Stephania T. Miller

Psychometric evaluation of the Problem Areas in Diabetes (PAID) survey in Southern, rural African American women with Type 2 diabetes

BackgroundThe Problem Areas in Diabetes (PAID) survey is a measure of diabetes-related stress for which reported use has been in largely Caucasian populations. Our purpose was to assess the psychometric properties of the PAID in Southern rural African American women with Type 2 diabetes.MethodsA convenience sample of African American women (N = 131) ranging from 21–50 years of age and diagnosed with Type 2 diabetes were recruited for a survey study from two rural Southern community health centers. Participants completed the PAID, Center for Epidemiological Studies-Depression Scale (CES-D), and the Summary of Diabetes Self-Care Activities Scale (SDSCA). Factor analysis, Cronbachs coefficient alpha, and construct validation facilitated psychometric evaluation.ResultsA principle component factor analysis of the PAID yielded two factors, 1) a lack of confidence subscale, and 2) a negative emotional consequences subscale. The Lack of Confidence and Negative Emotional Consequences subscales, but not the overall PAID scale, were associated with glycemic control and body mass index, respectively. Relationships with measures of depression and diabetes self-care supported construct validity of both subscales. Both subscales had acceptable (alpha = 0.85 and 0.94) internal consistency measures.ConclusionA psychometrically sound two-factor solution to the PAID survey is identified in Southern, rural African American women with Type 2 diabetes. Lack of confidence in and negative emotional consequences of diabetes self-care implementation provide a better understanding of determinants of glycemic control and weight than an aggregate of the two scales.

Reducing Unintentional Injuries on the Nation's Highways: A Literature Review

Death and injury on the nations highways is a public health crisis, especially for youth and members of selected minority groups. The objective of this paper is to review the literature on behavioral and environmental factors that increase risk for traffic morbidity and mortality in populations at high risk. Each of the following is a risky traffic-related behavior: not wearing seat belts, not using child safety seats, not wearing bicycle or motorcycle helmets, driving after drinking, driving while fatigued or distracted, speeding, running red lights, and aggressive driving. Environmental factors that modify risk include urban sprawl, highway design, public policy, racism and economic inequality. High risk groups include youths, males, pickup truck drivers, urban dwellers, the elderly, African Americans, American Indians, and Alaska Natives.A comprehensive approach must be developed for reducing traffic-related risk of death and injury, especially in high risk populations.

BMI and Seatbelt Use

Objective: Seatbelt use among obese persons may be reduced because seatbelts are uncomfortable. We investigated the association between obesity and seatbelt use with data from the 2002 Behavioral Risk Factor Surveillance System Survey.

Rural healthcare providers question the practicality of motivational interviewing and report varied physical activity counseling experience

OBJECTIVE To evaluate rural healthcare providers (HCP) physical activity (PA) counseling experiences and perceptions of motivational interviewing (MI), a behavioral counseling style, prior to MI training. METHODS Four moderator-led focus groups were conducted among rural HCPs providing care to rural African American women with Type 2 diabetes. Questions about experiences with PA counseling in this patient population were asked. Following a DVD demonstration of a MI patient/provider consultation, MI impressions were solicited. Focus groups data were transcribed verbatim. Content-based analysis was conducted using qualitative data analysis software, Atlas.ti., and thematic coding by two analysts. RESULTS Thirty-three HCPs (64% nurses) participated. Fifty-five percent reported little or no PA counseling comfort due to either the lack of knowledge of PA recommendations or individual challenges in being physically active. MI was viewed as a potentially effective communication approach (positive impression theme). However, HCPs voiced concern about the limited input of the provider during the MI consultation (disadvantage theme) and the feasibility of implementing MI in healthcare settings (disadvantage theme). CONCLUSION Future studies should evaluate whether integrating, into MI training, information about previous PA counseling experiences and impressions of MI from rural HCPs truly increases the effectiveness of MI training and subsequent PA interventions.

Physical Activity-Related Experiences, Counseling Expectations, Personal Responsibility, and Altruism among Urban African American Women with Type 2 Diabetes

Purpose The purpose of this study was to explore physical activity-related experiences, perceptions, and counseling expectations among urban, underactive, African American women with type 2 diabetes. Methods Participants were recruited via flyers and endocrinologist referral. A professional, African American female moderator led 2 focus groups among 11 participants. Focus groups were conducted in a video- and audio-equipped focus group room in the evening hours. Using a content-based, stepped analytic approach, 2 raters independently analyzed data and collaborated to compare results and finalize themes. Results Competing priorities and lack of motivation were perceived as significant barriers to physical activity. Physical activity-related counseling expectations (ie, physician encouragement) and experiences (physician advising) were inconsistent. Participants expressed a high degree of physical activity-related health responsibility. Altruistic intentions were high relative to helping others incorporate healthful lifestyle changes. Conclusions When counseling women about physical activity, diabetes educators should acknowledge and provide support and resources to help women incorporate more physical activity into their regular routines and enhance motivation for physical activity. Educators should also couple physical activity-related advice with encouragement and support. Because of high levels of altruism, educators should consider implementing group- and/or peer-based physical activity interventions in this patient group.

