Janet Page-Reeves

A comparative effectiveness study of two culturally competent models of diabetes self-management programming for Latinos from low-income households

BackgroundDiabetes risk is extremely high for Latinos from low-income households. Health guidelines recommend that individuals learn strategies to self-manage their diabetes, but getting people to adopt required lifestyle changes is challenging and many people are not able to prevent their pre-diabetes from escalating or effectively control their diabetes. Systematic reviews show that culturally competent self-management programs can significantly improve diabetes outcomes and different models for culturally competent programming have been developed.MethodsThis patient-engaged study will compare the effectiveness of two distinct evidence-based models for culturally competent diabetes health promotion at two sites that serve a large Latino patient population from low-income households: 1) The Diabetes Self-Management Support Empowerment Model, an educational session approach, and 2) The Chronic Care Model, a holistic community-based program. Data collection will involve interviews, focus groups, surveys and assessments of each program; and testing of patient participants for A1c, depression, Body Mass Index (BMI), and chronic stress with hair cortisol levels. We will recruit a total of 240 patient-social support pairs: Patients will be adults (men and women over the age of 18) who: 1.) Enter one of the two diabetes programs during the study; 2.) Self-identify as “Latino;” 3.) Are able to identify a social support person or key member of their social network who also agrees to participate with them; 4.) Are not pregnant (participants who become pregnant during the study will be excluded); and 5.) Have household income 250% of the Federal Poverty Level (FPL) or below. Social supports will be adults who are identified by the patient participants. PRIMARY OUTCOME: Improved capacity for diabetes self-management measured through improvements in diabetes knowledge and diabetes-related patient activation. SECONDARY OUTCOME: Successful diabetes self-management as measured by improvements in A1c, depression scale scores, BMI, and circulating levels of cortisol to determine chronic stress.DiscussionOur hypothesis is that the program model that interfaces most synergistically with patients’ culture and everyday life circumstances will have the best diabetes health outcomes.Trial registrationThis study was registered with ClinicalTrials.gov on December 16, 2016 (Registration #NCT03004664).

“Is always that sense of wanting … never really being satisfied”: Women’s Quotidian Struggles With Food Insecurity in a Hispanic Community in New Mexico

In this article, we explore women’s everyday experiences with food insecurity. Women’s narratives from a Hispanic community in New Mexico depict the poignant struggles women confront as they actively engage with buffering the experience of hunger to hide scarcity and mask and cope with emotional distress. These data give us a lens for understanding women’s lives in the context of disparity as it relates to food insecurity as a public health issue and provide a way to conceptualize how social determinants operate and integrate with quotidian life activities and processes.

Implementing Physical Activity Recommendations in a Tri-Ethnic Rural Community through a Community–University Partnership

Background: A tri-ethnic rural community with limited resources and a university Prevention Research Center (PRC) developed a partnership to promote evidence-based physical activity.Objective: The purpose of this study was to investigate how a community–university partnership can disseminate and implement ἀe Commu nity Guides recommendations for increasing physical activity and create a model for other under-resourced communities experiencing high rates of chronic disease.Methods: Qualitative data collected through 47 semistructured interviews, meeting minutes, and local newspaper articles were coded for themes and analyzed for patterns across the data.Results: Implementation resulted in the creation of new paths and trails, increased walkability throughout the community, local park enhancements, and a community-wide campaign. Lessons learned included the importance of community-defined goals and outcomes, leadership, volunteerism, mutually beneficial goals, synergy, and having nontraditional partners.Conclusion: This research provides a community-university partnership model for implementing evidence-based strategies to increase physical activity in rural communities.

Understanding "agency" in the translation of a health promotion program.

Health promotion interventions conducted under “ideal conditions” to prove their efficacy are often difficult to translate and disseminate for utilization in “real-world” settings. This article retrospectively integrates and analyzes the experience of three related projects. We investigate how the development and dissemination of a school-based nutrition and physical activity curriculum for American Indian elementary school children inspired the implementation of an across-the-lifespan train-the-trainer program that has trained more than 600 trainers in American Indian communities nationwide. This process provides an opportunity to explore how individuals in the community and the context in which the research was conducted affected project outcomes in ways which were not anticipated. Results challenge the use of “internal validity” as the primary measure of success in translation–dissemination–utilization research.

