Karen A. Amirehsani

Perceptions of Barriers in Managing Diabetes Perspectives of Hispanic Immigrant Patients and Family Members

Purpose Hispanics show poorer self-management of type 2 diabetes than non-Hispanic whites. Although previous studies have reported socioeconomic and cultural barriers to diabetes self-management by Hispanics, little is known about perceived barriers to diabetes self-management from the perspectives of both Hispanics and their family members. The purpose of the study was to explore perceived barriers among Hispanic immigrants with diabetes and their family members. Methods A qualitative study using 5 focus groups was conducted. A total of 73 Hispanic immigrants with type 2 diabetes (n = 36) and family members (n = 37) were recruited in the southeastern United States for a family-based intervention study of diabetes-self management. Participants were asked to describe their perceptions of barriers to self-management. The 5 sessions were audiotaped and transcribed, translated from Spanish into English, and analyzed using standard content analysis. Demographics, hemoglobin A1C levels, blood pressure, and body mass index (BMI) were obtained both for participants with diabetes and for their family members. Results Barriers to diabetes self-management identified by participants with diabetes were in 3 major themes categorized as: suffering from diabetes, difficulties in managing the disease, and lack of resources/support. Two key themes emerged pertaining to family members: we can provide support and we lack knowledge. Conclusions Perceived barriers to diabetes self-management described by Hispanic immigrants with diabetes and family members indicate a lack of intervention strategies to meet their needs. Interventions should include culturally relevant resources, family support, and diabetes self-management skills education.

A Family-Based Diabetes Intervention for Hispanic Adults and Their Family Members

Aims The purpose of this quasi-experimental, 1-group longitudinal study is to examine the effects of a family-based intervention program on diabetes self-management behaviors, A1C, other biomarkers, psychosocial factors, and health-related quality of life in Hispanics with diabetes. Methods Adult patients with diabetes (n = 36) and family members (n = 37) were recruited from a community clinic in rural central North Carolina. Patients and family members attended an 8-week culturally tailored diabetes educational program taught in Spanish. Data were collected pre- and post-intervention for both patients and family members, with an additional data collection for patients 1 month post-intervention. Results Most patients and family members were female, and almost all were immigrants. A1C decreased by 4.9% on average among patients from pre-intervention to 1 month post-intervention. Patients showed significant improvements in systolic blood pressure, diabetes self-efficacy, diabetes knowledge, and physical and mental components of health-related quality of life. Higher levels of intake of healthy foods and performance of blood glucose tests and foot inspections were reported. Family members significantly lowered body mass index and improved diabetes knowledge from pre-intervention to immediately post-intervention. No significant changes in levels of physical activity were found among patients with diabetes or family members. Conclusions Findings suggest that including family members in educational interventions may provide emotional and psychological support to patients with diabetes, help to develop healthy family behaviors, and promote diabetes self-management.

The Meaning of Insulin to Hispanic Immigrants With Type 2 Diabetes and Their Families

Purpose The purpose of this study was to explore the meaning of insulin among a sample of Hispanic immigrants with type 2 diabetes and their family members/significant others. Method Forty-three Hispanics with type 2 diabetes and their family members/significant others were recruited in the southeastern United States for a family-based intervention study on diabetes self-management. Focus groups were conducted in which participants with diabetes and family members were asked to describe their perceptions of insulin. The sessions were audiotaped and transcribed, translated from Spanish into English, and analyzed using standard content analysis. This article reports the findings as well as demographic information and hemoglobin A1C levels of participants. Results The meaning of insulin was described by both Hispanic immigrants with type 2 diabetes and their family members/significant others. Participants’ perceptions were categorized into three major themes: (1) negative perceptions of insulin therapy, (2) perceived barriers to insulin therapy, and (3) positive experiences with insulin emerged from qualitative data. Conclusions The Hispanic immigrants with diabetes and their family members/significant others in this study described perceptions and fears of insulin indicating a lack of understanding of the diabetes disease process and the progressive nature of diabetes. Strategies and further research are necessary to dispel negative perceptions and facilitate positive experiences with insulin for patients and family members/significant others.

A Family-Based, Culturally Tailored Diabetes Intervention for Hispanics and Their Family Members

Purpose The purpose of this study was to test efficacy of a family-based, culturally tailored intervention for Hispanics with type 2 diabetes and their family members. Methods Hispanic patients with type 2 diabetes and their family members recruited from community clinics and ethnic churches were assigned to groups (N = 186). The intervention group received an 8-week culturally tailored diabetes educational program delivered in Spanish while the attention control group received 8 weekly sessions on general health information and 2 sessions on diabetes after completion of the study. Data were collected at baseline, after intervention, and at 1- and 6-month follow-ups for both patients and families. Comparisons of change over time were performed using growth curve analyses after propensity score adjustment. Results Intervention patients improved in diabetes knowledge and diabetes self-efficacy over time (but did not sustain at 6-month follow-up). A1C was lower at 1-month follow-up. Family members had improvements in diabetes knowledge and physical health–related quality of life. Conclusions Including families in the interventions may improve glycemic control, diabetes knowledge, self-efficacy, and physical health–related quality of life. However, strategies for sustaining improvements are needed.

