Sharon W. Utz

Culturally Tailored Intervention for Rural African Americans With Type 2 Diabetes

Purpose The purpose of this pilot study was to evaluate a culturally tailored intervention for rural African Americans. Social Cognitive Theory provided the framework for the study. Methods Twenty-two participants were recruited and randomly assigned to either Group or Individual diabetes self-management (DSME). Group DSME included story-telling, hands-on activities, and problem-solving exercises. Individual DSME sessions focused on goal-setting and problem-solving strategies. Sessions were offered in an accessible community center over a 10-week period. Results Outcomes included glycosylated hemoglobin (A1C), self-care actions, self-efficacy level, goal attainment, and satisfaction with DSME. Participants in both Group and Individual DSME improved slightly over the 3-month period in self-care activities, A1C level, and goal attainment. Although differences were not statistically significant, trends indicate improved scores on dietary actions, foot care, goal attainment, and empowerment for those experiencing Group DSME. Conclusions The culturally tailored approach was well received by all participants. Improvements among those receiving Individual DSME may indicate that brief sessions using a culturally tailored approach could enhance self-care and glycemic control. Additional testing among more participants over a longer time period is recommended.

“Working Hard With It”: Self-management of Type 2 Diabetes by Rural African Americans

The specific aims of this study were to describe the experience of self-managing type 2 diabetes among rural dwelling African Americans, to identify facilitators and barriers to self-management, to describe the use of prescribed and alternative therapies, and to elicit recommendations for programs of diabetes care. Ten focus groups were held in 3 rural communities. Men and women were in separate groups with facilitators matched by race and gender. Seventy-three participants attended the focus groups to discuss the management of diabetes. Group sessions were tape-recorded and transcribed; field notes were also taken. Data were analyzed using Folio Views software and were reviewed by the multidisciplinary team. Results indicate both unique and common themes from this population.

Stress management during pregnancy: designing and evaluating a mind-body intervention.

The objective of this 12-week study was to determine whether a relaxation-guided imagery (R-GI) intervention designed as a primary prevention strategy for stress management was perceived as beneficial to African American women during the second trimester of pregnancy. All participants documented perceived benefits of the R-GI intervention that included the following: (1) improved breathing; (2) ability to relax, clear ones mind, and become calm; (3) ability to channel and decrease stress; (4) release of anxiety; (5) use of R-GI throughout the day helped control anger and state of mind, leading to a smoother day; and (6) improved ability to fall and stay asleep.

Plenty of Sickness : Descriptions by African Americans living in rural areas with type 2 diabetes

Purpose The purposes of this study were to (1) describe facilitators and barriers to self-care for African Americans with type 2 diabetes living in a rural community, (2) compare experiences of men and women, and (3) solicit recommendations for programs of care. Methods Focus groups with small numbers of men and women (n = 7) were held to explore facilitators and barriers to self-management. Groups were led by moderators of the same gender and race as participants. Data from these information-rich cases were analyzed thematically using Folio Views ® and Inspiration ®software. Results Final categories included “being diagnosed,” “diabetes as betrayal by the body,” “provider-individual-family relationship,” “self-management,” and “difficulty getting help.” Although limited by sample size and methodology, results indicate differences by gender that require additional investigation. Conclusions Knowledge of self-care patterns is foundational to designing culturally appropriate interventions and programs of care for rural African Americans living with diabetes.

A Systematic Review of the Relationship of Diabetes Mellitus, Depression, and Missed Appointments in a Low-Income Uninsured Population

The purpose of this systematic literature review was to determine the relationship between the diagnosis of diabetes and depression and missed appointments in a low-income, uninsured, racially heterogeneous, adult population. Research demonstrates that individuals with diabetes have an increased incidence of depression across socioeconomic and racial groups. Low-income individuals have an increased prevalence of depression. The cost and burden of diabetes are greatly increased among individuals with both diabetes and depression versus diabetes alone. The prevalence and effects of diabetes and depression in a low-income, uninsured, racially heterogeneous population have not been determined. Further research to explore the relationship of diabetes, depression, and missed appointments in this vulnerable population is needed before effective treatment models can be developed. Longitudinal studies are also needed to determine the cause and effect between diabetes and depression among all populations.

