Regine Haardörfer

Effects of self-care, self-efficacy, social support on glycemic control in adults with type 2 diabetes

BackgroundA number of studies have examined the influence of self-efficacy, social support and patient-provider communication (PPC) on self-care and glycemic control. Relatively few studies have tested the pathways through which these constructs operate to improve glycemic control, however. We used structural equation modeling to examine a conceptual model that hypothesizes how self-efficacy, social support and patient-provider communication influence glycemic control through self-care behaviors in Chinese adults with type 2 diabetes.MethodsWe conducted a cross-sectional study of 222 Chinese adults with type 2 diabetes in one primary care center. We collected information on demographics, self-efficacy, social support, patient-provider communication (PPC) and diabetes self-care. Hemoglobin A1c (HbA1c) values were also obtained. Measured variable path analyses were used to determine the predicted pathways linking self-efficacy, social support and PPC to diabetes self-care and glycemic control.ResultsDiabetes self-care had a direct effect on glycemic control (β = −0.21, p = .007), No direct effect was observed for self-efficacy, social support or PPC on glycemic control. There were significant positive direct paths from self-efficacy (β = 0.32, p < .001), social support (β = 0.17, p = .009) and PPC (β = 0.14, p = .029) to diabetes self-care. All of them had an indirect effect on HbA1c (β =–0.06, β =–0.04, β =–0.03 respectively). Additionally, PPC was positively associated with social support (γ = 0.32, p < .001).ConclusionsHaving better provider-patient communication, having social support, and having higher self-efficacy was associated with performing diabetes self-care behaviors; and these behaviors were directly linked to glycemic control. So longitudinal studies are needed to explore the effect of self-efficacy, social support and PPC on changes in diabetes self-care behaviors and glycemic control.

Pilot Study Results from a Brief Intervention to Create Smoke-Free Homes

Very few community-based intervention studies have examined how to effectively increase the adoption of smoke-free homes. A pilot study was conducted to test the feasibility, acceptability, and short-term outcomes of a brief, four-component intervention for promoting smoke-free home policies among low-income households. We recruited forty participants (20 smokers and 20 nonsmokers) to receive the intervention at two-week intervals. The design was a pretest-posttest with follow-up at two weeks after intervention. The primary outcome measure was self-reported presence of a total home smoking ban. At follow-up, 78% of participants reported having tried to establish a smoke-free rule in their home, with significantly more nonsmokers attempting a smoke-free home than smokers (P = .03). These attempts led to increased smoking restrictions, that is, going from no ban to a partial or total ban, or from a partial to a total ban, in 43% of the homes. At follow-up, 33% of the participants reported having made their home totally smoke-free. Additionally, smokers reported smoking fewer cigarettes per day. Results suggest that the intervention is promising and warrants a rigorous efficacy trial.

A Minimal Intervention to Promote Smoke-Free Homes Among 2-1-1 Callers: A Randomized Controlled Trial

OBJECTIVES We tested the efficacy of a minimal intervention to create smoke-free homes in low-income households recruited through the United Way of Greater Atlanta 2-1-1, an information and referral system that connects callers to local social services. METHODS We conducted a randomized controlled trial (n=498) from June 2012 through June 2013, with follow-up at 3 and 6 months. The intervention consisted of 3 mailings and 1 coaching call. RESULTS Participants were mostly smokers (79.7%), women (82.7%), African American (83.3%), and not employed (76.5%), with an annual household income of

Results From an Intervention to Improve Rural Home Food and Physical Activity Environments

10,000 or less (55.6%). At 6-months postbaseline, significantly more intervention participants reported a full ban on smoking in the home than did control participants (40.0% vs 25.4%; P=.002). The intervention worked for smokers and nonsmokers, as well as those with or without children. CONCLUSIONS Minimal intervention was effective in promoting smoke-free homes in low income households and offers a potentially scalable model for protecting children and adult nonsmokers from secondhand smoke exposure in their homes.

