RESUMEN
AIMS: This project tested the six-month impact of Stanford's Diabetes Self-Management Program (DSMP), adapted for Asians and Pacific Islanders (APIs), on behavioral and clinical indicators. METHODS: Participants attended DSMP workshops at a community health center. Employing a one-group, pre-post-test design, data were collected at baseline and six-months. Ninety-six eligible API adults were enrolled. All attended four or more of the six weekly sessions, and 82 completed data collection. Measures included body mass index, blood pressure, blood lipids, blood glucose, HbA1c, as well as health behaviors. Data were analyzed by descriptive statistics and paired t-tests. RESULTS: Adaptations to DSMP were minimal, but critical to the local acceptance of the program. At six-months, significant behavioral improvements included: (1) increased minutes in stretching and aerobic exercise per week (p<0.001); (2) reduced symptoms of hypoglycemia and hyperglycemia (p<0.001); (3) increased self-efficacy (p<0.001); and (4) increased number of days and times testing blood sugar levels (p<0.001). Significant clinical improvements included: (1) lower BMI (p<0.001); (2) lower HbA1c (p<0.001); (3) lower total cholesterol, triglycerides, and LDL (p<0.001); and (4) lower blood pressure (p<0.001). CONCLUSIONS: Findings suggest that the DSMP can be successfully adapted to API populations and can improve clinical measures as well as health behaviors.
Asunto(s)
Pueblo Asiatico , Diabetes Mellitus/psicología , Conductas Relacionadas con la Salud , Promoción de la Salud/métodos , Nativos de Hawái y Otras Islas del Pacífico , Educación del Paciente como Asunto/métodos , Autocuidado/métodos , Adulto , Anciano , Anciano de 80 o más Años , Glucemia/metabolismo , Presión Sanguínea/fisiología , Determinación de la Presión Sanguínea , Índice de Masa Corporal , Servicios de Salud Comunitaria , Diabetes Mellitus/sangre , Diabetes Mellitus/etnología , Ejercicio Físico , Femenino , Estudios de Seguimiento , Hawaii/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Grupos Minoritarios , Proyectos Piloto , Prevalencia , Estudios Retrospectivos , AutoeficaciaRESUMEN
Kokua Kalihi Valley, a federally qualified health center in Hawaii, collaborated with the National Heart, Lung, and Blood Institute to test the efficacy of community health workers (CHWs) to deliver the Healthy Heart, Healthy Family curriculum to low-income Filipinos with cardiovascular disease (CVD) risk factors. At 12 months, significant improvements were seen in health behaviors, knowledge, and self-efficacy in managing chronic diseases. We also observed decreases in total cholesterol from 186.25 mg/dl to 170.88 mg/dl (p=.001), low-density lipoprotein from 114.43 mg/dl to 103.04 mg/dl (p=.013), and fasting blood glucose from 117.95 mg/dl to 109.07 mg/dl (p=.034). Although these changes were statistically significant, they are small and not clinically meaningful in reducing CVD risk. The high-density lipoprotein was 3.3 mg/dl lower (worse) at 12 months (p=.003), mean values for blood pressure, BMI, and waist circumference increased. Community health workers can be trained to deliver evidence-based curricula that improve health behaviors and increase self-efficacy in managing chronic diseases.
Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Agentes Comunitarios de Salud , Conductas Relacionadas con la Salud/etnología , Educación en Salud/métodos , Conocimientos, Actitudes y Práctica en Salud/etnología , Adulto , Anciano , Anciano de 80 o más Años , Curriculum , Femenino , Hawaii , Humanos , Masculino , National Heart, Lung, and Blood Institute (U.S.) , Filipinas/etnología , Pobreza , Factores de Riesgo , Conducta de Reducción del Riesgo , Autoeficacia , Estados UnidosRESUMEN
PURPOSE OF THE STUDY: Stanford's Chronic Disease Self-Management Program (CDSMP) has been proven to increase patients' ability to manage distress. We describe how we replicated CDSMP in Asian and Pacific Islander (API) communities. DESIGN AND METHODS: We used the "track changes" tool to deconstruct CDSMP into its various components (e.g., recruitment and staffing) and the "adaptation traffic light" to identify allowable modifications to the original program. We monitored local leaders' fidelity of delivery of CDSMP and tracked participants' attendance, satisfaction, and 6-month outcomes. RESULTS: Between July 2007 and February 2010, 584 completed a CDSMP workshop. Baseline and 6-month data were available for 422 (72%), including 53 Caucasians, 177 Asians, and 194 Pacific Islanders. All 3 groups realized significant decreases in social and role activity limitations and significant increases in communication with physicians. Asians and Pacific Islanders also realized significant increases in self-rated health and time spent engaging in stretching/strengthening exercise. Asians also reported significant reductions in health distress and self-reported physician visits and increases in time spent in aerobic exercise, ability to cope with symptoms, and self-efficacy. IMPLICATIONS: Our experience suggests that CDSMP can be modified for increased cultural appropriateness for API communities while maintaining the key components responsible for behavior change.
Asunto(s)
Actitud Frente a la Salud/etnología , Enfermedad Crónica/terapia , Educación del Paciente como Asunto , Autocuidado/métodos , Anciano , Anciano de 80 o más Años , Asiático/estadística & datos numéricos , Diversidad Cultural , Práctica Clínica Basada en la Evidencia , Femenino , Hawaii , Humanos , Masculino , Persona de Mediana Edad , Nativos de Hawái y Otras Islas del Pacífico/estadística & datos numéricos , Satisfacción del Paciente , Encuestas y Cuestionarios , Población Blanca/estadística & datos numéricosRESUMEN
BACKGROUND: Kokua Kalihi Valley is one of the first federally qualified community health centers offering home-based palliative care (HBPC). Kokua Kalihi Valley serves low-income, immigrant populations from Asia and the Pacific Islands, whose end-of-life needs are rarely addressed. Our team includes a palliative medicine physician, nurse, case manager, psychologist, interpreter, and volunteers. OBJECTIVES: The purpose of this Institutional Review Board-approved study was to measure symptom relief and quality of life, resource utilization, and satisfaction with HBPC. METHODS: Over 12 months, 91 people including 46 patients with chronic advanced illnesses and 45 corresponding primary caregivers were enrolled. Data were collected prospectively, upon admission, and repeatedly thereafter, using the Missoula-Vitas Quality of Life Index, the Edmonton Symptom Assessment Scale, and the Palliative Performance Scale. Utilization of resources was tracked, including case management, hospice, emergency department, and hospital visits. RESULTS: The median age was 71 years, and more than half had chronic neurodegenerative conditions. Most patients (98%) were minority, including Samoans, Filipinos, Japanese, Micronesians, and Hawaiians. Median stay in HBPC was 7 months, with a median of 3.5 visits. Approximately 25% of patients enrolled in hospice (median stay 67.5 days). There was a decrease in hospitalizations (p = 0.002) after HBPC admission. Discussions and documentation of end-of-life wishes increased from 50% to 90% (p < 0.01). Caregiver satisfaction with HBPC was high. CONCLUSION: Data on outcomes and quality indicators of HBPC programs are scant, especially among immigrant Asian and Pacific Islanders patients. Our experience demonstrates the effectiveness of palliative care approaches in this population.