Amanda M. Brouwer

Adolescents and Type 2 Diabetes Mellitus: A Qualitative Analysis of the Experience of Social Support

Objective. Research on how adolescents with type 2 diabetes mellitus (T2DM) understand and use social support is limited. Therefore, we explored how adolescents with T2DM experience and perceive social support. Methods. Adolescents with T2DM were interviewed, and data were qualitatively analyzed using Consensual Qualitative Research methodology. Results. Four themes emerged: support for nondiabetes and diabetes-specific behaviors, feelings of belonging, and disclosure. All participants expressed emotional and self-care-specific support. For some, disclosure and a sense of belonging with others who had diabetes often led to support elicitation. Participants also expressed a fear of disclosing their diabetes to others. Discussion. Adolescents with T2DM value tangible and emotional support for behaviors both related and not related to diabetes. Fear of disclosure was a typical experience with disclosure often limited to close friends and family. Recommendations for health professionals to assist adolescents in promoting appropriate disclosure and means of requesting support are discussed.

Veterans service organization engagement in ‘POWER,’ a peer-led hypertension intervention

Objectives: The purpose of this study was to determine the influence of program factors on participant engagement in POWER, a peer-led intervention designed to reduce hypertension, increase hypertension knowledge, and improve other relevant health behaviors, such as diet and exercise, among US veterans involved in veterans service organizations throughout Southeastern Wisconsin. Methods: Two hundred and nineteen hypertensive members from 58 VSOs participated in a year-long peer-led intervention designed to improve hypertension knowledge, disease self-management behaviors, and health outcomes. This study represents a qualitative evaluation of post and participant engagement in this intervention. We triangulated data collected via three qualitative approaches (observations, focus groups, and in-depth interviews) from intervention posts to derive a model of engagement. Results: Our findings indicate that discrete characteristics of the peer leaders, post members, posts, and the intervention itself contributed to intervention engagement. Discussion: We make suggestions for future research studies, particularly as related to understanding how peer leader identities and cultural norms within VSOs might contribute to peer-led health intervention success.

Experiencing Type 2 Diabetes Mellitus Qualitative Analysis of Adolescents’ Concept of Illness, Adjustment, and Motivation to Engage in Self-Care Behaviors

Purpose The purpose of this study was to explore the perspectives of adolescents diagnosed with type 2 diabetes mellitus (T2DM) in terms of how youths conceptualized the effect of T2DM on daily life, adjustment to the illness, and motivation related to diabetes self-care management. The aims of the study were to gather essential information in order to develop appropriate intervention techniques and inform future studies intended to understand the psychosocial experiences of youths with T2DM. Methods Eight adolescents diagnosed with T2DM were recruited from an outpatient pediatric diabetes clinic at a Midwestern children’s hospital. A qualitative interview was developed, which was scheduled to last about 30 to 45 minutes. Data were analyzed using the consensual qualitative research methodology, wherein qualitative coders developed core ideas and themes related to the adolescent experience of T2DM. Results Three main themes were identified, including how the youths conceptualized the impact of T2DM, adjustment to self-care, and motivation to perform self-care behaviors. Knowledge related to the cause of T2DM and adjustment to completing self-care behaviors was varied among youths. Few adolescents spoke about motivation sources, although when mentioned, it typically involved witnessing negative health consequences in family members or friends with T2DM. Conclusions The data represent essential initial information related to youths with T2DM, which will help guide in developing future studies designed to understand the psychosocial experiences of youths with T2DM and appropriate intervention techniques. Future research that aims to increase internal and external motivation may be able to subsequently impact adherence to self-care behaviors.

Expanding the theory of planned behavior to predict healthy eating behaviors

Purpose – This paper aims to test whether overall and specific healthy eating behaviors and intentions could be better predicted by expanding the theory of planned behavior (TPB) to include a healthy eater identity. Major health organizations suggest increasing consumption of fruits, vegetables and whole grains to address the growing number of overweight and obese individuals, yet researchers have questioned the degree to which existing behavioral intervention programs sufficiently explain healthy eating behaviors. Design/methodology/approach – Adult women (N = 79) completed questionnaires related to TPB components and healthy eater identity. Participants then recorded food consumption for four days using food diaries and food frequency questionnaires. Findings – Using hierarchical multiple regressions, the authors demonstrated that identity as a healthy eater was a significant predictor of healthy eating intentions beyond the TPB components and a significant predictor of fruit and low-fat dairy consumpti...

