in a platform-dependent manner. This study provides promising pilot data for a subsequent large-scale and fully powered randomized controlled trial.

Training peers to deliver mental health support to adults with type 1 diabetes using the REACHOUT mobile app.

AIMS: While peer support research is growing in the Type 1 diabetes (T1D) community, the peer supporter training (PST) process is rarely documented in detail. This study provides a comprehensive description of PST and evaluation for the REACHOUT mental health support intervention, and examines the feasibility and perceived utility of PST. METHODS: Fifty-three adults with T1D were recruited to participate in a 6-hour, zoom-based PST program for mental health support. The program was structured in three parts: (1) internal motivation, resilience and empathy; (2) mindfulness, emotions and diabetes distress; and (3) active listening and deferring clinical questions to professionals. Candidates were evaluated based on eight pre-established competency criteria during a 5-day support trial with an assigned standardized T1D participant. Perceived usefulness of training skills was also assessed 3 months into the REACHOUT mental health support intervention. RESULTS: Fifty-one of the fifty-three candidates who completed training achieved the criteria to graduate. Mean scores for the eight competency domains were: listens actively (4.55); asks open-ended questions (4.12); expresses empathy (4.42); avoids passing judgment (4.67); sits with strong emotions (4.44); refrains from giving advice (4.38); makes reflections (4.5); and defers medical questions (4.58). Of the skills learned during the PST, 95% rated interpreting and discussing diabetes distress profile and expressing empathy as moderately to extremely useful. CONCLUSIONS: Findings demonstrate that it is feasible to recruit and graduate the number of trainees needed using a rigorous process. Only by making training protocols available can the PST be replicated and translated to other T1D populations (e.g. adolescents, parents of children with T1D).

Systematic review of technology-mediated peer support interventions in paediatric type 1 diabetes care.

AIMS: There is increasing interest in the role of peer support in diabetes care. However, technology-mediated peer support in paediatric type 1 diabetes remains understudied.We aimed todescribe technology-mediated peer support interventions for children living with type 1 diabetes, their caregivers and healthcare providers. METHODS: CINAHL, Embase and MEDLINE (Ovid) were searched from Jan 2007 to June 2022. We included randomised and non-randomised trials with peer support interventions for children living with diabetes, their caregivers and/or healthcare providers. Studies examining clinical, behavioural or psychosocial outcomes were included. Quality was assessed with the Cochrane risk of bias tool. RESULTS: Twelve of 308 retrieved studies were included, with a study duration range of 3 weeks to 24 months and most were randomised trials (n = 8, 66.67%). Four technology-based interventions were identified: phone-based text messages, video, web portal and social media, or a hybrid peer support model. Most (58.6%, n = 7) studies exclusively targeted children with diabetes. No significant improvement was observed in psychosocial outcomes (quality of life, n = 4; stress and coping, n = 4; social support, n = 2). Mixed findings were observed in HbA1c (n = 7) and 28.5% studies (n = 2/7) reported reduced incidence of hypoglycaemia. CONCLUSIONS: Technology-mediated peer support interventions may have the potential to improve diabetes care and outcomes. However, further well-designed studies are necessary that address the needs of diverse populations and settings, and the sustainability of intervention effects.

Using Human-Centered Design and Cocreation to Create the Live 5-2-1-0 Mobile App to Promote Healthy Behaviors in Children: App Design and Development.

