Preliminary efficacy of group medical nutrition therapy and motivational interviewing among obese African American women with type 2 diabetes: a pilot study.

OBJECTIVE: To assess the efficacy and acceptability of a group medical nutritional therapy (MNT) intervention, using motivational interviewing (MI). RESEARCH DESIGN & METHOD: African American (AA) women with type 2 diabetes (T2D) participated in five, certified diabetes educator/dietitian-facilitated intervention sessions targeting carbohydrate, fat, and fruit/vegetable intake and management. Motivation-based activities centered on exploration of dietary ambivalence and the relationships between diet and personal strengths. Repeated pre- and post-intervention, psychosocial, dietary self-care, and clinical outcomes were collected and analyzed using generalized least squares regression. An acceptability assessment was administered after intervention. RESULTS: Participants (n = 24) were mostly of middle age (mean age 50.8 ± 6.3) with an average BMI of 39 ± 6.5. Compared to a gradual pre-intervention loss of HbA1c control and confidence in choosing restaurant foods, a significant post-intervention improvement in HbA1c (P = 0.03) and a near significant (P = 0.06) increase in confidence in choosing restaurant foods were observed with both returning to pre-intervention levels. 100% reported that they would recommend the study to other AA women with type 2 diabetes. CONCLUSION: The results support the potential efficacy of a group MNT/MI intervention in improving glycemic control and dietary self-care-related confidence in overweight/obese AA women with type 2 diabetes.

Identifying US veterans who access services from health care for the homeless clinics.

Research on veterans experiencing homelessness is predominantly focused on the US Department of Veterans Affairs setting, despite the fact that substantial numbers receive services from Health Care for the Homeless (HCH) clinics. We explored how HCH clinics identified veteran patients through a survey of administrators (49% response rate). The majority (98%) identified veterans but used varied language and approaches. Implementing a streamlined, culturally competent identification process is vital to collecting accurate data, connecting veterans with benefits, and informing treatment plans.

Health status and health care experiences among homeless patients in federally supported health centers: findings from the 2009 patient survey.

OBJECTIVE: To examine health status and health care experiences of homeless patients in health centers and to compare them with their nonhomeless counterparts. DATA SOURCES/STUDY SETTING: Nationally representative data from the 2009 Health Center Patient Survey. STUDY DESIGN: Cross-sectional analyses were limited to adults (n = 2,683). We compared sociodemographic characteristics, health conditions, access to health care, and utilization of services among homeless and nonhomeless patients. We also examined the independent effect of homelessness on health care access and utilization, as well as factors that influenced homeless patients' health care experiences. DATA COLLECTION: Computer-assisted personal interviews were conducted with health center patients. PRINCIPAL FINDINGS: Homeless patients had worse health status-lifetime burden of chronic conditions, mental health problems, and substance use problems-compared with housed respondents. In adjusted analyses, homeless patients had twice the odds as housed patients of having unmet medical care needs in the past year (OR = 1.98, 95 percent CI: 1.24-3.16) and twice the odds of having an ED visit in the past year (OR = 2.00, 95 percent CI: 1.37-2.92). CONCLUSIONS: There is an ongoing need to focus on the health issues that disproportionately affect homeless populations. Among health center patients, homelessness is an independent risk factor for unmet medical needs and ED use.