Augmenting Visual Analysis in Single-Case Research With Hierarchical Linear Modeling

Background: Ecological models of healthy eating and physical activity emphasize the influence of behavioral settings such as homes and worksites in shaping behavior. Research on home environments suggests that both social and physical aspects of the home may impact physical activity and healthy eating.Objective: Using a community-based participatory research (CBPR) approach, the Emory Prevention Research Center (EPRC), Cancer Coalition of South Georgia, and the EPRCs Community Advisory Board (CAB) designed and tested a coach-based intervention to make the home environment more supportive of healthy eating and physical activity for rural adults.Methods: The 6-week intervention consisted of a tailored home environment profile, goal-setting, and behavioral contracting delivered through two home visits and two telephone calls. The study used a quasi-experimental design with data collected via telephone interviews at baseline, 2 and 4 months post-baseline. Ninety households (n = 90) completed all three telephone interviews.Results: Multilevel models indicated that intervention households reported significant improvements in household food inventories, purchasing of fruit and vegetables, healthier meal preparation, meals with the TV off, and family support for healthy eating, relative to comparison households. Intervention households also reported increased exercise equipment and family support for physical activity relative to comparison households. Percent of fat intake decreased significantly, but no changes were observed for fruit and vegetable intake, physical activity, or weight among intervention relative to comparison households, although trends were generally in a positive direction.Conclusion: Coaching combined with a focus on the home environment may be a promising strategy for weight gain prevention in adults.

Evaluation of a patient navigation program to promote colorectal cancer screening in rural Georgia, USA.

The purpose of this article is to demonstrate how hierarchical linear modeling (HLM) can be used to enhance visual analysis of single-case research (SCR) designs. First, the authors demonstrated the use of growth modeling via HLM to augment visual analysis of a sophisticated single-case study. Data were used from a delayed multiple baseline design, across groups of participants, with an embedded changing criterion design in a single-case literacy project for students with moderate intellectual disabilities (MoID). Visual analysis revealed a functional relation between instruction and sight-word acquisition for all students. Growth HLM quantified relations at the group level and revealed additional information that included statistically significant variability among students at initial-baseline probe and also among growth trajectories within treatment subphases. Growth HLM showed that receptive vocabulary was a significant predictor of initial knowledge of sight words, and print knowledge significantly predicted growth rates in both treatment subphases. Next, to show the benefits of combining these methodologies to examine a different behavioral topography within a more commonly used SCR design, the authors used repeated-measures HLM and visual analysis to examine simulated data within an ABAB design. Visual analysis revealed a functional relation between a hypothetical intervention (e.g., token reinforcement) and a hypothetical dependent variable (e.g., performance of a target response). HLM supported the existence of a functional relation through tests of statistical significance and detected significant variance among participants’ response to the intervention that would be impossible to identify visually. This study highlights the relevance of these procedures to the identification of evidence-based interventions.

A systematic review of special events to promote breast, cervical and colorectal cancer screening in the United States

Colorectal cancer (CRC) is a leading cause of cancer death in the United States. Early detection through recommended screening has been shown to have favorable treatment outcomes, yet screening rates among the medically underserved and uninsured are low, particularly for rural and minority populations. This study evaluated the effectiveness of a patient navigation program that addresses individual and systemic barriers to CRC screening for patients at rural, federally qualified community health centers.

DECOY: Documenting Experiences with Cigarettes and Other Tobacco in Young Adults.