BACKGROUND: The prevalence of obesity among Canadian children is rising, partly because of increasingly obesogenic environments that limit opportunities for physical activity and healthy nutrition. Live 5-2-1-0 is a community-based multisectoral childhood obesity prevention initiative that engages stakeholders to promote and support the message of consuming ≥5 servings of vegetables and fruits, having <2 hours of recreational screen time, participating in ≥1 hour of active play, and consuming 0 sugary drinks every day. A Live 5-2-1-0 Toolkit for health care providers (HCPs) was previously developed and piloted in 2 pediatric clinics at British Columbia Children's Hospital. OBJECTIVE: This study aimed to co-create, in partnership with children, parents, and HCPs, a Live 5-2-1-0 mobile app that supports healthy behavior change and could be used as part of the Live 5-2-1-0 Toolkit for HCPs. METHODS: Three focus groups (FGs) were conducted using human-centered design and participatory approaches. In FG 1, children (separately) and parents and HCPs (together) participated in sessions on app conceptualization and design. Researchers and app developers analyzed and interpreted qualitative data from FG 1 in an ideation session, and key themes were subsequently presented separately to parents, children, and HCPs in FG-2 (co-creation) sessions to identify desired app features. Parents and children tested a prototype in FG 3, provided feedback on usability and content, and completed questionnaires. Thematic analysis and descriptive statistics were used for the qualitative and quantitative data, respectively. RESULTS: In total, 14 children (mean age 10.2, SD 1.3 years; 5/14, 36% male; 5/14, 36% White), 12 parents (9/12, 75% aged 40-49 years; 2/12, 17% male; 7/12, 58% White), and 18 HCPs participated; most parents and children (20/26, 77%) participated in ≥2 FGs. Parents wanted an app that empowered children to adopt healthy behaviors using internal motivation and accountability, whereas children described challenge-oriented goals and family-based activities as motivating. Parents and children identified gamification, goal setting, daily steps, family-based rewards, and daily notifications as desired features; HCPs wanted baseline behavior assessments and to track users' behavior change progress. Following prototype testing, parents and children reported ease in completing tasks, with a median score of 7 (IQR 6-7) on a 7-point Likert scale (1=very difficult; 7=very easy). Children liked most suggested rewards (28/37, 76%) and found 79% (76/96) of suggested daily challenges (healthy behavior activities that users complete to achieve their goal) realistic to achieve. Participant suggestions included strategies to maintain users' interest and content that further motivates healthy behavior change. CONCLUSIONS: Co-creating a mobile health app with children, parents, and HCPs was feasible. Stakeholders desired an app that facilitated shared decision-making with children as active agents in behavior change. Future research will involve clinical implementation and assessment of the usability and effectiveness of the Live 5-2-1-0 app.

Disruptions in Lifestyle Habits and Access to Social Support in the Time of COVID-19: Associations With Diabetes Distress and Depression Among Adults With Type 1 Diabetes Living in British Columbia.

OBJECTIVES: In this study, we examined rates of diabetes distress and depressive symptoms in adults with type 1 diabetes (T1D) during the COVID-19 lockdown and its association with disruptions in lifestyle habits and access to social support. METHODS: This cross-sectional investigation included a convenience sample of 60 adults with T1D who completed a survey assessing diabetes distress (Type 1 Diabetes Distress Scale), depressive symptoms (Personal Health Questionnaire-9), and disruptions in lifestyle habits (sleep patterns, dietary patterns, exercise routine) and access to support from family/friends. Linear regression analyses examined COVID-19 disruption variables as predictors of diabetes distress and depressive severity. RESULTS: Seventy-three percent and 38% of participants reported elevated diabetes distress and depressive symptoms, respectively. Greater eating disruption predicted higher depressive symptom severity (ß=1.33, p=0.045) and eating distress (ß=0.28, p=0.045). Greater social support disruption predicted higher eating distress (ß=0.36, p=0.019). CONCLUSIONS: Findings revealed high rates of diabetes distress and depressive symptoms in this T1D sample during the COVID-19 lockdown. Moreover, disruptions in some lifestyle habits and access to social support were associated with worse mental health outcomes.

Diabetes distress mediates the relationship between depressive symptoms and glycaemic control among adults with type 2 diabetes: Findings from a multi-site diabetes peer support intervention.

