Christopher R. Long

Diabetes and Hypertension in Marshallese Adults: Results from Faith-Based Health Screenings

BackgroundThe Pacific Islander population in the USA is growing rapidly. However, research on Pacific Islanders in the USA is limited, or sometimes misleading due to aggregation with Asian Americans. This project seeks to add to the dearth of health literature by conducting a health assessment of Marshallese in northwest Arkansas.MethodsUsing a community-based participatory research approach, nine health screening events were conducted at local Marshallese churches. Participants completed the Behavioral Risk Factors Surveillance Survey core questionnaire and diabetes module if applicable. Biometric data, including Hemoglobin A1c, blood pressure, and body mass index, were gathered by an interprofessional team.ResultsFour hundred one participants completed health screenings. High proportions of diabetes, obesity, and hypertension were found. A high percentage of participants were uninsured, and multiple barriers to health care were found within the sample.DiscussionThis project represents one of the first broad health assessments of Pacific Islanders in the USA. Proportions of diabetes, hypertension, obesity, and uninsured found in the sample are much higher than national proportions.

Health research participants’ preferences for receiving research results

Background: Participants in health research studies typically express interest in receiving the results from the studies in which they participate. However, participants’ preferences and experiences related to receiving the results are not well understood. In general, the existing studies have had relatively small sample sizes and typically address specific and often sensitive issues within targeted populations. Methods: This study used an online survey to explore attitudes and experiences of registrants in ResearchMatch, a large database of past, present, and potential health research participants. Survey respondents provided information related to whether or not they received research results from studies in which they participated, the methods used to communicate the results, their satisfaction with the results, and when and how they would like to receive research results from future studies. In all, 70,699 ResearchMatch registrants were notified of the study’s topic. Of the 5207 registrants who requested full information about the study, 3381 respondents completed the survey. Results: Approximately 33% of respondents with previous health research participation reported receiving the results. Approximately half of respondents with previous research participation reported no opportunity to request the results. However, almost all respondents said researchers should always or sometimes offer the results to participants. Respondents expressed particular interest in the results related to their (or a loved one’s) health, as well as information about studies’ purposes and any medical advances based on the results. In general, respondents’ most preferred dissemination methods for the results were email and website postings. The least desirable dissemination methods for the results included Twitter, conference calls, and text messages. Across all the results, we compare the responses of respondents with and without previous research participation experience and those who have worked in research organizations versus those who have not. Compared to respondents who have previous participation experience, a greater proportion of respondents with no participation experience indicated that the results should always be shared with participants. Likewise, respondents with no participation experience placed higher importance on the receipt of each type of results’ information included in the survey. Conclusion: We present findings from a survey assessing attitudes and experiences of a broad sample of respondents that addresses gaps in knowledge related to participants’ preferences for receiving the results. The study’s findings highlight the potential for inconsistency between respondents’ expressed preferences to receive specific types of results via specific methods and researchers’ unwillingness or inability to provide them. We present specific recommendations to shift the approach of new studies to investigate participants’ preferences for receiving research results.

Design of a randomized, controlled, comparative-effectiveness trial testing a Family Model of Diabetes Self-Management Education (DSME) vs. Standard DSME for Marshallese in the United States

Background Type 2 diabetes (T2D) is a significant public health problem, with U.S. Pacific Islander communities—such as the Marshallese—bearing a disproportionate burden. Using a community-based participatory approach (CBPR) that engages the strong family-based social infrastructure characteristic of Marshallese communities is a promising way to manage T2D. Objectives Led by a collaborative community-academic partnership, the Family Model of Diabetes Self-Management Education (DSME) aimed to change diabetes management behaviors to improve glycemic control in Marshallese adults with T2D by engaging the entire family. Design To test the Family Model of DSME, a randomized, controlled, comparative effectiveness trial with 240 primary participants was implemented. Half of the primary participants were randomly assigned to the Standard DSME and half were randomly assigned to the Family Model DSME. Both arms received ten hours of content comprised of 6–8 sessions delivered over a 6–8 week period. Methods The Family Model DSME was a cultural adaptation of DSME, whereby the intervention focused on engaging family support for the primary participant with T2D. The Standard DSME was delivered to the primary participant in a community-based group format. Primary participants and participating family members were assessed at baseline and immediate post-intervention, and will also be assessed at 6 and 12 months. Summary The Family Model of DSME aimed to improve glycemic control in Marshallese with T2D. The utilization of a CBPR approach that involves the local stakeholders and the engagement of the family-based social infrastructure of Marshallese communities increase potential for the interventions success and sustainability.

