Perceived Risk of Diabetes Among Vietnamese Americans With Prediabetes: Mixed Methods Study.

BACKGROUND: Vietnamese Americans have a relatively high risk of developing diabetes at younger ages, yet there are no published studies exploring their risk perceptions. OBJECTIVE: This mixed methods study describes perceived diabetes risk in the context of an underserved population. METHODS: This study was guided by the Common-Sense Model of Self-Regulation. Snowball sampling was used to recruit 10 Vietnamese Americans with prediabetes and achieve data saturation. Qualitative and quantitative descriptive methodologies with data transformation were used to analyze data from semistructured interviews and questionnaires to explore the dimensions of perceived diabetes risk. RESULTS: Participants were between the ages of 30 and 75 years with diversity also noted in diabetes risk factors. The 3 risk perception domains from qualitative data were risk factors, disease severity, and preventing diabetes. The main perceived diabetes risk factors were eating habits (including cultural influences), sedentary lifestyle, and family history of diabetes. Quantitative data supported qualitative findings of a low-to-moderate level of perceived diabetes risk. Despite the lower levels of perceived diabetes risk, Vietnamese Americans do believe that the severity of diabetes is a "big concern." CONCLUSIONS: Vietnamese Americans with prediabetes have a low-to-moderate level of perceived diabetes risk. Understanding the perceived diabetes risk in this population provides a foundation for diabetes prevention interventions that consider cultural influences on diet and exercise.

Transitions from jail to rural community for adults with mental illness.

OBJECTIVES: Describe the facilitators and inhibitors of accessing healthcare services for adults with mental illness transitioning from a rural jail to a rural community. DESIGN/SAMPLE/MEASUREMENTS: A qualitative descriptive approach was used to conduct this study in a rural southwest county. Purposive sampling was used to recruit eight adults. Data were collected using semi-structured telephonic interviews and analyzed using open coding and thematic analysis with clustering of emergent data. RESULTS: The overarching theme, "Out of Jail, but No Freedom," is supported by four domains: Situational Transition Facilitators; Situational Transition Inhibitors; Health-Illness Transition Facilitators; and Health-Illness Transition Inhibitors. CONCLUSIONS: Transitions from the rural jail to the community were facilitated by friends, family, and peer navigators. Systemic inequality endemic within the justice system and exacerbated by rurality creates an environment in which marginalization is ubiquitous for persons with mental illness and inhibits their transition from jail to the rural community. Nurses are well positioned to lead systematic reform in public policy, guiding healthcare funding, and jail utilization.

The Diné (Navajo) Hózhó Lifeway: A Focused Ethnography on Intergenerational Understanding of American Indian Cultural Wisdom.

Purpose: Hózhó is the cultural wisdom that guides the Diné lifeway. This study examines understanding of cultural wisdom (CW) across three generations: elders, adults, and adolescents. Method: A focused ethnography was conducted on the Navajo Nation. Twenty-two Diné (Navajo) were recruited through convenience sampling. Data were collected via two semistructured interviews and photovoice methods. Data were analyzed using content analysis, thematic analysis, and participatory visual analysis of photos. Results: The Diné elders embodied the greatest in-depth understanding of CW followed by the adolescents. An unexpected finding was the scarcity of understanding of CW among the adults. Conclusion: The Diné understanding of CW is transferred through discussion with elders, listening to and speaking traditional language, cultural preservation activities, and participation in cultural practices. The Diné believe cultural wisdom is a health sustaining protective factor, therefore strategies to restore, promote, and support the intergenerational transfer of cultural wisdom remains a tribal priority.

Perceived Risk of Developing Diabetes in the General Population and Asian Americans: Systematic Review.

Introduction: The purpose of this systematic review was to explore perceived diabetes risk with foci on prediabetic persons and Asian Americans. Persons with prediabetes and of Asian descent are at higher risk for developing diabetes, but little is known about their perceived diabetes risk. Method: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided this systematic review. Electronic searches were conducted in three databases. The authors conducted eligibility determination, data extraction, synthesis, and evaluation. Twelve articles were selected. Results: Key findings include (1) limited studies including Asian populations, (2) a low percentage of persons in the general population with moderate to high levels of perceived diabetes risk, (3) a lack of congruency between actual and perceived diabetes risk in the general population, and (4) no interventions effectively changing the level of perceived diabetes risk. Discussion: More studies regarding perceived diabetes risk are needed, especially with a focus on Asian Americans.

Effects of a Family-Based Diabetes Intervention on Family Social Capital Outcomes for Mexican American Adults.

