Soohyun Nam

Unmet needs for social support and effects on diabetes self-care activities in Korean Americans with type 2 diabetes

Objective The purpose of this study was (1) to characterize the primary sources of social support and the extent of unmet needs for support (defined as the gap between social support needs and the receipt of social support) in a sample of Korean Americans (KAs) with type 2 diabetes and (2) to examine the effect of unmet needs for support on their self-care activities. Methods Baseline data obtained from a community-based intervention trial were used for this study of 83 middle-aged KAs with type 2 diabetes. Study design and data analysis were guided by social cognitive theory. The key variables were dictated the order of the variables in multivariate regression analysis. Results Our findings indicated that for diabetic KAs, the primary source of social support differed according to gender. Unmet needs for support were significantly associated with self-care activities, but the amount of support needs and of social support received were not. Multivariate analysis also confirmed that unmet needs for social support are a significant strong predictor of inadequate type 2 diabetes self-care activities, after controlling for other covariates. The hierarchical regression model explained about 30% of total variance in self-care activities. Conclusions The findings highlight the importance of considering unmet needs for social support when addressing self-care activities in type 2 diabetes patients. Future interventions should focus on filling gaps in social support and tailoring approaches according to key determinants, such as gender or education level, to improve self-care activities in the context of type 2 diabetes care.

Effect of culturally tailored diabetes education in ethnic minorities with type 2 diabetes: a meta-analysis.

Background:Diabetes is a major cause of cardiovascular morbidity and mortality. Ethnic minorities experience a disproportionate burden of diabetes; however, few studies have critically analyzed the effectiveness of a culturally tailored diabetes intervention for these minorities. Objective:The aim of this study was to evaluate the effectiveness of a culturally tailored diabetes educational intervention (CTDEI) on glycemic control in ethnic minorities with type 2 diabetes. Method:We searched databases within PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Education Resources Information Center (ERIC), PsycINFO, and ProQuest for randomized controlled trials (RCTs). We performed a meta-analysis for the effect of diabetes educational intervention on glycemic control using glycosylated hemoglobin (HbA1c) value in ethnic minority groups with type 2 diabetes. We calculated the effect size (ES) with HbA1c change from baseline to follow-up between control and treatment groups. Results:The 12 studies yielded 1495 participants with a mean age of 63.6 years and a mean of 68% female participants. Most studies (84%) used either group education sessions or a combination of group sessions and individual patient counseling. The duration of interventions ranged from 1 session to 12 months. The pooled ES of glycemic control in RCTs with CTDEI was −0.29 (95% confidence interval, −0.46 to −0.13) at last follow-up, indicating that ethnic minorities benefit more from CTDEI when compared with the usual care. The effect of intervention was greatest and significant when HbA1c level was measured at 6 months (ES, −0.41; 95% confidence interval, −0.61 to −0.21). The ES also differed by each participant’s baseline HbA1c level, with lower baseline levels associated with higher ESs. Conclusions:Based on this meta-analysis, CTDEI is effective for improving glycemic control among ethnic minorities. The magnitude of effect varies based on the settings of intervention, baseline HbA1c level, and time of HbA1c measurement. More rigorous RCTs that examine tailored diabetes education, ethnically matched educators, and more diverse ethnic minority groups are needed to reduce health disparities in diabetes care.

Development and validation of the high blood pressure-focused health literacy scale

OBJECTIVE While the role of health literacy in chronic disease management is well documented, few intervention studies have been reported. A major barrier to designing and implementing such interventions is the lack of valid health literacy tools. This study developed and tested a novel health literacy scale for individuals with high blood pressure (HBP). METHODS A two-step design process was used: In the construction phase, focus group studies and a literature review were conducted to generate a pool of items. The testing phase involved a psychometric evaluation and pilot-testing of the scale on hypertensive Korean Americans (n=386). The end product was a HBP-health literacy scale (HBP-HLS) with two essential domains, print literacy and functional health literacy. RESULTS Psychometric testing indicated that the scale was reliable (Kuder-Richardson-20 coefficient=0.98), valid (content validity index ≥0.8), and significantly correlated with theoretically selected variables (education, r=0.67, p<0.01; HBP knowledge, r=0.33, p<0.01). CONCLUSION The HBP-HLS demonstrated its utility for evaluating HBP management interventions in the community setting. PRACTICE IMPLICATIONS Utilizing the HBP-HLS should be considered as a potential tool for improving health literacy and evaluating intervention studies in the context of HBP management.