Improving Culturally Appropriate Care Using a Community-Based Participatory Research Approach: Evaluation of a Multicomponent Cultural Competency Training Program, Arkansas, 2015-2016.

Introduction The United States continues to become more racially and ethnically diverse, and racial/ethnic minority communities encounter sociocultural barriers to quality health care, including implicit racial/ethnic bias among health care providers. In response, health care organizations are developing and implementing cultural competency curricula. Using a community-based participatory research (CBPR) approach, we developed and evaluated a cultural competency training program to improve the delivery of culturally appropriate care in Marshallese and Hispanic communities. Methods We used a mixed-methods evaluation approach based on the Kirkpatrick model of training evaluation. We collected quantitative evaluation data immediately after each training session (March 19, 2015–November 30, 2016) and qualitative data about implementation at 2 points: immediately after each session and 6 months after training. Individuals and organizational units provided qualitative data. Results We delivered 1,250 units of in-person training at 25 organizations. Participants reported high levels of changes in knowledge (91.2%), competence (86.6%), and performance (87.2%) as a result of the cultural competency training. Organizations reported making policy and environmental changes. Conclusion Initial outcomes demonstrate the value of developing and implementing cultural competency training programs using a CBPR approach. Additional research is needed to determine the effect on long-term patient outcomes.

Physical Activity and Diabetes-related Health Beliefs of Marshallese Adults

OBJECTIVE We sought to improve understanding of diabetes-related health beliefs and physical activity behaviors of Marshallese adults with and without type 2 diabetes (T2D). METHODS We used tests of comparison and regression analyses to examine data from 376 Marshallese adults collected at church-based events. RESULTS One in 5 (20.2%) respondents had received a T2D diagnosis. About one-fourth of the respondents fell into one of 4 physical activity levels: zero times per week (28.7%), one time per week (19.4%), 2-3 times per week (24.7%) and ≥4 times per week (26.9%). Using logistic regression, we found T2D diagnosis status was not statistically associated with level of physical activity. However, having time to be physically active was significantly associated with being physically active ≥4 times per week. Being obese, having less than a high school education, not having time, and not having a comfortable place to exercise were significantly associated with never being physically active. CONCLUSIONS These findings help fill gaps in Pacific Islander health literature and will inform public health interventions to improve rates of physical activity among the Marshallese and other Pacific Islander communities.

Cost-related Nonadherence to Medication Treatment Plans

Background: Adherence to medication treatment plans is important for chronic disease (CD) management. Cost-related nonadherence (CRN) puts patients at risk for complications. Native Hawaiians and Pacific Islanders (NHPI) suffer from high rates of CD and socioeconomic disparities that could increase CRN behaviors. Objective: Examine factors related to CRN to medication treatment plans within an understudied population. Research Design: Using 2014 NHPI-National Health Interview Survey data, we examined CRN among a nationally representative sample of NHPI adults. Bonferroni-adjusted Wald test and multivariable logistic regression were performed to examine associations among financial burden-related factors, CD status, and CRN. Results: Across CD status, NHPI engaged in CRN behaviors had, on an average, increased levels of perceived financial stress, financial insecurity with health care, and food insecurity compared with adults in the total NHPI population. Regression analysis indicated perceived financial stress [adjusted odds ratio (AOR)=1.16; 95% confidence intervals (CI), 1.10–1.22], financial insecurity with health care (AOR=1.96; 95% CI, 1.32–2.90), and food insecurity (AOR=1.30; 95% CI, 1.06–1.61) all increase the odds of CRN among those with CD. We also found significant associations between perceived financial stress (AOR=1.15; 95% CI, 1.09–1.20), financial insecurity with health care (AOR=1.59; 95% CI, 1.19–2.12), and food insecurity (AOR=1.31; 95% CI, 1.04–1.65) and request for lower cost medication. Conclusions: This study demonstrated health-related and non–health-related financial burdens can influence CRN behaviors. It is important for health care providers to collect and use data about the social determinants of health to better inform their conversations about medication adherence and prevent CRN.