''I am a blood sugar checker'': Intervening effects of self-as-doer identity on the relationship between self-efficacy and diabetes self-care behaviors

The mechanisms by which self-efficacy contribute to improved diabetes self-care behaviors are poorly understood. We propose that the “self-as-doer” identity might help explain the relationship between behavioral self-efficacy and health behavior enactment. Adults with diabetes (type I = 200, type II = 130) completed self-report measures assessing diabetes management-specific self-efficacy, self-as-doer, and self-care behaviors. We tested the intervening effects of the “self-as-doer” identity on the relationship between self-efficacy and diabetes self-care behaviors. For persons with type I diabetes, self-as-doer was a significant intervening variable for all self-care behaviors. Significant indirect effects of self-as-doer were found for exercise, diet, and blood glucose monitoring for persons with type II diabetes. Implications and recommendations for interventions are discussed.

Shared Illness and Social Support Within Two HIV-Affected African American Communities

A key source of resiliency within HIV-affected African American communities is informal social support. Data from dyadic conversations and focus groups were used to address the following research question: What are HIV-positive African Americans’ social support experiences within their informal social networks in response to HIV-related problems? Circumstances that exacerbated HIV-related problems included others’ fear of contagion, reticence to be involved, judgment and rejection, and disregard for privacy. Support from HIV-negative others buffered the impact of problems when others communicate interest, take the initiative to help, or make a long-term investment in their success. Support from other HIV-positive persons was helpful given the shared connection because of HIV, the opportunity to commiserate about what is mutually understood, and the fight for mutual survival. Based on these findings, we offer suggestions for future research and social network interventions aimed at bolstering connections between HIV-positive peers, reducing stigma, and improving family support.

Motivating Healthy Diet Behaviors: The Self-As-Doer Identity

We investigated whether the experimental manipulation of a self-as-doer identity predicted improved healthy food consumption immediately and one month post-intervention. Women (N = 124), 18–53 years old (M = 22.1, SD = 5.8) were randomly assigned to one of three conditions (i.e., control, education, or education and self-as-doer activity) and recorded their diets over six weeks. Repeated measures ANCOVAs were performed to determine if the self-as-doer intervention created change in healthy food consumption. Self-as-doer participants ate more healthy foods one month post-intervention than did other participants. Self-as-doer participants maintained overall healthy eating behaviors while education and control participants decreased these behaviors over the six-week period. Findings demonstrate initial evidence of an intervention effect on healthy food consumption and we discuss ways to advance research on the self-as-doer identity construct.

Patterns of missing data in ethnic minority health research: a survey project with Russian-speaking immigrant women with hypertension.

We explored cultural-level variables and their associations with missing data in a group of immigrants from the Former Soviet Union (FSU). Elderly hypertensive women (N = 105) completed a health survey. Prevalence of missing data and z scores were calculated to determine which survey items and measures were more likely to have missing data. Hierarchical linear regressions were performed to test whether cultural variables predicted the rate of missing data beyond individual variables. Culture variables associated with survey nonresponse and missing data were related to depression, anxiety, medication beliefs and practices, attitudes toward physicians, and cultural and behavioral identity. An interpretation of the patterns of missing data and strategies to reduce the likelihood of missing data in this population are discussed. Cultural norms likely influence patients’ orientations toward their health care providers. Providers would do well to normalize difficulties with medical adherence and encourage patients to ask questions about such directives. We recommend that researchers consider the cultural appropriateness of survey items and consider alternative methods (i.e., qualitative designs) for culturally sensitive topics such as mental health and sexuality.

Self-as-Doer for Diabetes: Development and Validation of a Diabetes-Specific Measure of Doer Identification

Background: The purpose of this study was to develop and validate a scale to measure the level of self-care behavior “doer identity” in persons with diabetes. Methods: Persons with diabetes (N = 355) completed questionnaires assessing self-as-doer identity and other related constructs. Principle components and parallel analyses and tests of reliability and validity were performed. Results: A 7 factor solution explained 55.24% of the total variance on behaviors. Cronbach’s alpha was .93 for the overall scale. Extracted components moderately correlated with one another and theoretically similar constructs. Self-as-doer identity significantly predicted all self-care behaviors (except for blood glucose monitoring) and glycemic control over and above related variables for persons with type 1 diabetes. Self-as-doer identity also predicted diet behaviors for persons with type 2 diabetes. Conclusions: Evidence for a reliable and valid factor structure of the Self-as-doer-Diabetes measure was demonstrated.

“Cancer was a speed bump in my path to enlightenment:” A qualitative analysis of situational coping experiences among young adult survivors of childhood cancer

ABSTRACT Young adult survivors of childhood cancer (N = 47) completed essays exploring situational coping within a mixed methods study. Data were qualitatively analyzed using consensual qualitative research-modified methodology. Five themes emerged: (1) initial reactions to cancer, (2) adjustment/coping with cancer diagnosis and treatment, (3) provisions of social support, (4) perceived effects of cancer experience, and (5) reflections on the cancer experience. Perceptions of childhood cancer experiences appear generally positive, with the majority of negative reactions emerging immediately following diagnosis. Cognitive behavioral and supportive interventions may be most beneficial in the initial postdiagnosis period and should emphasize lasting benefits, accomplishments, and profound effects.