AIMS: Diabetes distress is positively associated with HbA1c and may mediate the relationship between depressive symptoms and HbA1c . This study examined these relationships in a geographically, socioeconomically, and ethnically diverse sample of adults with type 2 diabetes. METHODS: Using data from five US sites evaluating peer support for diabetes management (n = 917), Structural Equation Modeling (SEM) examined whether diabetes distress (four items from Diabetes Distress Scale) mediated the relationship between depressive symptoms (PHQ-8) and HbA1c . Sites compared interventions of varying content and duration with control conditions. Time from Baseline Assessment to Final Assessment varied from six to 18 months. Site characteristics were controlled by entering site as a covariate along with age, sex, education, diabetes duration, insulin use, and intervention/control assignment. RESULTS: Depressive symptoms, diabetes distress, and HbA1c were all intercorrelated cross-sectionally and from Baseline to Final Assessment (rs from 0.10 to 0.57; ps <0.05). In SEM analyses, diabetes distress at Final Assessment mediated the relationship between Baseline depressive symptoms and HbA1c at Final Assessment (indirect effect: b = 0.031, p < 0.001), controlling for Baseline HbA1c and covariates. Parallel analysis of whether depressive symptoms mediated the relationship between Baseline diabetes distress and HbA1c at Final Assessment was not significant. CONCLUSIONS: In this diverse sample, diabetes distress mediated the influence of depressive symptoms on HbA1c but the reverse, depressive symptoms mediating the effect of distress, was not found. These findings add to the evidence that diabetes distress is a worthy intervention target to improve clinical status and quality of life among individuals with type 2 diabetes.

Social support and diabetes distress: Does the messenger matter as much as the message?

We explored the relationship between social support (family/friends and health care team) and four diabetes distress subscales in 196 adults with type 2 diabetes in a specialty care setting. Health care support was associated with lower physician- and regimen-related distress, while friends/family support was related to lower interpersonal distress. The study was registered on clinicaltrials.gov (NCT02804620).

Autopsy of a telephone-based peer support intervention: Exploring participants' perspectives of and experiences with a self-management support model for adults with type 2 diabetes from speciality care settings.

AIMS: To explore participants' experiences with and perspective of a telephone-based, peer-led diabetes self-management intervention targeting adults with type 2 diabetes (T2D) from speciality care settings. We also sought to identify areas for improvement for future iterations of the intervention. METHODS: This study recruited 25 adults with T2D from the intervention arm of a randomized controlled trial of a peer support intervention for diabetes. Individuals took part in semi-structured interviews that explored the following topics: perceived impact of the intervention, relationship with peer leader, desirable characteristics in a peer leader, and suggestions for improving the intervention. Focus groups were recorded, transcribed, quality checked, coded, and analysed to develop themes and subthemes. RESULTS: Four core themes emerged: (1) importance of the 'participant-peer leader' match, (2) peer leader roles and responsibilities, (3) need for flexible support models, and (4) factors affecting intervention implementation and engagement. The quality of the participant-peer leader relationship appeared to be linked to intervention satisfaction. Beyond demographic features such as age and sex, key characteristics for forming a strong match included stage of life, lifestyle, diabetes-related factors, and communication style. CONCLUSIONS: Participants have unique ideas about what support should look like and preferences for how support is best delivered. Future models of peer support need to be customizable to individuals' needs and responsive to changes in life circumstances. If participants are the decision makers in the matching process, they may experience greater satisfaction and derive maximal benefits.

From clinic to community: A randomized controlled trial of a peer support model for adults with type 2 diabetes from specialty care settings in British Columbia.