Health research participants are not receiving research results: a collaborative solution is needed

Health research participants want the results of the studies in which they participate but do not typically receive them. Researchers generally express support for sharing results with participants but, in practice, may be unprepared or unwilling to do so. Many funders call for increased dissemination of research results beyond academic and clinical audiences, but few funders sponsor research to improve result sharing with participants. Although the solution appears straightforward (e.g., funders could incentivize researchers to share results with participants), there are critical gaps in knowledge that suggest the need for a more deliberate approach. For example, what ethical or practical concerns discourage researchers from returning results to participants? What exactly do participants plan to do with the results that they would like to receive? What are the best channels of communication for sharing results with particular participant populations? To address these knowledge gaps, we argue for a collaborative process to develop a research agenda related to result sharing with participants. With support and encouragement by funders, such research should evaluate the effects of different types of results (and results from different types of studies) on participants’ behaviors, attitudes, and emotions; it should also examine the researchers’ ethical, financial, logistical, methodological, and skill-related concerns and constraints related to sharing results with participants. Over time, collaborative research between researchers and participants can yield an evolving set of evidence-based guidelines for ethical, effective result sharing with participants.

Identifying and Understanding Barriers and Facilitators to Medication Adherence Among Marshallese Adults in Arkansas

Background: Significant health disparities are present in Marshallese adults residing in the United States, most notably a high incidence of type 2 diabetes and other chronic conditions. There is limited research on medication adherence in the Marshallese population. Objective: This study explored perceptions of and experiences with medication adherence among Marshallese adults residing in Arkansas, with the aim of identifying and better understanding barriers and facilitators to medication adherence. Methods: Eligible participants were Marshallese adults taking at least one medication for a chronic health condition. Each participant completed a brief survey and semistructured interview conducted in Marshallese by a bilingual Marshallese staff member. Interviews were recorded, transcribed, and translated from Marshallese to English. Qualitative data were coded for a priori and emergent themes. Results: A total of 40 participants were included in the study. The most common contributing factor for nonadherence was forgetting to take medication (82%). A majority of participants (70%) reported difficulty paying for medicine, 45% reported at least one form of cost-related nonadherence, and 40% engaged in more than one cost-related nonadherence practice. Family support and medication pill boxes were identified as facilitators for medication adherence. The majority of the participants (76.9%) stated that they understood the role of a pharmacist. Participants consistently desired more education on their medications from pharmacy providers. Conclusion: This is the first study to explore barriers and facilitators to medication adherence among Marshallese patients. The findings can be used to develop methods to improve medication adherence among Marshallese.

Sleep deficiency among Native Hawaiian/Pacific Islander, Black, and White Americans and the association with cardiometabolic diseases: analysis of the National Health Interview Survey Data

PURPOSE Examine sleep deficiency, factors, and associations with cardiometabolic diseases in United States Native Hawaiian/Pacific Islanders (NHPI), Blacks, and Whites. DESIGN Data from the 2014 National Health Interview Survey and NHPI National Health Interview Survey household interviews of adults were analyzed. PARTICIPANTS Of 31,724 participants, 7% were NHPI, 14% were Black, and 79% were White. METHODS Habitual sleep duration and quality, sociodemographic/economic covariates, health behaviors, psychological distress, and chronic diseases were self-reported. Sleep duration was coded as very short (VSS; <5 hours), short (SS; 5-6 hours), long (LS; >8 hours), or healthy (7-8 hours). Using multivariate logistic regressions, the association between sleep duration and diseases was assessed after adjusting for covariates. RESULTS NHPI were more likely to report sleep <7 hours compared to Whites (40.2% NHPI, 29.3% White) and less LS than Blacks (7% NHPI, 9.2% Black), report poor sleep quality, and use fewer sleep medications. VSS was related to smoking and psychological distress in NHPI men. VSS was associated with hypertension and SS with diabetes in NHPI, even in adjusted models. The relationship between SS and diabetes was higher in NHPI (risk ratio [RR]: 1.40, 95% confidence interval [CI]: 1.03-1.90) than Whites (RR: 1.01, 95% CI: 0.90-1.14, P = .027) and Blacks (RR: 1.02, 95% CI: 0.85-1.23, P = .043) even after adjusting for other covariates. CONCLUSIONS NHPI reported suboptimal sleep duration that was linked to hypertension and diabetes even after controlling for covariates. Additional prospective studies in NHPI are needed to understand biological, behavioral, and psychological factors of sleep deficiency and its impact on chronic diseases.

The Mediating Role of Sleep Quality and Quantity in the Link Between Food Insecurity and Obesity Across Race and Ethnicity

The objective of the study was to examine the mediating role of sleep quality and quantity in the relationship between food insecurity and obesity across races/ethnicities.