PURPOSE: The purpose of the study is to test the effects of a culturally tailored family-based self-management education and social support intervention on family social capital with Mexican American (MA) adults with type 2 diabetes (T2DM) and their family member. METHODS: Using a 2-group, experimental repeated-measures design, 157 dyads were randomly assigned to an intervention (group education and social support, home visits, and telephone calls) or a wait list control group. Data were collected at baseline, immediately postintervention (3 months), and 6 months postintervention. A series of 2 × 3 repeated-measures analyses of variance with interaction contrasts were used to test the hypotheses regarding the differential effects on family social capital. RESULTS: Social capital outcomes included social integration, social support, and family efficacy. Social integration scores, high for family members and friends and low for community engagement, did not change over time for participants or family members. Participants perceived high support from family for physical activity with an immediate increase postintervention and moderate sabotage for healthy eating with no change over time. A sustained intervention effect was noted for family efficacy for general health and total family efficacy in participants and family members. CONCLUSIONS: This family-based culturally tailored intervention demonstrated the potential to improve social capital, specifically social support for physical activity and family efficacy for diabetes management for MA adults with T2DM. Ongoing research that examines the family as a critical context in which T2DM self-management occurs and that targets strategies for sustained family social capital outcomes for T2DM is needed.

A Modified Behavior Risk Factor Surveillance System to Assess Diabetes Self-management Behaviors and Diabetes Care in Monterrey Mexico: A Cross-sectional Study.

Type 2 diabetes mellitus (T2DM) is one of the leading causes of death from worldwide non-communicable diseases. The prevalence of diabetes in the Mexico (MX)-United States border states exceeds the national rate in both countries. The economic burden of diabetes, due to decreased productivity, disability, and medical costs, is staggering and increases significantly when T2DM-related complications occur. The purpose of this study was to use a modified behavioral risk factor surveillance system (BRFSS) to describe the T2DM self-management behaviors, diabetes care, and health perception of a convenience sample of adults with T2DM in Monterrey, MX. This cross-sectional study design, with convenience sampling, was conducted with a convenience sample (n = 351) of adults in the metropolitan area of Monterrey, MX who self-reported a diagnosis of T2DM. Potential participants were recruited from local supermarkets. Twenty-six diabetes and health-related items were selected from the BRFSS and administered in face-to-face interviews by trained data collectors. Data analysis was conducted using descriptive statistics. The mean age was 47 years, and the mean length of time with T2DM was 12 years. The majority was taking oral medication and 34% required insulin. Daily self-monitoring of feet was performed by 56% of the participants; however, only 8.8% engaged in blood glucose self-monitoring. The mean number of health-care provider visits was 9.09 per year, and glycated hemoglobin level (HbA1c) was assessed 2.6 times per year. Finally, only 40.5% of the participants recalled having a dilated eye exam. We conclude the modified BRFSS survey administered in a face-to-face interview format is an appropriate tool for assessing engagement in T2DM self-management behaviors, diabetes care, and health perception. Extension of the use of this survey in a more rigorous design with a larger scale survey is encouraged.

Effects of a Family-based Diabetes Intervention on Behavioral and Biological Outcomes for Mexican American Adults.

Purpose The purpose of the study was to investigate the effects of a family-based self-management support intervention for adults with type 2 diabetes (T2DM). Methods Using a 2-group, experimental repeated measures design, 157 dyads (participant with T2DM and family member) were randomly assigned to an intervention (education, social support, home visits, and telephone calls) or a wait list control group. Data were collected at baseline, postintervention (3 months), and 6 months postintervention. A series of 2 × 3 repeated measures ANOVAs were used to test the hypotheses with interaction contrasts to assess immediate and sustained intervention effects. Results Significant changes over time were reported in diet self-management, exercise self-management, total self-management, diabetes self-efficacy for general health and total diabetes self-efficacy, physician distress, regimen distress, interpersonal distress, and total distress. There were likewise sustained effects for diet self-management, total self-management, diabetes self-efficacy for general health, total self-efficacy, physician distress, regimen distress, and interpersonal distress. Conclusions Results support and extend prior research documenting the value of culturally relevant family-based interventions to improve diabetes self-management and substantiate the need for intensive, longer, tailored interventions to achieve glycemic control.

Undocumented migration in the United States: an overview of historical and current policy contexts.

The aims of this overview are to provide a brief historical review of federal, state, and local immigration policies and to examine the historical origin and current constructions of the undocumented immigrant. We discuss how past and current policies promote, regulate, restrict, and deter immigration into the United States and access to health services and draw implications for the profession of nursing.

Undocumentedness and public policy: the impact on communities, individuals, and families along the Arizona/Sonora border.