African American perspectives on health care: the voice of the community.

African Americans often have interactions with health care systems, services, and providers that are quite different from those of other population groups. Residents in a predominantly African American community in the southeastern United States identified issues that had a significant influence on their health care interactions. Their insights about health insurance concerns, perceived quality of health care, and trust in the health care system provide a useful framework for the redesign of care that will better meet their health care needs.

Reducing Unintentional Injuries on the Nation's Highways: Research and Program Policy to Increase Seat Belt Use

Death, disability, and injury from motor vehicle accidents constitute a public health crisis. The goal of this paper is to describe how Meharry Medical Colleges Center for Community Based Research plans to address this problem. A model of how high-risk groups are influenced to engage in behaviors that increase risk for traffic crashes is articulated. Five strategies for reducing risk for motor vehicle morbidity and mortality are identified: 1) influencing the individual at the point of decision; 2) mobilizing communities and coalitions to support individual and systems changes; 3) modifying environmental factors to modify behaviors; 4) changing laws and public policy; and 5) working towards the elimination of underlying causes. The Center for Community Based Researchs promotion of seat belt use, based on each of these five strategies, is described. Addressing the public health crisis resulting from death and injury on the nations roads and the excess risk faced by minority groups in this country will require the coordinated efforts of many groups. This work must be driven by research, the outcome of which will be a reduction in preventable injury, disability and premature death.

Preliminary efficacy of group medical nutrition therapy and motivational interviewing among obese African American women with type 2 diabetes: a pilot study.

Objective. To assess the efficacy and acceptability of a group medical nutritional therapy (MNT) intervention, using motivational interviewing (MI). Research Design & Method. African American (AA) women with type 2 diabetes (T2D) participated in five, certified diabetes educator/dietitian-facilitated intervention sessions targeting carbohydrate, fat, and fruit/vegetable intake and management. Motivation-based activities centered on exploration of dietary ambivalence and the relationships between diet and personal strengths. Repeated pre- and post-intervention, psychosocial, dietary self-care, and clinical outcomes were collected and analyzed using generalized least squares regression. An acceptability assessment was administered after intervention. Results. Participants (n = 24) were mostly of middle age (mean age 50.8 ± 6.3) with an average BMI of 39 ± 6.5. Compared to a gradual pre-intervention loss of HbA1c control and confidence in choosing restaurant foods, a significant post-intervention improvement in HbA1c (P = 0.03) and a near significant (P = 0.06) increase in confidence in choosing restaurant foods were observed with both returning to pre-intervention levels. 100% reported that they would recommend the study to other AA women with type 2 diabetes. Conclusion. The results support the potential efficacy of a group MNT/MI intervention in improving glycemic control and dietary self-care-related confidence in overweight/obese AA women with type 2 diabetes.

Health Care Disparities and Diabetes Care: Practical Considerations for Primary Care Providers

IN BRIEF Disparities in diabetes care are prevalent in the United States. This article provides an overview of these disparities and discusses both potential causes and efforts to address them to date. The authors focus the discussion on aspects relevant to the patient-provider dyad and provide practical considerations for the primary care providers role in helping to diminish and eliminate disparities in diabetes care.

Needs, Priorities, and Recommendations for Engaging Underrepresented Populations in Clinical Research: A Community Perspective.

Engaging underrepresented groups in outcomes research is a public health priority for reducing health and health care disparities; yet, engaging these groups is challenging. Failure to involve these underrepresented populations in research further exacerbates these disparities. This article presents the health and research priorities of diverse groups of underrepresented populations in biomedical research, their concerns for participating in research, and strategies to engage them in their healthcare and research studies. Eleven community listening sessions, ranging from 7 to 13 community members each (N = 117), representing racial/ethnic minority, economically disadvantaged (e.g., uninsured), and hearing impaired communities. We used an inductive, qualitative content analysis approach to analyze the data for emerging themes. We identified the following themes: Uncertainties of underrepresented populations regarding research participation; Ineffective communication about research opportunities and research findings; Research on primary care and prevention are priorities for underrepresented populations in research; and Research teams need training in cultural competence and humility. Underrepresented groups provided research priorities, concerns, and strategies to engage them in their healthcare and in research studies. Findings from this study could facilitate improvement of research participation among underrepresented groups, ultimately reducing health disparities and improving quality of life among groups commonly omitted from research recruitment and participation.