RESUMEN
Diabetes is the sixth leading cause of death in the United States. To date, most research and resulting clinical strategies have focused on the individual with short-term health improvements that have not been maintained over time. Researchers more recently have recognized the need to consider the social determinants of diabetes and health along with individual factors. The purpose of this literature review is to examine current understanding of the social determinants affecting diabetes and health. A search of medical and nursing literature was conducted using PubMed, PsychInfo, CINAHL and MEDLINE databases, selecting articles published between 2000 and 2013. Search terms included: type 2 diabetes, social determinants, and health determinants. Inclusion criteria were: English language, human studies, social determinants of diabetes and health, and research in the United States. Additional search methods included reference chaining of the literature. Twenty research articles met the inclusion criteria for the review and analysis and included quantitative and qualitative methods. All studies selected for this review were descriptive in nature (n = 20). Fifteen studies were quantitative studies and five were qualitative studies. No intervention studies met inclusion criteria. Each study is summarized and critiqued. Study findings indicate that external or upstream factors consistently affect individuals diagnosed with diabetes, influencing self-management. Significant methodological limitations result directly from small sample sizes, convenience or nonprobability sampling, and low statistical power.
RESUMEN
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.
Asunto(s)
Negro o Afroamericano , Enfermedades Cardiovasculares/psicología , Características Culturales , Diabetes Mellitus Tipo 2/psicología , Educación del Paciente como Asunto , Población Rural , Autocuidado , Adulto , Negro o Afroamericano/psicología , Negro o Afroamericano/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/prevención & control , Enfermedades Cardiovasculares/terapia , Cultura , Diabetes Mellitus Tipo 2/prevención & control , Diabetes Mellitus Tipo 2/terapia , Estudios de Factibilidad , Femenino , Hemoglobina Glucada/metabolismo , Humanos , Masculino , Persona de Mediana Edad , Grupo de Atención al Paciente , Calidad de Vida , Factores de Riesgo , Población Rural/estadística & datos numéricos , Autocuidado/psicología , Estados Unidos/epidemiologíaRESUMEN
Recruiting rural African Americans for research presents special problems because of cultural differences, the view of researchers as cultural "outsiders", and transportation problems. This paper reports successful strategies in recruiting rural African American adults with type 2 diabetes for research studies. The researchers tested recruitment strategies commonly used in research, such as flyers, advertisements in local newspapers and radio stations. The researchers also encouraged referrals from medical professionals. When recruitment goals were not met, the researchers modified strategies. Twenty-two rural African American participants were recruited and randomly assigned to culturally-tailored Group or Individual Diabetes Self Management Education (DSME). The latter included storytelling and an interactive learning approach. The key recruitment strategies involved spending time in the community, visits to churches, and flyers to key leaders in the Black community. Enrolling rural African Americans required cultural competence, careful planning, and time in the community. Recruiting for clinical research is challenging and more difficult when targeting minority members in rural settings. Research in diabetes care is needed with rural African Americans because of high rates of diabetes, and limited health care access for this population. Effective recruitment and retention strategies are needed to test interventions to reduce health disparities.
RESUMEN
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 usinga culturally tailored approach could enhance self-care and glycemic control. Additional testing among more participants over a longer time period is recommended.
Asunto(s)
Población Negra , Cultura , Diabetes Mellitus Tipo 2/rehabilitación , Educación del Paciente como Asunto , Población Rural , Autocuidado , Adulto , Anciano , Anciano de 80 o más Años , Diabetes Mellitus Tipo 2/psicología , Evaluación Educacional , Estudios de Factibilidad , Hemoglobina Glucada/análisis , Humanos , Persona de Mediana Edad , Grupo de Atención al Paciente , Satisfacción Personal , Proyectos Piloto , Encuestas y Cuestionarios , Estados UnidosRESUMEN
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 one's 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.
Asunto(s)
Imágenes en Psicoterapia/métodos , Complicaciones del Embarazo/prevención & control , Estrés Psicológico/prevención & control , Adolescente , Adulto , Negro o Afroamericano , Femenino , Humanos , Proyectos Piloto , Embarazo , Complicaciones del Embarazo/etnología , Complicaciones del Embarazo/psicología , Nacimiento Prematuro/etnología , Nacimiento Prematuro/prevención & control , Nacimiento Prematuro/psicología , Estrés Psicológico/complicaciones , Estrés Psicológico/etnologíaRESUMEN
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.