The focus of this article is the health impact and implications of undocumentedness along the U.S.-Mexico border, particularly the Arizona/Sonora region. We describe the direct and indirect influences of immigration policies on the health of individuals, families, and communities. The Arizona border region maintains close social, cultural, and linguistic ties to Mexico, and the amplified efforts to secure the border have been dramatic on the region and on the people who live there. The 261-mile stretch across the Arizona-Sonora Desert is the most deadly corridor for immigrants crossing into the United States because they are at risk of being killed, kidnapped, and coerced into smuggling drugs or dying in the desert. Gang-related violence is pushing more Central Americans, including unaccompanied minors, to the United States. The impact on individual migrants and their families has been devastating. We examine the health implications of policy and applaud the actions of the Arizona Nurses Association and the American Academy of Nursing to address the health needs of border communities.

The impact and implications of undocumented immigration on individual and collective health in the United States.

A nation of immigrants, the United States currently has more foreign-born residents than any other country; approximately 28% of these foreign-born residents are undocumented immigrants--individuals who either entered or are currently residing in the country without valid immigration or residency documents. The complex and constantly changing social, political, and economic context of undocumented migration has profound effects on individuals, families, and communities. The lack of demographic and epidemiologic data on undocumented immigrants is a major public health challenge. In this article, we identify multiple dimensions of vulnerability among undocumented persons; examine how undocumentedness impacts health and health care access and utilization; and consider the professional, practice, and policy issues and implications for nurses.

Partnering With Families to Refine and Expand a Diabetes Intervention for Mexican Americans.

PURPOSE: The purpose of this study was to refine and expand a culturally tailored individual-level diabetes self-management intervention to a family-level intervention. METHODS: Using community-based participatory research principles, Mexican American adults (n = 12) with type 2 diabetes mellitus (T2DM) and family members (n = 12) in the United States-Mexico border region participated in 6 focus group interviews, conducted by bilingual, bicultural facilitators. Facilitators and barriers to T2DM management were identified. Transcripts were analyzed using qualitative content analysis. RESULTS: Through an iterative analysis process, 5 categories represented participants with T2DM: (1) strategies my family can use to support our managing T2DM, (2) be sensitive to my challenges, (3) stop telling me what to eat or do, (4) how can we peacefully coexist, and (5) I feel supported. Categories identified by family members were (1) changing behaviors together, (2) sharing not controlling, (3) supporting positive behaviors, and (4) your behaviors frustrate me. CONCLUSIONS: The family was reinforced as a major influence for successful T2DM management. Family support requires that families value and develop knowledge and skills for T2DM management. This family intervention builds on family assets and relationships, shifting from traditional externally motivated individual models to create a shared commitment to manage T2DM among Mexican American adults.

Analysis of behavior risk factor surveillance system data to assess the health of Hispanics with diabetes in US-Mexico border communities.

PURPOSE: The purpose of this study is to describe and compare personal characteristics, health care access and utilization, and self-management behaviors of Hispanic American adults diagnosed with diabetes who reside in 3 US-Mexico border counties in Arizona, New Mexico, and Texas. This study also examines the status of this population in attaining Healthy People (HP) 2020 diabetes target goals. METHODS: Data were extracted from the 2005-2009 Selected Metropolitan/Micropolitan Area Risk Trends (SMART): Behavioral Risk Factor Surveillance System (BRFSS) to analyze behavioral and health system factors associated with diabetes management among Hispanic American adults who reside in the border counties (N = 600). Data were analyzed using descriptive statistics and compared using chi-square and one-way analysis of variance. RESULTS: There were significant differences in health care access and utilization and in 1 self-management behavior (daily feet checks) across the counties. The majority of participants (83.4%) had a care provider, however the HP 2020 diabetes target goals for A1C monitoring or foot exams conducted by a care provider were not met. Participants in all counties met the target goal for dilated eye exams. CONCLUSIONS: Improvement of diabetes management among this population should focus on border health system barriers to attaining HP 2020 diabetes target goals.

Perceived impact of an interprofessional education program on community resilience: an exploratory study.

The purpose of this study was to explore the perceived impact of an interprofessional education (IPE) program for health sciences students on two culturally diverse, underserved communities. A community resilience/capacity framework, consisting of catalysts (primarily the creation of awareness) and capital components: human (workforce development), social (networking and empowerment) and economic (volunteer labor and money spent by the program), provided the conceptual underpinnings for the study. Focus groups with stakeholders in two communities, one rural and one metropolitan, were audio-recorded, transcribed and analyzed by categorizing data according to each capital component. In addition to the concepts contained in the capacity framework a new category, informational capital (data specific to the community) emerged during the analysis. We suggest that by acting as a catalyst a community based interprofessional program can affect components of community resilience/capacity, primarily human, social, and informational capital. Using the community resilience/capacity framework facilitated exploration of the perceived impact of an educational program on one rural and one urban underserved community beyond assessing student outcomes or number of clients served.