AIMS: To examine the impact of a 12-month peer-led diabetes self-management support intervention delivered via telephone amongst adults with type 2 diabetes (T2D) from specialty care settings in British Columbia (BC). METHODS: One-hundred ninety-six adults with T2D were randomly assigned to either a 12-month Peer-Led, Empowerment-based, Approach, to Self-management Efforts in Diabetes (PLEASED) intervention or a usual care condition. PLEASED involved weekly telephone contacts from a peer leader (PL) in the first 3 months followed by bi-weekly telephone contacts in the last 9 months. Assessments were conducted at baseline, 3 and 12 months. The primary outcome was HbA1c ; secondary outcomes included diabetes distress (DD), ApoB, systolic and diastolic blood pressure (BP), body mass index, waist circumference and depressive symptoms. RESULTS: No within or between group changes were observed for HbA1c at 3 or 12 months. However, amongst participants with HbA1c  ≥ 69 mmol/mol (8.5%), the PLEASED group significantly lowered their HbA1c at 12 months [-11.7 mmol/mol (-1.07%); 95% CI: -20.7, -2.5 (-1.89, -0.23); p = 0.016] compared to usual care. Amongst secondary outcomes, within-group improvements in overall DD were found at 3 months (-0.21; 95% CI: -0.35, -0.08; p = 0.002) for the PLEASED group and at 12 months for both groups (PLEASED: -0.35; 95% CI: -0.49, -0.21; p < 0.001 and control: -0.33; 95% CI: -0.47, -0.19; p < 0.001), however, no between-group differences were observed. The PLEASED group improved systolic BP at 12 months (-5.4 mm Hg; 95% CI: -10.0, -0.8; p = 0.023) compared to usual care. CONCLUSIONS: Participation in a peer support intervention in diabetes delivered via telephone leads to long-term improvements in HbA1c amongst high-risk adults with T2D living in BC. TRIAL REGISTRATION: The study was registered on clinicaltrials.gov (NT02804620).

Efficacy of a Commercial Weight Management Program Compared With a Do-It-Yourself Approach: A Randomized Clinical Trial.

Importance: Given the prevalence of obesity, accessible and effective treatment options are needed to manage obesity and its comorbid conditions. Commercial weight management programs are a potential solution to the lack of available treatment, providing greater access at lower cost than clinic-based approaches, but few commercial programs have been rigorously evaluated. Objective: To compare the differences in weight change between individuals randomly assigned to a commercial weight management program and those randomly assigned to a do-it-yourself (DIY) approach. Design, Setting, and Participants: This 1-year, randomized clinical trial conducted in the United States, Canada, and United Kingdom between June 19, 2018, and November 30, 2019, enrolled 373 adults aged 18 to 75 years with a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 25 to 45. Assessors were blinded to treatment conditions. Interventions: A widely available commercial weight management program that included reduced requirements for dietary self-monitoring and recommendations for a variety of DIY approaches to weight loss. Main Outcomes and Measures: The primary outcomes were the difference in weight change between the 2 groups at 3 and 12 months. The a priori hypothesis was that the commercial program would result in greater weight loss than the DIY approach at 3 and 12 months. Analyses were performed on an intention-to-treat basis. Results: The study include 373 participants (272 women [72.9%]; mean [SD] BMI, 33.8 [5.2]; 77 [20.6%] aged 18-34 years, 74 [19.8%] aged 35-43 years, 82 [22.0%] aged 44-52 years, and 140 [37.5%] aged 53-75 years). At 12 months, retention rates were 88.8% (166 of 187) for the commercial weight management program group and 95.7% (178 of 186) for the DIY group. At 3 months, participants in the commercial program had a mean (SD) weight loss of -3.8 (4.1) kg vs -1.8 (3.7) kg among those in the DIY group. At 12 months, participants in the commercial program had a mean (SD) weight loss of -4.4 (7.3) kg vs -1.7 (7.3) kg among those in the DIY group. The mean difference between groups was -2.0 kg (97.5% CI, -2.9 to -1.1 kg) at 3 months (P < .001) and -2.6 kg (97.5% CI, -4.3 to -0.8 kg) at 12 months (P < .001). A greater percentage of participants in the commercial program group than participants in the DIY group achieved loss of 5% of body weight at both 3 months (40.7% [72 of 177] vs 18.6% [34 of 183]) and 12 months (42.8% [71 of 166] vs 24.7% [44 of 178]). Conclusions and Relevance: Adults randomly assigned to a commercial weight management program with reduced requirements for dietary self-monitoring lost more weight and were more likely to achieve weight loss of 5% at 3 and 12 months than adults following a DIY approach. This study contributes data on the efficacy of commercial weight management programs and DIY weight management approaches. Trial Registration: ClinicalTrials.gov Identifier: NCT03571893.