GED Privatization as a Social Determinant of Health

This article explores a novel place-based effort to improve health outcomes in a ten-square block neighborhood in Albuquerque, New Mexico by assisting people with obtaining a GED. Research conducted as a community-engaged study documents the history and preliminary outcomes of the initiative and how, in the context of the recent privatization of the GED, the welfare of individuals intersects with neoliberal politics. This research offers a timely investigation of the relationship between health and education in the context of ongoing neoliberal restructuring.

Conceptualizing Intersecting Dynamics, Disjunctures and Disparities in the Experience of Food Allergy

Abstract This article details the state of knowledge regarding the experience of food allergy through a systematic review of the small but relevant social science literature and an exploration of mainstream perspectives and understandings. An overview of the biomedical definition of food allergy and the scope of food allergy as an emerging health concern is provided, including an explanation of the social dimensions of food allergy-related health, and the ways that the elusiveness of food allergy diagnosis are central to our understanding of food allergy as a health issue. Epistemological challenges and the creation of alternative or competing nomenclatures are described. Emphasis is accorded to disparities related to gender, socio-economic status and race/ethnicity. Four dimensions of the experience of food allergy are discussed: (1) how food allergy interfaces with cultural and gendered dimensions of food; (2) perception gaps and epistemological conflicts; (3) the food allergy industry and its impacts on consumption; and (4) political and moral discourses. Insights are provided for thinking about food allergy as a food justice issue.

Engaging Latino Patients in Diabetes Research: What We Are Learning

Abstract Through a collaborative partnership between Latino diabetes patients, community stakeholders, and researchers, we developed insights into patient-engaged research. Here, we share what we have learned about a patient-engaged research process in relation to the experience of our Patient Advisors and to the research itself. To develop this manuscript, we engaged in ex post facto critical analysis of our collaborative experience. We include our own musings with input and insights from our Patient Advisors. We learned how our Patient Advisors experience and participate in research, and we revealed dimensions of the research process. Our patient-engaged research with this population is supported by funding for stipends and food, acknowledging patient perspectives and experience, attention to communication issues, strong listening skills, relationship-building, and spending time creating an integrated group dynamic. Using this approach, patient ideas and concerns can be successfully incorporated into re...

Collaboration and Outside-the-Box Thinking to Overcome Training-Related Challenges for Including Patient Stakeholders as Data Collectors in a Patient-Engaged Research Project

Including patient stakeholders as active members of the research team is essential to a patient-engaged research design. To hire community-based research staff for a study comparing the effectiveness of diabetes self-management programs for Latinos, we had to provide phlebotomy training which was not allowed under the fiscal guidelines of our funders. By collaborating with partners at the Clinical and Translational Science Center, we were not only able to find a creative solution and provide phlebotomy training to our research staff but the process of creating the training also contributed to improved infrastructure for patient-engaged research at our institution.

Community-Based Participatory Research for Health:

The new edition of Community-Based Participatory Research for Health by Nina Wallerstein and colleagues is an extremely valuable resource for a wide variety of stakeholders interested in collaborative work to promote health equity. This updated collection succinctly delineates the theory, history, principles, and practices of community-based participatory research (CBPR) to help the reader understand CBPR as an approach, a philosophy, and an ethic. This updated edition will serve as a helpful resource for those interested in incorporating CBPR principles and approaches into their work. The chapters are authored by leaders and innovators in CBPR who provide insights, share experiences, and describe case studies that expand our ability to understand and envision the transformative power of CBPR in practice. The book is divided thematically into seven parts plus 13 appendices. Updates to this edition align with critical dialogues about positionality, privilege, and power in a way that encourages healthy self-reflection.

Community–University Health Research Partnerships

In recent years, there have been positive changes to the health research landscape, with increasing interest amongst community organisations and university investigators in establishing research partnerships and with more funding opportunities for communityengaged work. However, creating a community–university partnership requires new skills, new types of knowledge, and new ways of creating and maintaining relationships. On both sides of the research equation, people are looking for guidance. The discussion here uses our experience to off er concrete tips in plain language for strategies that can be used to build capacity for community–university partnerships for organisations and researchers in pre-partnership and early partnership stages. We comment on debates about epistemology and knowledge production in research and how anthropologists are well positioned to contribute to this process.