Type 2 diabetes self-management social support intervention at the U.S.-Mexico border.

OBJECTIVES: To pilot test the efficacy of a culturally tailored diabetes self-management social support intervention for Mexican American adults with Type 2 diabetes (T2DM) living in the U.S.-Mexico border region and to test the feasibility of recruiting and training promotoras to participate in intervention delivery. DESIGN AND SAMPLE: This study used a single-group pretest and posttest design. The convenience sample consisted of 21 Mexican American adults with T2DM. The setting for the study was a community in the Arizona-Sonora, Mexico border region. INTERVENTIONS: A bilingual, bicultural certified diabetes educator (CDE) and a nurse researcher developed the intervention to improve T2DM self-management activities for Mexican Americans. Data were collected using self-report questionnaires, glycosolated hemoglobin (HbA(1c)), and anthropometric measures. RESULTS: Intervention efficacy was demonstrated by an increase in participants' diabetes self-management activities and diabetes knowledge and a decrease in diabetes-related distress and sedentary behaviors. There were no significant changes in physiologic outcomes. Feasibility of recruitment and training of 2 promotoras who participated in intervention delivery was established. CONCLUSIONS: Promotoras, in collaboration with a CDE, successfully delivered a culturally tailored diabetes self-management social support intervention for Mexican American adults with T2DM. This intervention positively affected diabetes self-management behaviors.

Caregiving burden, acculturation, familism, and Mexican American elders' use of home care services.

Caregiving burden has been shown to predict use of home care services among Anglo Americans. In a previous study, only one of two dimensions of caregiving burden predicted such use among Mexican American caregivers. Because acculturation and familism may affect burden, we conducted analyses to test three hypotheses: increased acculturation decreases familism; decreased familism increases burden; and increased burden increases use of home care services. Among 140 Mexican American family caregivers, acculturation was positively correlated with familism; familism was not significantly correlated with burden; objective burden was positively correlated with use of home care services, and objective and subjective burden significantly interacted in their effect on the use of home care services. Targeted interventions may be needed to increase use of home care services and preserve the well-being of Mexican American elders and caregivers.

Saying "no" to professional recommendations: client values, beliefs, and evidence-based practice.

PURPOSE: The purpose of this article is to explore the phenomenon of saying "no" to secondary prevention recommended by healthcare providers. DATA SOURCES: Extracted findings from two qualitative studies in which participants have said "no" to provider recommendations for secondary prevention, specifically screening mammograms or treatment for latent tuberculosis infection, are discussed. CONCLUSIONS: Although these two studies focus on different aspects of secondary prevention, both studies emphasize how client values and beliefs impact health decisions. In evidence-based practice (EBP), both scientific evidence and client values and beliefs must be considered. Nurse practitioners (NPs) have the skill set and are in a position to assist clients to mediate between their values and beliefs and current scientific evidence. IMPLICATIONS FOR PRACTICE: Several findings from the two qualitative studies are relevant for practice: qualitative studies provide information about values and beliefs for EBP, and findings from these particular qualitative studies demonstrated that women were protective about their health even though their values and beliefs did not align with current scientific evidence. Through client narratives, NPs can facilitate clients aligning personal values and beliefs with current scientific evidence in relationship to caring for self.

Resistance, health, and latent tuberculosis infection: Mexican immigrants at the U.S.-Mexico border.

Mexican immigrants living in the U.S.-Mexico border region are confronted with different national explanations about latent tuberculosis infection (LTBI) and preventive treatment. The purpose of this study was to explore how a group of Mexican immigrant women (N = 8) at risk of LTBI treatment failure interpreted and ultimately resisted LTBI preventive treatment. A critical ethnographic methodology, grounded in asymmetrical power relations that are historically embedded within the U.S.-Mexico border culture, was used to examine the encounters between the participants and the health care provider. The study findings are discussed from the perspective of women who experienced oppression and resistance in the U.S.-Mexico border region, providing an account of how Mexican immigrant women become entangled in U.S.-Mexico TB health policies and through resistance manage to assert control over health care choices. In the context of the U.S.-Mexico border region, health care professionals must be skilled at minimizing asymmetrical power relations and use methods that elicit immigrant voices in reconciling differences in health beliefs and practices.

Health-illness transition experiences among Mexican immigrant women with diabetes.

Multiple and complex health-illness transitions are required for successful diabetes self-management. Diabetes health-illness transitions influence the daily lives and interactions of Mexican immigrant women with diabetes. This article reports the findings from an intervention study designed to facilitate the health-illness transition in Mexican immigrant women with type 2 diabetes who reside in the Arizona-Sonora region of the US-Mexico border. There was a significant (P<0.001) increase from preintervention to postintervention in diabetes knowledge and diabetes self-efficacy and a significant decrease (P