'We just don't have this in us ': Understanding factors behind low levels of physical activity in South Asian immigrants in Metro-Vancouver, Canada.

BACKGROUND: South Asian immigrants in western countries are at a high risk for metabolic syndrome and associated chronic disease. While a physically active lifestyle is crucial in decreasing this risk, physical activity (PA) levels among this group remain low. The objectives of this study were to explore social and cultural factors that influence PA behavior, investigate how immigration process intersects with PA behaviors to influence PA levels and to engage community in a discussion about what can be done to increase PA in the South Asian community. METHODS: For this qualitative study, we conducted four Focus Group Discussions (FGDs) among a subset of participants who were part of a larger study. FGD data was coded and analysed using directed content analysis to identify key categories. RESULTS: Participants expressed a range of opinions, attitudes and beliefs about PA. Most believed they were sufficiently active. Women talked about restrictive social and cultural norms that discouraged uptake of exercise. Post-immigration levels of PA were low due to change in type of work and added responsibilities. CONCLUSION: Health promoters need to consider social, cultural, and structural contexts when exploring possible behavior change interventions for South Asian immigrants.

Predictors and Effects of Participation in Peer Support: A Prospective Structural Equation Modeling Analysis.

BACKGROUND: Peer support provides varied health benefits, but how it achieves these benefits is not well understood. PURPOSE: Examine a) predictors of participation in peer support interventions for diabetes management, and b) relationship between participation and glycemic control. METHODS: Seven peer support interventions funded through Peers for Progress provided pre/post data on 1,746 participants' glycemic control (hemoglobin A1c), contacts with peer supporters as an indicator of participation, health literacy, availability/satisfaction with support for diabetes management from family and clinical team, quality of life (EQ-Index), diabetes distress, depression (PHQ-8), BMI, gender, age, education, and years with diabetes. RESULTS: Structural equation modeling indicated a) lower levels of available support for diabetes management, higher depression scores, and older age predicted more contacts with peer supporters, and b) more contacts predicted lower levels of final HbA1c as did lower baseline levels of BMI and diabetes distress and fewer years living with diabetes. Parallel effects of contacts on HbA1c, although not statistically significant, were observed among those with baseline HbA1c values > 7.5% or > 9%. Additionally, no, low, moderate, and high contacts showed a significant linear, dose-response relationship with final HbA1c. Baseline and covariate-adjusted, final HbA1c was 8.18% versus 7.86% for those with no versus high contacts. CONCLUSIONS: Peer support reached/benefitted those at greater disadvantage. Less social support for dealing with diabetes and higher PHQ-8 scores predicted greater participation in peer support. Participation in turn predicted lower HbA1c across levels of baseline HbA1c, and in a dose-response relationship across levels of participation.

"Tis Better to Give Than to Receive?" Health-related Benefits of Delivering Peer Support in Type 2 Diabetes: An Explanatory Sequential Mixed-methods Study.

OBJECTIVES: Existing peer support literature in diabetes has focussed predominantly on the health impact it has on the beneficiaries rather than the benefactors. In this mixed-methods study, we examined the effect of delivering peer support (vs receiving) on glycated hemoglobin (A1C) and diabetes distress (DD) at 3 and 12 months as part of a larger diabetes self-management support randomized controlled trial. Maintenance or improvement of outcomes was expected. We also assessed peer leaders' experiences with the program. METHODS: We utilized a sequential explanatory mixed-methods research design that included 58 adults with diabetes (i.e. peer leaders) who completed a 30-hour training program. Peer leaders (n=52) were matched with participants (adults with type 2 diabetes) and invited to undergo assessments at baseline, 3 months and 12 months. Primary clinical and psychosocial outcomes included A1C and DD, respectively. Secondary outcomes were cardiovascular risk factors and depressive symptoms. After the intervention, 17 peer leaders participated in semistructured interviews about their experience. RESULTS: Peer leaders had a mean age of 57.5±11 years and a long history of diabetes (13.9±11 years); over half were male (53.8%) and married/partnered (55.8%). At baseline, peer leaders were at target for A1C (7.0±0.9% [53±10 mmol/mol]) and reported a low level of DD (1.67±0.52). Of the 43 (82.7%) peer leaders who completed the 12-month study, A1C and DD remained stable over 12 months. Secondary outcomes also remained within the normal range from the start to the end of the intervention. CONCLUSION: Delivering peer support may help maintain glycemic control and DD over the long term.