BackgroundSpecial events are common community-based strategies for health promotion. This paper presents findings from a systematic literature review on the impact of special events to promote breast, cervical or colorectal cancer education and screening.MethodsArticles in English that focused on special events involving breast, cervical, and/or colorectal cancer conducted in the U.S. and published between January 1990 and December 2011 were identified from seven databases: Ovid, Web of Science, CINAHL, PsycINFO, Sociological Abstract, Cochrane Libraries, and EconLit. Study inclusion and data extraction were independently validated by two researchers.ResultsOf the 20 articles selected for screening out of 1,409, ten articles on special events reported outcome data. Five types of special events were found: health fairs, parties, cultural events, special days, and plays. Many focused on breast cancer only, or in combination with other cancers. Reach ranged from 50–1732 participants. All special events used at least one evidence-based strategy suggested by the Community Guide to Preventive Services, such as small media, one-on-one education, and reducing structural barriers. For cancer screening as an outcome of the events, mammography screening rates ranged from 4.8% to 88%, Pap testing was 3.9%, and clinical breast exams ranged from 9.1% to 100%. For colorectal screening, FOBT ranged from 29.4% to 76%, and sigmoidoscopy was 100% at one event. Outcome measures included intentions to get screened, scheduled appointments, uptake of clinical exams, and participation in cancer screening.ConclusionsSpecial events found in the review varied and used evidence-based strategies. Screening data suggest that some special events can lead to increases in cancer screening, especially if they provide onsite screening services. However, there is insufficient evidence to demonstrate that special events are effective in increasing cancer screening. The heterogeneity of populations served, event activities, outcome variables assessed, and the reliance on self-report to measure screening limit conclusions. This study highlights the need for further research to determine the effectiveness of special events to increase cancer screening.

The influence of home food environments on eating behaviors of overweight and obese women.

OBJECTIVES We examined psychographic characteristics associated with tobacco use among Project DECOY participants. METHODS Project DECOY is a 2-year longitudinal mixed-methods study examining risk for tobacco use among 3418 young adults across 7 Georgia colleges/universities. Baseline measures included sociodemographics, tobacco use, and psychographics using the Values, Attitudes, and Lifestyle Scale. Bivariate and multivariable analyses were conducted to identify correlates of tobacco use. RESULTS Past 30-day use prevalence was: 13.3% cigarettes; 11.3% little cigars/cigarillos (LCCs); 3.6% smokeless tobacco; 10.9% e-cigarettes; and 12.2% hookah. Controlling for sociodemographics, correlates of cigarette use included greater novelty seeking (p < .001) and intellectual curiosity (p = .010) and less interest in tangible creation (p = .002) and social conservatism (p < .001). Correlates of LCC use included greater novelty seeking (p < .001) and greater fashion orientation (p = .007). Correlates of smokeless tobacco use included greater novelty seeking (p = .006) and less intellectual curiosity (p < .001). Correlates of e-cigarette use included greater novelty seeking (p < .001) and less social conservatism (p = .002). Correlates of hookah use included greater novelty seeking (p < .001), fashion orientation (p = .044), and self-focused thinking (p = .002), and less social conservatism (p < .001). CONCLUSIONS Psychographic characteristics distinguish users of different tobacco products.

Third-hand smoke as a potential intervention message for promoting smoke-free homes in low-income communities

OBJECTIVE To describe home food environments and examine which aspects are associated with fruit and vegetable intake and percent calories from fat among overweight and obese women. DESIGN Baseline data from a weight gain prevention trial collected through telephone interviews. SETTING Participants were recruited from 3 federally qualified health centers in rural Georgia. PARTICIPANTS Overweight and obese patients (n = 319) were referred by their providers if they had a body mass index (BMI) > 25 and lived with at least 1 other person. Participants were primarily African American (83.7%), with a mean BMI of 38.4. MAIN OUTCOME MEASURES Fruit and vegetable intake and percent calories from fat. ANALYSIS Descriptive statistics and multiple regression. RESULTS Participants reported a large variety of both fruits and vegetables and unhealthy foods in their homes, and an average of 2.6 family meals from non-home sources per week. Eating family meals with the television on was common. Availability of fruits and vegetables in the home (P < .001) and frequency of fruit shopping (P = .01) were associated with fruit and vegetable intake. The number of unhealthy foods in the home (P = .01) and food preparation methods (P = .01) were associated with percent calories from fat. CONCLUSIONS AND IMPLICATIONS Home food environments may be effective intervention targets for nutrition programs designed for overweight and obese women.