Tricia S. Tang

Social Support, Quality of Life, and Self-Care Behaviors Among African Americans With Type 2 Diabetes:

Purpose The purpose of this study was to examine social support and its relationship to diabetes-specific quality of life and selfcare behaviors in African Americans with type 2 diabetes. Methods The study followed a cross-sectional, observational design and recruited 89 African American adults, age 40 and older (mean = 60, SD = 10.5), diagnosed with type 2 diabetes. Participants completed measures assessing dia- betes-specific quality of life, self-care behaviors (healthy eating, physical activity, self-monitoring of blood glucose, foot care, medication and/or insulin use), demographic background, and diabetes-related social support. Diabetes-related social support variables included amount of social support received, satisfaction with support, positive support behavior, negative support behavior, and primary source of support. Results Stepwise regressions, controlling for demographic variables, were conducted to identify predictors of diabetes-specific quality of life and selfcare behaviors from the diabetes-related social support variables. Satisfaction with support was a predictor for improved diabetes-specific quality of life (r = –.579, P < .001) and blood glucose monitoring (r = .258, P < .05). Positive support behavior was a predictor for following a healthy eating plan (r = .280, P < .05), spacing out carbohydrates evenly throughout the day (r = .367, P < .01), and performing physical activity at least 30 minutes per day (r = .296, P < .05). Negative support behavior was a predictor for not taking medication as recommended (r = –.348, P < .01). Conclusions Findings indicate that social support plays a role in diabetes-specific quality of life and self-management practices. Social support encompasses multiple dimensions that differentially influence specific diabetes health-related outcomes and behaviors.

Self-management support in “real-world” settings: An empowerment-based intervention

OBJECTIVEnThis study examined the impact of a 6-month, empowerment-based diabetes self-management support (DSMS) intervention on clinical outcomes, self-care behaviors, and quality of life (QOL) compared to a 6-month control period.nnnMETHODSnThis control-intervention cohort study recruited 77 African-American adults with type 2 diabetes. Baseline, 6-month, and 12-month assessments measured A1C, weight, body mass index (BMI), blood pressure, lipids, self-care behaviors, and QOL. During the control period, participants received weekly educational newsletters. During the intervention period, participants attended weekly DSMS groups as frequently as they needed. Sessions were guided by participants self-management questions and concerns, and also emphasized experiential learning, coping, problem-solving, and goal-setting.nnnRESULTSnThe control period found significant improvements for diastolic BP (p<0.05), serum cholesterol (p<0.001), following a healthy diet (p<0.01), and monitoring blood glucose (p<0.01). The intervention period found significant additional improvements for A1C (p<0.001), weight (p<0.05), BMI (p<0.05), and LDL (p<0.001). Compared to the control period, participation in the intervention led to a significant reduction in A1C (p<0.01).nnnCONCLUSIONnFindings suggest that an empowerment-based, DSMS intervention is promising for improving and/or maintaining diabetes-related health, particularly A1C.nnnPRACTICAL IMPLICATIONSnIncorporating empowerment principles in DSMS interventions may be useful for supporting patients self-management efforts in real-world settings.

Implementing an Empowerment-Based Diabetes Self-management Education Program

Diabetes educators are challenged to develop culturally appropriate, integrated, behaviorally based, effective education programs. This article describes the intervention used in a problem-based educational program for urban African Americans with diabetes. The intervention consisted of six 2-hour, weekly group educational and data collection sessions. No lectures were used, and the content was determined by participants’ questions and concerns. Culturally tailored written educational materials were also provided.

Language Interpreter Utilization in the Emergency Department Setting: A Clinical Review

The emergency department (ED) serves as the entry point into the U.S. health care system for many patients with limited English proficiency (LEP). This paper reviews the literature on language interpreter utilization in the ED setting. We focused on three clinical issues related to professional language interpretation: (1) patient satisfaction, (2) health care delivery, and (3) current interpreter utilization practices. Compared with-English speaking patients, LEP patients report less satisfaction with medical encounters, have different rates of diagnostic testing, and receive less explanation and follow-up. Although professional interpretation has been associated with improvements in patient satisfaction, communication, and health care access, these services are largely under-utilized in ED settings. Reliance on untrained ad hoc interpreters, perceived time and labor associated with obtaining and working with an interpreter, and costs of implementing professional interpreter services serve as barriers to implementation and utilization.