Participant-Directed Intervention Tailoring Is Associated With Improvements in Glycemic Control for South Asian Adults With Type 2 Diabetes.

OBJECTIVES: Our aim was to determine the impact of a 3-month diabetes self-management education and support (DSME/DSMS) intervention involving both professional and peer support on glycemic control and diabetes distress in South Asian adults with type 2 diabetes (T2D) living in Metro Vancouver. METHODS: We recruited 114 South Asian adults with T2D for a study conducted across 7 sites in Metro Vancouver. A previous DSME/DSMS intervention was modified using participant feedback. Participants attended the updated intervention involving 6 biweekly group-based DSME sessions co-led by a diabetes educator and peer leader and 6 biweekly DSMS sessions delivered by a peer leader. Assessments were conducted at baseline and 3 months. Primary outcomes were glycated hemoglobin (A1C) and diabetes distress. Secondary outcomes included apolipoprotein B, blood pressure (BP), height and weight, waist circumference, diabetes support and depressive symptoms. RESULTS: After the 3-month intervention, linear mixed-effects modelling demonstrated A1C decreased significantly from 8.2% (66 mmol/mol) to 7.8% (62 mmol/mol) (p<0.0001), as did body mass index (from 30.02 to 29.7 kg/m2; p=0.0005) and diastolic BP (from 75.86 to 70.78 mmHg; p<0.0001). These reductions persisted after adjusting for the fixed-effects of age, sex, intensification of diabetes and BP medication, as well as random effects for subject and location. CONCLUSIONS: Participation in a professional plus peer-led intervention tailored by South Asian adults with T2D is associated with improved glycemic control and other favourable health outcomes.

Device-worn measures of sedentary time and physical activity in South Asian adults at high risk for type 2 diabetes in Metro-Vancouver, Canada.

BACKGROUND: South Asians have high incidence of chronic disease. Physical activity (PA) and sedentary time are modifiable risk factors for chronic disease but their assessment in South Asians has been primarily based on self-report. This study presents directly-measured PA and sedentary time in South Asian adults in Canada. METHODS: A subset of 100 South Asian participants from a larger study who were identified at being at a higher risk for type 2 diabetes wore Actical accelerometers for 7 days. Anthropometric measures were taken and socio-demographic factors including age, income, education level, years since immigration, presence of children under the age of 12 years in the household and employment status were self-reported. RESULTS: Ninety-one participants (mean age 65.6 years) provided valid accelerometer data. Participants accumulated mean 673.5 (95% CI: 656.6, 691.0) min/day sedentary time, 130.5 (95% CI: 117.3, 145.3) min/day light PA (LPA) and 2.3 (95% CI: 1.3, 4.2) min/day moderate-to-vigorous PA (MVPA). For sedentary time and LPA, sex and BMI explained 51% of variability. For MVPA, BMI, season of assessment and employment status explained 23% variability with those who were employed accumulating significantly higher mean min/day of MVPA compared to those who were unemployed; (5.8, 95% CI: 1.5, 21.7) vs (1.5, 95% CI: 5.3, 20.0) respectively. CONCLUSION: High sedentary time, and low MVPA indicates the need to focus health promotion efforts on shifting sedentary time into LPA while trying to increase MVPA. Future studies need to be based on larger, representative samples of South Asians.

Profiling "Success": Demographic and Personality Predictors of Effective Peer Leaders in a Diabetes Self-management Intervention.

