Alexandra A. García

Assessing Outcomes of a Study Abroad Course for NURSING STUDENTS

RESEARCH ABSTRACT There is little debate about the importance of preparing nursing graduates to provide culturally sensitive care to an increasingly diverse society. However, it is difficult for nurse educators to fit learning experiences that help students develop cultural competence into already full programs and create mechanisms to evaluate the results.This article describes a study to assess the impact of a study abroad program on developing cultural competence, including cultural awareness, sensitivity, knowledge, and skills. Results from the Cultural Awareness Survey, reflective journals, and interviews illustrate how the study abroad experience influenced the development of components of cultural competence and might influence clinical practice. Results suggest effective teaching strategies to assist students in becoming culturally competent are experiential in nature and include role modeling, reflective activities, and group discussion.

Ethnic-Specific Weight-Loss Interventions for Low-Income Postpartum Women Findings and Lessons

Promoting weight loss among overweight low-income postpartum women has proven difficult. The study’s aims were to pilot-test ethnic-specific weight-loss interventions using randomized control-group designs for White/Anglo (n = 23), African American (n = 25), and Hispanic low-income postpartum women (n = 23) and draw lessons from psychosocial data and follow-up interviews. Interventions lasting 13 weeks were offered in group settings in the community. Similar to other randomized trials with low-income mothers, weight changes between intervention and control groups were nonsignificant in each ethnic group; however, changes correlated significantly with self-efficacy (Spearman r = .50) for White/Anglo women and self-efficacy (Spearman r = −.48) and perceived stress (Spearman r = .48) for African American women. In follow-up interviews, women felt interventions gave a good foundation for weight loss, but program and situational factors affected participation and weight loss. Control groups (mailed interventions later) were generally more pleased with their assignment than intervention groups.

Using focus groups to plan and evaluate diabetes self-management interventions for Mexican Americans.

Using focus groups also can balance the sense of power between researchers and participants.2 Focus group participants are the experts regarding the issue under study. They possess knowledge that is of value to researchers and can provide new and original perspectives that allow researchers to gain a better understanding of the issue at hand. This role reversal empowers the participant, distributing authority more equally between the researcher and the participant.

Symptom prevalence and treatments among mexican americans with type 2 diabetes

Purpose The purpose of this study was to examine the prevalence of diabetes-related symptoms among Mexican Americans with type 2 diabetes, their perceptions of symptom seriousness, treatments used to self-manage the symptoms, and ratings of treatment effectiveness. Methods As part of a larger descriptive correlational study conducted with 87 Mexican American adults in a southwest metropolitan area, data were collected during one-on-one interviews during outpatient visits using the Diabetes Symptom Self-care Inventory and analyzed with descriptive methods, t tests, and χ2s. Results Participants experienced 4.9 diabetes-related symptoms in a 30-day period and used a variety of treatments to self-manage the symptoms. Many of the self-management strategies were not appropriate for the most common causes of the symptoms. Few people tested their blood glucose levels in response to symptoms even though most owned glucometers. Conclusions Most people who experience diabetes symptoms used self-care to treat the symptoms, did not verify the cause of the symptom, and perceived their treatments as effective. The appropriateness of the treatments used cannot be evaluated without knowing the etiology of the symptom for a particular person and time. Clinicians must assess symptoms and their treatments to best develop effective individualized treatments.

Depression and Adherence to Lifestyle Changes in Type 2 Diabetes A Systematic Review

Purpose Depression affects millions of people worldwide and is prevalent among those with diabetes. The purpose of this review was to synthesize recent research on depression and adherence to dietary and physical activity recommendations in persons with type 2 diabetes (T2DM). Methods This systematic review is a subanalysis of an NIH-funded model-testing meta-analysis. Thirteen electronic databases were searched using terms: depression, adherence, T2DM, diabetes. Selected studies: were reported in English between 2000 and 2012, focused on adults with T2DM, and measured depression and dietary and/or physical activity adherence. Results Twenty-seven studies involving 7266 participants were selected; participants were 54% female and 62 years of age, on average. When reported, depression prevalence in study samples ranged from 4.5% to 74%. Six intervention studies targeted diabetes treatment, with or without depression treatment; no studies focused solely on treating depression. Twenty-one descriptive studies examined relationships between depression and diet/physical activity adherence, finding a negative association. Only 2 of the 6 intervention studies examined this relationship; findings were inconsistent. Conclusion Depression was associated with lower adherence to diabetes self-care, as evidenced primarily by descriptive studies; results of intervention studies were conflicting. Future research should focus on the effects of treating depression on diabetes health outcomes.

Altered perceptions of personal control about retained weight and depressive symptoms in low-income postpartum women.

Postpartum weight retention and depressive symptoms have a high prevalence among low income women. This qualitative study describes low-income womens experiences of weight changes and depressive symptoms during the late postpartum period. Women (n = 25) who were either overweight or had depressive symptoms, or both, at 12 months postpartum participated in an ethnically-congruent focus group. Womens experiences indicated altered personal control related to retained postpartum weight and depressive feelings. Retained weight negatively affected self-esteem and family functioning. Depression left women feeling isolated yet reluctant to seek help. These findings could provide the basis for health promotion interventions relevant to this population.