Challenges of Diabetes Management in Immigrant Korean Americans

Purpose To examine challenges in diabetes self-management among Korean Americans to guide clinicians in providing culturally appropriate and population-targeted diabetes care. Methods Five focus groups with 23 Korean Americans with type 2 diabetes, 30 to 75 years of age, were conducted. Open-ended questions were presented focusing on previous experiences in living with diabetes; digital recordings were transcribed verbatim; transcripts were coded and themes were identified. Results Most participants were reluctant to disclose diabetes because of social stigma and said that they did not know much about diabetes and its complications. Diabetes self-management is not always a top priority for Korean Americans over other family obligations or financial stability in their busy immigration lives. Many Korean Americans experience conflicts with family members in managing diabetes or would not request support from family members for their diabetes care. Traditional women’s roles and demanding immigration life seem to leave women particularly vulnerable to a lack of self-care. Lack of English proficiency limits access to mainstream health care. Conclusions Providing diabetes education at the community level is important to raise public awareness of diabetes and to eliminate social stigma. To facilitate family support for individuals with type 2 diabetes, it is appropriate to include the entire family in diabetes educational programs and to promote individual family members’ health in the context of maintaining their role within the family. Future efforts should be made with full implementation of language services in various clinical encounters and diabetes education.

Occupational factors associated with obesity and leisure-time physical activity among nurses: A cross sectional study

BACKGROUND AND OBJECTIVE Adverse working conditions contribute to obesity and physical inactivity. The purpose of this study was to examine the associations of occupational factors with obesity and leisure-time physical activity among nurses. METHODS This study used cross-sectional data of 394 nurses (mean age 48 years, 91% females, 61% white) randomly selected from the California Board of Registered Nursing list. Data on demographic and employment characteristics, musculoskeletal symptom comorbidity, physical and psychosocial occupational factors, body mass index (BMI), and physical activity were collected using postal and on-line surveys from January to July in 2013. RESULTS Of the participants, 31% were overweight and 18% were obese; 41% engaged in regular aerobic physical activity (≥ 150 min/week) and 57% performed regular muscle-strengthening activity (≥ 2 days/week). In multivariable logistic regression models, overweight/obesity (BMI ≥ 25 kg/m(2)) was significantly more common among nurse managers/supervisors (OR=2.54, 95% CI: 1.16-5.59) and nurses who worked full-time (OR=2.18, 95% CI: 1.29-3.70) or worked ≥ 40 h per week (OR=2.53, 95% CI: 1.58-4.05). Regular aerobic physical activity was significantly associated with high job demand (OR=1.63, 95% CI: 1.06-2.51). Nurses with passive jobs (low job demand combined with low job control) were significantly less likely to perform aerobic physical activity (OR=0.49, 95% CI: 0.26-0.93). Regular muscle-strengthening physical activity was significantly less common among nurses working on non-day shifts (OR=0.55, 95% CI: 0.34-0.89). Physical workload was not associated with obesity and physical activity. CONCLUSIONS Our study findings suggest that occupational factors significantly contribute to obesity and physical inactivity among nurses. Occupational characteristics in the work environment should be considered in designing effective workplace health promotion programs targeting physical activity and obesity among nurses.

Factors associated with health-related quality of life in elderly Korean patients with heart failure.

Background:Heart failure (HF) is a debilitating chronic disease with incidence and prevalence increasing worldwide. People with HF experience deteriorating functional status, severe fatigue, dyspnea, and repeated hospital admissions, which negatively affect health-related quality of life (HRQoL). Therefore, 1 of the primary goals of HF management is to improve HRQoL. Objective:The purpose of this study was to describe the relationship among sociodemographics, clinical factors, functional status, depression, and HRQoL in elderly Korean patients with HF. Methods:A descriptive, cross-sectional study design was used. We enrolled 134 HF patients from outpatient cardiology clinics at an academic-affiliated hospital and a tertiary care academic referral medical center in Cheonan, South Korea. We obtained sociodemographic and psychosocial variables from face-to-face interviews and obtained clinical variables from medical record reviews. We used the Minnesota Living With Heart Failure Questionnaire to measure HRQoL. Results:Using hierarchical multiple regression analysis and after controlling for sociodemographic and clinical factors, we determined that HRQoL was independently influenced by depression (&bgr; = .443, P < .001), New York Heart Association classification (&bgr; = .148, P < .05), and functional status (&bgr; = –.403, P < .001). Depression and functional status explained about 26% of the variance in HRQoL. Conclusions:Depression and functional status were significantly associated with HRQoL in elderly patients with HF. Our findings emphasize the need for careful clinical screening of both depression and functional status in older patients with HF. More research needs to be conducted to develop effective intervention strategies to improve HRQoL and, in turn, HF outcomes.