BACKGROUND: The sociodemographic and personality profiles of effective peer leaders in the context of diabetes self-management interventions are poorly understood. In this study, we explored the demographic and personality characteristics of peer leaders participating in a 12-month, telephone-based type 2 diabetes self-management intervention. METHODS: We used a sequential explanatory mixed-methods research design and recruited 52 peer leaders. Thirty-seven peer leaders had at least 1 participant complete both the baseline and the 12-month assessments. Eligible peer leader candidates were English-speaking adults (≥21 years of age) with diabetes and a self-reported glycated hemoglobin (A1C) level of ≤8% who had access to a phone and transportation and were willing to attend a 30-hour training program. Peer leaders completed a self-report survey assessing sociodemographic characteristics and a Mini-International Personality Item Pool scale measuring the "Big 5" personality traits. After the intervention, 17 peer leaders participated in semistructured interviews on their program experience. We categorized peer leaders as effective if their participants sustained or improved their A1C and diabetes distress (DD) scores from baseline to 12 months, and as ineffective if their participants worsened on any of these parameters. RESULTS: Our cohort scored highest on agreeableness and lowest on neuroticism. Twenty peer leaders were considered effective, most of whom were male, married, employed and educated. They also had significantly lower mean DD levels (p=0.02) and a higher extroversion score (p=0.03) at baseline. CONCLUSIONS: Extroversion emerged as the best personality predictor of peer leader effectiveness. These results, in combination with interview responses, were used to produce a peer leader selection model.

Out of the mouths of Peer Leaders: Perspectives on how to improve a telephone-based peer support intervention in type 2 diabetes.

OBJECTIVE: To explore the experiences of peer leaders with respect to delivering core components of a 12-month, telephone-based peer support intervention in type 2 diabetes within a tertiary-care setting. METHODS: Seventeen peer leaders were recruited and interviewed. Interviews lasted approximately 20 to 45 min, were audio-taped, and transcribed verbatim. The transcripts were analysed by two team members using the qualitative descriptive approach. FINDINGS: Peer leaders reported mutually beneficial and reciprocal relationships with participants. They encountered challenges in maintaining regular contact with participants and in motivating them to make lifestyle changes. To improve the programme, peer leaders suggested having more frequent - but shorter - training sessions and reducing the diabetes education component of the training programme. To enhance the intervention fidelity and retention rate, they recommended matching peer leaders to participants on more meaningful variables (e.g. diabetes-related commonalities, personality, life experiences, etc.) beyond just gender, geographic proximity and availability. They also requested more frequent face-to-face contacts with participants (Modality of Contact), and additional ongoing support from the research team. CONCLUSION: Peer leaders were satisfied with the intervention design. However, future studies may consider more comprehensive peer leader-matching algorithms and increased opportunities for in-person communication modalities. CLINICALTRIALS: gov Identifier: NCT02804620.

Undiagnosed Hypertension in Vancouver's Punjabi Sikh Community: A Cross-Sectional Study.

South Asians bear a greater burden of cardiovascular disease (CVD) compared to other ethnic groups and hypertension is a major modifiable risk factor. The purpose of this study was to examine rates and predictors of uncontrolled blood pressure among an immigrant Punjabi Sikh community in Vancouver. We recruited 350 adults (40% women; mean age 67.3 ± 11.9 years) across 5 Sikh temples and measured blood pressure, heart rate, height, weight, waist circumference, socio-demographic background, and health history. 42% of participants had uncontrolled blood pressure of which one-third reported no previous history of hypertension. Based on modified cut-offs for South Asians, the mean waist circumferences across groups were well above target and 50% classified as obese. A higher percentage in the uncontrolled group (vs. controlled group) were of an older age, had a diabetes history and reported a physically active lifestyle. Findings suggest more efforts are needed to reduce the rates of uncontrolled blood pressure in this community. Interventions such as blood pressure drives, community-based outreach programs, and physical activity and dietary interventions should be explored to lower this CVD risk factor in this community.