Health beliefs of Mexican Americans with type 2 diabetes: The Starr County border health initiative.

PURPOSE The purpose of this study was to compare 2 culturally competent diabetes self-management interventions designed for Mexican Americans: an original extended program (24 hours of education, 28 hours of support groups) versus a shorter, more resource-efficient compressed strategy (16 hours of education, 6 hours of support groups). The effects of the interventions on health beliefs are compared. METHODS The authors recruited 216 persons between 35 and 70 years of age diagnosed with type 2 diabetes for at least 1 year. Intervention groups of 8 participants and 8 support persons were randomly assigned to 1 of the interventions. RESULTS Mean health belief scores on each subscale improved for both intervention groups. Both intervention groups reported significant improvements in perceptions of control of their diabetes. Improvements in health beliefs were more sustained at 12 months for individuals in the longer, extended program. The health belief subscale control was the most significant predictor of HbA1c levels at 12 months. CONCLUSIONS Both culturally competent diabetes self-management education interventions were effective in promoting more positive health beliefs. These findings on health beliefs indicate a dosage effect of the intervention and support the importance of ongoing contact through support groups to attain more sustainable improvements in health beliefs.

Effects of food-related interventions for African American women with type 2 diabetes.

Purpose The purpose of this systematic review is to synthesize research that tested culturally competent food-related interventions designed for African American women with type 2 diabetes, to review the current state of the literature and suggest recommendations for future research. Many African American women with type 2 diabetes are challenged to change their culturally rooted food habits to achieve diabetes control. Diabetes educators and clinicians who work with African American women need knowledge of effective interventions to assist their clients. Methods Online databases and research articles’ reference lists were searched for relevant studies published from 1989 to 2010 that tested culturally competent type 2 diabetes management interventions for African American women, that included at least 1 educational session on diet or nutrition, and that addressed a physiologic outcome, such as glycosylated hemoglobin or fasting blood glucose. Results Fifteen studies met the inclusion criteria for this review. Among them, 64% to 100% of the participants were African Americans, and 65% to 100% were women. Six studies showed significant improvements in food practices, and 8 showed significant improvements in glycemic control as a result of the interventions. Conclusions Few studies focused solely on helping African American women make culturally relevant dietary changes to control type 2 diabetes. Most interventions addressed food habits as one of many components for diabetes control, perhaps overwhelming research participants with large amounts of varied information. Targeted interventions are recommended that focus on dietary changes as the foundation for diabetes self-management education for African American women.

Biobehavioral determinants of glycemic control in type 2 diabetes: A systematic review and meta-analysis.

OBJECTIVES To conduct a model-driven meta-analysis of correlational research on psychological and motivational predictors of diabetes outcomes, with adherence factors as mediators. METHODS A comprehensive literature search of published and unpublished studies located a sample of 775 individual correlational or predictive studies reported across 739 research reports. RESULTS Results varied according to the outcome variable included in the regression models. Depression had a larger negative effect on adherence to physical activity than on dietary adherence. Coping and self-efficacy were strongly related to dietary adherence, which was strongly related to improved glycemic control. Medication adherence was related to glycosylated hemoglobin, whereas medications and self-monitoring were related to fasting blood glucose. Adding appointment keeping to the models did not significantly alter the results. CONCLUSION Self-efficacy was the most consistent predictor of all adherence behaviors and dietary adherence was the most significant predictor of HbA1c. Physical activity was the most predictive factor of BMI and glucose self-monitoring the most predictive of FBG. PRACTICE IMPLICATIONS Metabolic control is a primary goal in T2DM, so the best pathway to attaining that goal appears to be an emphasis on self-efficacy and dietary adherence.

Home-based diabetes symptom self-management education for Mexican Americans with type 2 diabetes

This pilot study evaluated an innovative diabetes symptom awareness and self-management educational program for Mexican Americans, a fast growing minority population experiencing a diabetes epidemic. Patients with diabetes need assistance interpreting and managing symptoms, which are often annoying and potentially life-threatening. A repeated measures randomized controlled trial was conducted with 72 Mexican Americans aged 25-75 years with type 2 diabetes. Experimental condition participants received eight weekly, in-home, one-on-one educational and behavior modification sessions with a registered nurse focusing on symptom awareness, glucose self-testing and appropriate treatments, followed by eight biweekly support telephone sessions. Wait-listed control condition participants served as comparisons at three time points. Hierarchical linear modeling was used to evaluate the effects of the intervention between- and within groups on psychosocial, behavioral and clinical outcomes. Participants were predominantly female, middle-aged, moderately acculturated and in poor glycemic control. Experimental group participants (n = 39) significantly improved glycemic control, blood pressure, symptoms, knowledge, self-efficacy, empowerment and quality of life. Post intervention focus groups reported satisfaction with the symptom focus. Addressing symptoms led to clinical and psychosocial improvements. Symptoms seem to be an important motivator and a useful prompt to engage patients in diabetes self-management behaviors to relieve symptoms and prevent complications.