The Role of Cultural Variables in Breast Self-Examination and Cervical Cancer Screening Behavior in Young Asian Women Living in the United States

This study examined cultural factors as predictors of breast self-examination (BSE) and participation in cervical cancer screening in young Asian and Caucasian women in the United States. Comparisons between Asian and Caucasian samples revealed significant differences in ever performing BSE and obtaining a pap test; the Caucasian women reported higher participation in both behaviors. Factor analysis of cultural barriers to screening revealed four factors: communication with mother, openness around sexuality, prevention orientation, and utilization of Western medicine. Logistic regression predicting BSE performance from demographics, acculturation, and cultural barriers revealed openness around sexuality to be a significant predictor. Pap test participation was predicted by year in college, ever having engaged in sexual intercourse, prevention orientation, and global acculturation. Cultural factors should be considered in programs to enhance participation in cancer screening.

Developing a New Generation of Ongoing Diabetes Self-management Support Interventions A Preliminary Report

Purpose The study examined the feasibility, acceptability, and potential impact of an innovative, community-based, ongoing self-management intervention aimed at enhancing and sustaining self-care behaviors over the long term among urban African Americans with type 2 diabetes. Methods Sixty-two African American men and women completed the study. Participants were invited to attend 24 weekly, consecutive, diabetes self-management support/ education groups. The flow of the weekly group sessions was guided by questions and concerns of the patients. Baseline and 6-month follow-up metabolic functioning, lipid profiles, cardiovascular functioning, and self-care behaviors were assessed. Results Ninety percent (n = 56) of the sample attended at least 1 session; 40% attended at least 12 or more sessions. Paired t tests found significant improvements in body mass index (P< .001), total cholesterol (P< .01), high density lipoprotein (P< .05), and low-density lipoprotein (P< .001). Significant increases were also found for self-care behaviors (P< .05). Conclusions Preliminary evidence suggests that participation in this weekly problem-based, self-management support intervention can yield diabetes-related health benefits.

Learning by Teaching: A Peer-Teaching Model for Diversity Training in Medical School

Background: The sociocultural medicine teaching experience examines the viability and efficacy of a peer teaching model in enhancing diversity-focused attitudes, knowledge, and skills in medicine among advanced level medical students. Description: This experience recruited 4th year students to facilitate diversity-focused case-based discussions for 2nd year students. Peer teachers participated in a training session that addressed personal exploration of sociocultural background, health care disparities, biosociocultural aspects of the patient case, and facilitation skills. Evaluation assessed learning outcomes, teaching experience; and attitudes, knowledge, and skills related to sociocultural medicine. Evaluation: Paired t tests revealed a greater understanding of the relation among sociocultural background, health, and medicine (p <. 05), and greater proficiency with teaching sociocultural medicine topics to peers (p <. 01). Overall, peer teachers agreed the experience increased their exposure to sociocultural factors in patient care, enhanced their case conceptualization skills, and encouraged them to consider personal belief systems. Conclusion: Findings suggest peer teaching can be an effective model to refine knowledge, attitudes, and skills related to diversity issues in health care. The model may be a viable approach for diversity training in graduate and continuing medical education.