Asunto(s)
Cuidadores , Estimulación Encefálica Profunda/métodos , Demencia/complicaciones , Trastornos del Humor/terapia , Trastornos del Sueño-Vigilia/terapia , Anciano , Demencia/terapia , Humanos , Trastornos del Humor/etiología , Trastornos del Sueño-Vigilia/etiologíaRESUMEN
PURPOSE: The purpose of this study was to examine the impact of family and friends on the management of persons with diabetes and their willingness to be involved in a culturally tailored program. METHODS: This qualitative study was based within a larger quasi-experimental study that focused on the impact of a culturally tailored group intervention compared with individual standard diabetes education on the outcomes of self-management and glycemic control among rural African Americans with type 2 diabetes. Twenty-one participants were randomly assigned to an individual education group or a culturally tailored intervention group. Family members/peers (n = 6) attended invited group sessions to obtain information about diabetes and family/peer support. The facilitator of the invited group sessions used a guide to help with group discussions. The investigators used an iterative approach to enhance the examination of the responses from the discussion guide, thus identifying recurring themes within the participants' responses. RESULTS: The data revealed that family and friends made a difference in the diabetes management of individuals with diabetes. Although family and friends may have been helpful at times, they also created moments of problems and an environment that made it more difficult to care for diabetes. The data also revealed that diabetes is hard to manage and control. Participants reported that taking medications and being aware of types of foods to keep a well-maintained glucose level were often challenging. CONCLUSIONS: These findings confirm that family and peers greatly influence diabetes management among rural African Americans. The study's results will help health care providers understand the importance of involving family members and friends in the treatment and diabetes management of individuals with type 2 diabetes, particularly within rural African American communities where resources are limited.
Asunto(s)
Población Negra , Diabetes Mellitus Tipo 2/psicología , Familia , Adulto , Anciano , Anciano de 80 o más Años , Población Negra/estadística & datos numéricos , Cultura , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Humanos , Relaciones Interpersonales , Masculino , Persona de Mediana Edad , Estados Unidos/epidemiologíaRESUMEN
PURPOSE: To describe how decisions occurred to transfer nursing home (NH) residents to emergency departments (EDs). DESIGN: Three nursing homes (NHs) in Virginia were selected based on geographic and ownership variability. The phenomenon of concern was the decision-making process culminating in the transfer of NH residents to EDs. Sixteen transfers met the inclusion criteria and were analyzed. A minimum of two informants per transfer were interviewed, with a range of 2 to 4 interviews per transfer. All 42 respondents were asked to describe how the transfer decision was reached, to identify who participated in making the decision, and to describe any particular positive or negative aspects of reaching the transfer decision. METHOD: Data were analyzed with hermeneutic phenomenological methods. Journal writing, audit trails, informal and formal member checks, and expert consultation were used to control bias. FINDINGS: The three main themes identified were Consensus, Conflict, and Cogency. Consensus, or agreement, occurred when all decision participants reported similar interpretations as to the severity and acuity of the presenting problem or had shared interpretations of the best interests of the elder. When decision participants held dissimilar interpretations, conflict occurred. Decision participants used cogency by persuading others, in order to reach consensus. CONCLUSIONS: The findings cannot be generalized to long-term care facilities across the US or to other countries, but they enhance understanding about some of the ways transfer decisions occur and the role of nurses in those transfers, especially when conflict arises.
Asunto(s)
Toma de Decisiones , Servicio de Urgencia en Hospital , Casas de Salud , Transferencia de PacientesRESUMEN
Diabetes has a disproportionate impact on people of color, including Black Americans. An understanding of the perspectives of rural Blacks is needed to design effective programs of diabetes care. The purpose of this study was to examine the experience of being diagnosed with diabetes as described by rural Blacks. This descriptive, exploratory study conducted gender-separated focus groups in 3 rural communities to capture diagnosis perspectives. Findings may be useful to healthcare professionals providing diabetes care to rural Blacks. Participants could describe events surrounding diagnosis with clarity. For many, the diagnosis was not an emotional and/or surprising experience. Participants commonly used expressive or figurative language to relate their stories of diagnosis, and gender differences were noted. Descriptions of diagnosis revealed valuable infor-mation about participants' perceptions of their diabetes.
Asunto(s)
Negro o Afroamericano/psicología , Diabetes Mellitus/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Grupos Focales , Humanos , Masculino , Persona de Mediana Edad , NarraciónRESUMEN
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.
Asunto(s)
Negro o Afroamericano , Diabetes Mellitus Tipo 2/terapia , Población Rural , Autocuidado , Adulto , Anciano , Anciano de 80 o más Años , Terapias Complementarias , Femenino , Grupos Focales , Humanos , Masculino , Mid-Atlantic Region , Persona de Mediana EdadRESUMEN
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 FolioViews 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.