Mexican Americans With Type 2 Diabetes in an Emerging Latino Community: Evaluation of Health Disparity Factors and Interventions

Mexican Americans suffer from disproportionately higher rates of type 2 diabetes and its associated complications than the general population. They also confront significant obstacles to health care access and may not receive the same quality of health care as non-Hispanic Whites. Understanding the factors contributing to their health disparities is critical for nurses and other health care providers working with Latino immigrants, especially those in emerging Latino communities such as North Carolina who may lack the established infrastructure of more traditional Latino communities. The purpose of this article is to explicate these factors and examine culturally competent diabetes interventions being used to assist Mexican Americans increase their knowledge of diabetes and health promoting behaviors in order to achieve better glycemic control and prevent complications.

Tés, Licuados, and Cápsulas Herbal Self-Care Remedies of Latino/Hispanic Immigrants for Type 2 Diabetes

Purpose The purpose of this cross-sectional, descriptive study was to explore the characteristics of herbal remedy use for diabetes among Latinos/Hispanics with type 2 diabetes. Methods A convenience sample of 75 Latino/Hispanic adults with type 2 diabetes was recruited from community-based settings in North Carolina. Data were collected through face-to-face bilingual interviews. Measures included a demographic questionnaire; the Traditional, Complementary, and Alternative Practices Questionnaire; and biophysical indicators of A1C and body mass index. Results Sixty-nine percent of the sample reported using herbal remedies for diabetes self-care. Forty-nine herbal products were identified. The most commonly reported products were prickly pear cactus, aloe vera, celery, and chayote. The perceived effectiveness of products varied; some said they helped “a lot” while others noted the development of side effects. Over three quarters (77%) of persons using herbal remedies reported concurrent use with prescribed medications. Also, some participants reported skipping or altering the dose of diabetes medications when using herbal remedies. Most (77%) reported not disclosing herbal remedy use to health care providers. Conclusions Diabetes educators and other health care providers need to ask Latino/Hispanic clients about their use of herbal remedies and become knowledgeable about herbal products to provide advice about safety.

Increasing Healthy Behaviors in Adolescents of Mexican Heritage in Rural Emerging Latino Communities: Results from a School-Based Health Intervention Pilot Study

The rapid Latino population growth in emerging Latino communities (EmLCs) presents a challenge to health care providers as most current health interventions and health promotion programs intended for Latinas/os are based on characteristics of established Latino communities (EsLCs). This study addresses the gap in the literature by modifying and testing the beginning efficacy of a school-based health intervention for adolescents of Mexican heritage in a rural EmLC. Seventy adolescents of Mexican heritage attending a rural middle school participated in the intervention. Paired samples t-tests were performed to determine differences between healthy behaviors at post-intervention compared to pre-intervention. Significant improvements in participants’ physical activity and healthy eating were observed between pre-intervention and post-intervention. A school-based health intervention designed to increase healthy behaviors of adolescents of Mexican heritage in a rural EmLC was successful.

US Healthcare Experiences of Hispanic Patients with Diabetes and Family Members: A Qualitative Analysis

ABSTRACT Hispanics in the United States experience significant health disparities. Using focus groups conducted in Spanish, we explored the perspectives of 172 Hispanic adults regarding their healthcare experiences. Many participants were women (64.5%) and primarily from Mexico (80%). Four major qualitative themes emerged: (a) provide us with information, (b) want attentive and respectful relationships, (c) want better care, and (d) perceived discrimination. Suboptimal patient-provider interactions were described. Research is needed to explore interventions that address these issues. Incorporating person-centered care principles and practices such as clear and understandable communication, culturally competent care, and customer service skills may benefit provider interactions with Hispanics.

Dabigatran etexilate: An alternative to warfarin for patients with nonvalvular atrial fibrillation

Purpose:To critically appraise the evidence on dabigatran etexilate, Pradaxa, as an alternative to warfarin for stroke prevention among patients with nonvalvular atrial fibrillation. This information can assist nurse practitioners in making informed treatment decisions. Data sources:A review of the literature was conducted using CINAHL and PubMed databases. Reports published on cardiovascular organizational web sites were also searched, along with reference lists of relevant published articles and reports. Conclusions:Significant evidence from the PETRO and RE‐LY trials and postmarketing analyses of dabigatran etexilate indicate that this direct thrombin inhibitor is as efficacious as warfarin in ischemic stroke prevention. In fact, the studies found that patients taking dabigatran etexilate had fewer incidences of ischemic stroke and intracranial hemorrhage than those taking warfarin. Risk for major gastrointestinal bleeding appears to be higher than that for warfarin. Implications for practice:Patients taking dabigatran etexilate do not require blood work to assess international normalized ratio (INR) levels. Because this drug is excreted primarily by the kidneys, reassessment of renal function is critical during treatment, especially with concomitant use of diuretics, fluctuating renal function, or hypovolemia. As with warfarin, nurse practitioners should educate patients about when to seek immediate care for the development of anticoagulant‐associated bleeding.