Preliminary engagement of a patient advisory board of African American community members with type 2 diabetes in a peer-led medication adherence intervention.

BACKGROUND: The Peers Supporting Health Literacy, Self-efficacy, Self-Advocacy, and Adherence (Peers LEAD) program is a culturally tailored educational-behavioral 8-week intervention that addressed psychosocial and sociocultural barriers to diabetes medication adherence in African Americans. A brief 3-week version of the Peers LEAD intervention used a community engagement approach to examine the feasibility and acceptability of the intervention amongst patient stakeholders. MAIN BODY: African Americans who were adherent to their diabetes medicines were paired with those who were non-adherent to their medicines. Together, they participated in the group and phone-based medication adherence intervention. Input from this brief intervention was important for the design of the remainder weeks of the 8-week program. The intervention targeted negative beliefs about diabetes, use of diabetes medicines, and offering culturally tailored peer support to improve medication adherence in African Americans. To receive input in the development and implementation of the program, we worked with community advisors and a peer ambassador board of African Americans who were adherent to their diabetes medicines. The peer ambassador board and community advisors reviewed intervention materials to ensure they were understandable and appropriate for the community. As well, they provided feedback on the process for intervention delivery. CONCLUSION: The active engagement of the peer ambassador board and community advisors led to a revised intervention process and materials for a medication adherence program for African Americans with type 2 diabetes.

A Case Study of Engaging Hard-to-Reach Participants in the Research Process: Community Advisors on Research Design and Strategies (CARDS)®.

Lack of diversity among study participants in clinical research limits progress in eliminating health disparities. The engagement of lay stakeholders, such as patient or community advisory boards (CABs), has the potential to increase recruitment and retention of underrepresented groups by providing a structure for gathering feedback on research plans and materials from this target population. However, many CABs intentionally recruit prominent stakeholders who are connected to or comfortable with research and academia and thus may not accurately represent the perspectives of underrepresented groups who have been labeled hard-to-reach, including racial minorities and low-income or low-literacy populations. We developed a partnership between the University of Wisconsin-Madison School of Nursing and two community centers to deliberately engage hard-to-reach people in two lay advisory groups, the Community Advisors on Research Design and Strategies (CARDS)®. Community center staff recruited the CARDS from center programs, including parenting and childcare programs, women's support groups, food pantries, and senior meal programs. The CARDS model differs from other CABs in its participants, processes, and outcomes. Since 2010, the CARDS have met monthly with nurses and other researchers, helping them understand how research processes and the language, tone, appearance, and organization of research materials can discourage people from enrolling in clinical studies. We have successfully used the CARDS model to bring hard-to-reach populations into the research process and have sustained their participation. The model represents a promising strategy for increasing the diversity of participants in clinical research. © 2016 Wiley Periodicals, Inc.

Perspectives on healthy behaviors among low-income Latino and non-Latino adults in two rural counties.

OBJECTIVES: Rural populations and individuals with low incomes are less likely than the general population to achieve recommended levels of physical activity and fruit and vegetable consumption. The purpose of this study was to describe the perspectives of low-income adults in 2 rural Wisconsin counties on the factors that influence physical activity and healthy eating. DESIGN AND SAMPLE: A qualitative descriptive study was conducted using 4 focus groups: 2 in English and 2 in Spanish. A convenience sample (N=20) was recruited. MEASURES: Focus group questions and data analysis were based on an ecological framework. A team of 3 researchers performed content analysis of focus group transcripts. RESULTS: Participants reported individual, social, and community influences on health behaviors. Individual barriers included lack of motivation and lack of knowledge. Participants described the importance of family, friends, and the community social climate for health behaviors. Latinos emphasized the need for resources such as community gardens and public spaces for physical activity, while non-Latinos recommended community education related to healthy eating. CONCLUSIONS: The results suggest that relevant health promotion strategies in rural, low-income populations include multilevel approaches, the development of schools as health promotion resources, and strategies to build social connections among community residents.

PUBLIC HEALTH NURSING IN MISSISSIPPI: CHANGES IN CONTEXT AND PRACTICE.

Current standards and competencies guiding public health nursing (PHN) practice promote population-focused practice, but few studies have examined the extent to which change toward this type of practice has occurred. A cross-sectional, mail-back survey was conducted among public health nurses in Mississippi to examine recent changes in their practice, contextual factors related to population-focused practice, and recommendations for improving practice and educational preparation for practice. The survey response rate was 54% (n=150 [of 277]). Participants were predominantly female (95%), White (85%), 46 years or older (62%) and held an associate degree in nursing (69%). Most experienced nurses (n=106, 70%) reported perceived practice changes compared to five years prior, but did not consistently report changes toward greater population-focused practice. Participants reported funding decreases and negative effects on practice stemming from the nursing shortage. Recommendations for improving practice conditions included increasing resources, improving workplace environment and management practices, changing the focus of services, and promoting awareness of public health and PHN. Recommendations for improving education included providing more clinical experiences in public health settings and increasing financial supports and distance learning options. Additional research is needed to determine the nature and characteristics of population-focused PHN as practiced in Mississippi and elsewhere.

Perceived influences on physical activity and diet in low-income adults from two rural counties.

BACKGROUND: Despite the increased use of ecological models in health behavior research, multilevel influences on health behaviors in rural, low-income people, an aggregate at high risk for sedentary behavior and inadequate diets, have been examined in few studies. OBJECTIVE: The purpose of this study was to describe influences on physical activity and diet in low-income, rural adults. METHOD: A cross-sectional survey was conducted using face-to-face interviews in a convenience sample of 137 low-income Anglo and Latino adults recruited from two rural Wisconsin counties. The survey included questions on health behaviors, self-efficacy, barriers, social support, and community environments. Self-report data on physical activity and fruit and vegetable intake were categorized into outcome variables of meets recommendation or does not meet recommendation. Latent class cluster analysis was used to identify clusters of participants with similar influences on health behaviors, and cluster membership was used as an independent variable in logistic regression of physical activity and diet outcomes. RESULTS: Fifty-two percent of participants met a recommendation for physical activity, but only 8% met their MyPyramid recommendation for fruit and vegetable intake. Participants in the moderate self-efficacy/high safety cluster were significantly more likely than those in the low self-efficacy/moderate safety cluster to meet a recommendation for physical activity (odds ratio = 2.65). For healthy diet, participants in the low barriers cluster were significantly more likely to eat more fruits and vegetables (odds ratio = 4.13) than those in the high barriers cluster. DISCUSSION: People with healthier behaviors were distinguished from those with less healthy behaviors by higher levels of intrapersonal, interpersonal, and community supports. Results support the importance of multilevel approaches to promoting healthy lifestyles in rural, low-income adults.