Enhancing Diabetes Self-care Among Rural African Americans With Diabetes Results of a Two-year Culturally Tailored Intervention

Purpose The purpose of this study is to test the feasibility of conducting a community-based randomized controlled trial evaluating a culturally tailored community-based group diabetes self-management education (DSME) program among rural African Americans. Methods Thirty-two African American rural adults with type 2 diabetes were recruited and 25 adults were retained and participated in an interventional study designed to test the effectiveness of the “Taking Care of Sugar” DSME program for the 2-year follow-up. Participants were selected from rural central Virginia. Primary outcomes variables included average blood sugar levels, cardiovascular risk factors, and general physical and mental health. These outcomes were assessed at baseline, 3 months, 6 months, and 12 months post baseline. Results From baseline to 3-month follow-up assessment, participants exhibited significant improvement on several physiological and behavioral measures. Given the small sample size, hypothesis testing was limited. Results show change from baseline over time, illustrating that the primary outcome of A1C decreased, although not significant. Additionally, participants reported more knowledge about diabetes self-management and personal care skills (ie, exercise and foot care) that persisted over time. The feasibility of the culturally tailored DSME was established, and participation with the program was high. Conclusions A community-based group DSME program using storytelling is feasible. This research will help to inform clinicians and health policymakers as to the types of interventions that are feasible in a larger rural population. If such a program is carried out, we can improve knowledge, reduce complications, and improve quality of life among rural African Americans.

The Relationship Between Diabetes Mellitus, Depression, and Missed Appointments in a Low-Income Uninsured Population

Purpose The purpose of this project is to identify rates of depression and document mental health needs of adults with diabetes who obtained care in free clinics. Data were collected to determine if there is a relationship between diabetes and depression and missed appointments in a sample of patients who were low-income, uninsured, and represented a variety of racial groups. Methods A sample of 183 adults with diabetes participated by completing paper and computerized questionnaires. Instruments included the Patient Health Questionnaire 9 (to measure prevalence of depression), the RAND 36 Health Survey (to measure quality of health), the Audit of Diabetes Dependent Quality of Life (to measure diabetes-dependent quality of life), and the Diabetes Empowerment Scale (to measure self-efficacy). Results The prevalence of depression at a moderate or greater level in the sample was found to be 30.1%. Levels of quality of health and self-efficacy were found to be reduced among those with the presence of depression. A significant increase in the rate of depression was found among those who had attended the free clinic for a longer period. No significant differences were found in diabetes-dependent quality of life and missed appointments among those with depression compared with those without. Conclusions Rates of depression among adults with diabetes in a free clinic setting were found to be comparable with the highest rates reported by other studies of insured populations. Results of this study support the need to develop mental health treatment programs for free clinic settings.

The effect of instructions on cognitive strategies and performance in biofeedback.

An experimental study was conducted in which 40 subjects, randomly assigned to four groups, were given differing instructions about using auditory biofeedback to lower forehead muscle tension. During each of three sessions, measures were taken of forehead electromyograph (EMG) and ability to discriminate and control muscle tension in order to measure learning during biofeedback. Cognitive strategies used by subjects were measured by taped verbal reports which were judged using four criteria based on two models of learning in biofeedback: “feedforward” and “feedback.” Data were analyzed by chi-square, ANOVA, ANCOVA, and content analysis. Results indicate that subjects used predominantly a feedforward type of learning strategy in all four groups. Implications for teaching during biofeedback are discussed.

Cranial electrical stimulation: potential use in reducing sleep and mood disturbances in persons with dementia and their family caregivers.

Family caregivers of persons with dementia and their care recipients frequently experience sleep and mood disturbances throughout their caregiving and disease trajectories. Because conventional pharmacologic treatments of sleep and mood disturbances pose numerous risks and adverse effects to elderly persons, the investigation of other interventions is warranted. As older adults use complementary and alternative medicine interventions for the relief of sleep and mood disturbances, cranial electrical stimulation, an energy-based complementary and alternative medicine, may be a viable intervention. The proposed mechanism of action and studies that support cranial electrical stimulation as a modality to reduce distressing symptoms are reviewed. Directions for research are proposed.

Teaching the Art of Holistic Nursing Care

(4) Information analysis skills Holistic nursing requires analyzing different information in ways different from the reductionistic approach. Students must ask the right questions, analyze client behavior, and generate hypotheses. To do holistic nursing well, students must ask these types of questions of themselves as they structure and carry out the client assessment process: ~ What complexities of the client’s life coexist with the health deviation? ~ How to the physiological and psychosocial aspects of the client’s life interact? ~ What individual, family, and social pressures does the client experience? ~ Are there any environmental changes or hazards that affect the client’s health? ~ What are the client’s feelings and coping behaviors ?