A Review of Volunteer-Based Peer Support Interventions in Diabetes

Given the complexity of diabetes self-management activities and patients resultant need for lifelong diabetes self-management support (DSMS), peer support has been increasingly examined as a potential model for diabetes self-management education (DSME) and ongoing DSMS.1 Dennis2 defines peer support as “the provision of emotional, appraisal, and informational assistance by a created social network member who possesses experiential knowledge of a specific behavior or stressor and similar characteristics as the target population, to address a health-related issue of a potentially or actually stressed focal person.” During the past decade, there has been a proliferation of research examining the feasibility, acceptability, and health-related impact of peer support interventions in the context of diabetes care.3–14nnBased on a review of peer support interventions for patients with diabetes, Heisler15,16 identified five models of peer support, including 1 ) face-to-face group self-management programs, 2 ) peer coaches or mentors, 3 ) community health workers (CHWs), 4 ) telephone-based peer support, and 5 ) Internet or e-mail–based peer support.nnFace-to-face group support typically involves a peer supporter or a team of peer supporters delivering DSME or DSMS in a group-based setting such as the diabetes-specific version of the chronic disease self-management program of Lorig and Gonzales.17 Peer coaching or mentoring usually involves individuals working with patients on a less structured basis providing emotional support and serving as a role model.18 CHWs are individuals who live in the same community and share the same cultural background, values, and customs as the target patient population.19,20 CHWs provide informational, instrumental, and emotional support and often function as a bridge between community members and the health care system.19,20 In fact, some studies in a 2007 systematic review of diabetes interventions21 involving CHWs reported improvements in clinical (glycemic control, …

Implementation and evaluation of an undergraduate Sociocultural Medicine Program.

Purpose To demonstrate an effective model for designing, implementing, and evaluating the Sociocultural Medicine Program (SMP), part of a comprehensive sociocultural medicine curriculum at the University of Michigan Medical School. Method This study followed a cross-sectional, pre- and post-intervention survey design. A total of 167 medical students completed a measure of attitudes toward sociocultural issues in medicine prior to and following participation in the SMP. Students attitudes were assessed in the domains of “exposure to sociocultural issues,” “sociocultural factors in clinical scenarios,” and “sociocultural background in patient/physician/health status issues.” Results Paired t-tests of the pre- and post-intervention responses revealed significant positive changes for items in the domain of exposure to sociocultural issues in medicine: experience with sociocultural issues in a clinical setting (p < .01), understanding of relationship among sociocultural background, health, and medicine (p < .001), and importance of sociocultural background in students future patient populations (p < .01). Significant changes were also found for the impact of sociocultural background in patient/physician/health status issues: physician—patient relationship (p < .001) and patients health behavior (p < .001). Conclusions The SMP had a significant educational impact on students attitudes towards sociocultural issues in medicine. Students reported greater exposure to these issues conceptually and clinically, and greater influence of sociocultural factors in patients behaviors and patient— physician relationships. Critical components of this SMP were faculty development, multiple teaching approaches, and pre- and post-intervention evaluation.

Sustaining short-term improvements over the long-term: Results from a 2-year diabetes self-management support (DSMS) intervention

AIMnThis study examined the long-term impact of a 24-month, empowerment-based diabetes self-management support (DSMS) intervention on sustaining health-gains achieved from previous diabetes self-management education (DSME).nnnMETHODSnPrior to the intervention, all participants received 6 months of mailed DSME consisting of weekly educational newsletters coupled with clinical feedback. The intervention consisted of 88 weekly group-based sessions that participants were encouraged to attend as frequently as they needed. Sessions were guided by participants self-management questions and also emphasized experiential learning, coping, goal-setting, and problem-solving. Baseline, 6-month, and 30-month assessments measured A1C, weight, body mass index (BMI), blood pressure, lipids, self-care behaviors, and QOL.nnnRESULTSnThis report is based on 60 African-American adults with type 2 diabetes (n=89 recruited at baseline) who completed the study. Post 6-month DSME, participants demonstrated significant improvements for diastolic BP (p<0.05), serum cholesterol (p<0.001), healthy diet (p<0.01), blood glucose monitoring (p<0.05) and foot exams (p<0.01). Post 24-month intervention, participants sustained the improvements achieved from the 6-month DSME and reported additional improvements for healthy diet (p<0.05), carbohydrate spacing (p<0.01), insulin use (p<0.05), and quality of life (p<0.05).nnnCONCLUSIONSnFindings suggest that an empowerment-based DSMS model can sustain or improve diabetes-related health gains achieved from previous short-term DSME.