Social networks and future direction for obesity research: A scoping review

Despite significant efforts to decrease obesity rates, the prevalence of obesity continues to increase in the United States. Obesity risk behaviors including physical inactivity, unhealthy eating, and sleep deprivation are intertwined during daily life and are difficult to improve in the current social environment. Studies show that social networks-the thick webs of social relations and interactions-influence various health outcomes, such as HIV risk behaviors, alcohol consumption, smoking, depression, and cardiovascular mortality; however, there is limited information on the influences of social networks on obesity and obesity risk behaviors. Given the complexities of the biobehavioral pathology of obesity and the lack of clear evidence of effectiveness and sustainability of existing interventions that are usually focused on an individual approach, targeting change in an individuals health behaviors or attitude may not take sociocontextual factors into account; there is a pressing need for a new perspective on this problem. In this review, we evaluate the literature on social networks as a potential approach for obesity prevention and treatment (i.e., how social networks affect various health outcomes), present two major social network data analyses (i.e., egocentric and sociometric analysis), and discuss implications and the future direction for obesity research using social networks.

Weight Status, Gender, and Race/Ethnicity Are There Differences in Meeting Recommended Health Behavior Guidelines for Adolescents?

Healthy behaviors including limited screen time (ST), high physical activity (PA), and adequate fruits and vegetables consumption (FV) are recommended for adolescents, but it is unclear how gender, race/ethnicity, and weight status relate to these public health guidelines in diverse urban adolescents. Participants (N = 384) were recruited from three public high schools in or near New Haven, Connecticut. Descriptive statistics and logistic regression analyses were conducted. Most adolescents exceeded recommended levels of ST (70.5%) and did not meet guidelines for PA (87.2%) and FV (72.6%). Only 3.5% of the sample met all three guidelines. Boys were more likely to meet guidelines for PA (p < .01), while girls were engaged in less ST (p < .001). Black, non-Latinos were less likely to meet PA guidelines (p < .05). There were no significant differences in meeting ST, PA, or FV guidelines by weight status for the overall sample or when stratified by gender or race/ethnicity. We found alarmingly low levels of healthy behaviors in normal weight and overweight/obese adolescents.

Predictors of exercise intervention dropout in sedentary individuals with type 2 diabetes

PURPOSE: While the benefits of exercise in people with type 2 diabetes mellitus is well-known, knowledge of factors associated with dropouts of exercise intervention trials is limited. Examining clinical and psychosocial factors related to dropout is a necessary first step to developing an effective exercise program. We examined the predictors of a randomized trial of exercise intervention dropout among sedentary individuals with type 2 diabetes mellitus. METHODS: Participants (n = 140) were randomly allocated to a 6-month, 3 times per week exercise intervention, or to a control group. Psychological well-being was assessed using a 36-item Short Form Health Survey, the Profile of Mood States questionnaire, and an Exercise Self-Efficacy scale. Total percent body fat and abdominal subcutaneous and visceral fat were measured. Insulin resistance was assessed with the quantitative insulin sensitivity check index. Fitness was expressed as VO2 peak during treadmill testing. RESULTS: There were significantly more dropouts in the exercise group than in the control group (r = 20.220; P < .01). Those who dropped out of the study had less exercise self-efficacy for lifting weight (r = 0.187; P < .05). Physiological parameters associated with dropouts included low fitness (r = 0.255; P < .01), higher insulin resistance (r = 0.167; P < .05), higher total percent body fat (r = 20.213; P < .05), and higher subcutaneous abdominal fat (r = 20.220; P < .05). In the multiple logistic regression model, exercise group assignment, insulin resistance, and fitness remained significant predictors of dropouts. CONCLUSIONS: Special attention to the sedentary individuals with high insulin resistance and poor fitness should be incorporated into implementing exercise programs to improve diabetes treatment.

Utility of a Point-of-Care Device in Recruiting Ethnic Minorities for Diabetes Research with Community Partners

Background. Recruitment of hard-to-reach ethnic minorities such as Korean Americans (KAs) requires substantial time, cost, and strategic effort. A point-of-care (POC) A1c test could facilitate the recruitment of such populations for diabetes research in community settings. Methods. A two-step approach for participant screening was employed: Potential participants were first screened using the POC A1c test at a community location. Only those with POC A1c levels ≥7.5% were referred for a confirmatory lab test within two weeks. Results. In total, 237 KAs were screened using the POC A1c test; 92 were referred for confirmatory testing and 83 who got the laboratory A1c measurement were confirmed eligible (A1c ≥7.5%). There was a strong positive correlation between the POC and reference laboratory measurements (ρ=0.83, p≤.001). Conclusion. Using a POC A1c method as a front-line screening test can facilitate the recruitment of KAs with type 2 diabetes, while saving cost, time, and effort.