RESUMO
OBJECTIVES: This study helps to fill the existing research gap related to participant engagement in behavioural interventions and diabetes management. We examined type 2 diabetes control over time among Mexican Americans by level of engagement in a chronic care management (CCM) program that included community health worker (CHW)-delivered multilevel interventions. The programme complemented clinical care and promoted behaviour changes to improve diabetes self-management. DESIGN: Quasiexperimental study. SETTING: The study was implemented in the Rio Grande Valley region in the USA. Recruitment was conducted in clinics and community events. All other visits were provided in participant homes and community locations. PARTICIPANTS: 5649 adults (aged ≥18 years) with poorly controlled type 2 diabetes who enrolled in a community-delivered CCM programme between September 2013 and 2018. INTERVENTIONS: The intervention comprised two components: CHW home visits conducted every 3 months and diabetes self-management education (DSME) classes provided in community locations. PRIMARY OUTCOME MEASURES: The primary outcome was haemoglobin A1c (HbA1c) measured at baseline every 3 months for up to 24 months. We first examined changes in HbA1c levels over time. The number of completed CHW and DSME encounters was used to classify participants into engagement groups-high engagement defined as ≥10 encounters (n=2952); low engagement defined as 1-9 encounters (n=2697). We used univariable and multivariable longitudinal linear regression models with a generalised estimating equation method. We tested interactions between engagement groups and time. RESULTS: Participants' mean HbA1c decreased from 10.20% at baseline to 8.93% (p<0.0001) at 3 months, remaining stable thereafter. Changes in HbA1c were statistically different between the engagement groups. High engagement participants had lower HbA1c levels over the first 15 months of the follow-up period compared with low engagement participants, as compared at 3 months (-0.44%, 95% CI -0.57% to -0.31%; p<0.0001), 6 months (-0.31%, 95% CI -0.43% to -0.14%; p<0.0001), 9 months (-0.27%, 95% CI -0.42% to -0.13%; p=0.0001), 12 months (-0.23%, 95% CI -0.37% to -0.08%; p=0.0025) and 15 months (-0.32%, 95% CI -0.54% to -0.10%; p=0.0040). At months 18, 21 and 24, the HbA1c differences were not statistically significant (18 months: -0.34%, 95% CI -0.77% to 0.08%; p=0.1086; 21 months: -0.22%, 95% CI -1.00% to 0.56%; p=0.5721; 24 months: -0.42%, 95% CI -1.38% to 0.55%; p=0.3966). CONCLUSIONS: Higher engagement in the CCM programme delivered by CHWs and coordinated with clinical care was associated with beneficial improvements in type 2 diabetes control, but both engagement groups showed strong improvements.
Assuntos
Doenças Autoimunes , Diabetes Mellitus Tipo 2 , Adulto , Humanos , Adolescente , Agentes Comunitários de Saúde , Hemoglobinas Glicadas , Diabetes Mellitus Tipo 2/terapia , Comportamentos Relacionados com a Saúde , Americanos MexicanosRESUMO
This study explores the perceptions and motivation for weight loss among participants who completed a free community-based weight loss program in a predominantly Hispanic and low-income region along the US-Mexico border using a Self-Determination Theory (SDT) perspective. This manuscript is timely as qualitative research on the effect of motivation as a factor in behavioral interventions to reduce overweight or obesity is currently lacking. Individual semi-structured interviews were conducted with 20 participants (80%, n = 16 female) who completed a community weight-loss intervention to assess motivation for weight loss and participating, and the role of social support and self-efficacy in weight loss. Directed content analysis was used with SDT guiding the questions and subsequent theme analysis. The findings communicate perspectives of participants relevant to 8 prominent themes. The regulation types and constructs related to SDT included: non-regulation, external regulation, introjected regulation, identified regulation, integrated regulation, and intrinsic regulation as well as competence and relatedness. Participants mentioned external sources of motivation, such as wanting to improve their physical appearance, and motivation due to financial incentives. Fewer participants reported intrinsic motivators, which the literature suggests are more likely to create lasting change and improved health behaviors. Understanding the motivation for behavior change and completion of weight loss programs is essential to help participants reach their goals effectively and sustain weight loss. A greater emphasis during weight loss programs on the motives for individuals to lose weight may help improve outcomes in weight-loss interventions. Additionally, increasing strategies targeted at enhancing intrinsic motivation for weight loss may be beneficial.
Assuntos
Programas de Redução de Peso , Feminino , Humanos , México , Motivação , Autonomia Pessoal , Redução de PesoRESUMO
Objectives: Purpose of study is to explore the roles religiosity and fatalistic beliefs play in diabetes management among newly, currently, and long-term enrolled Mexican-American participants in a Type 2 diabetes mellitus (T2DM) chronic care management program. Methods: In 2017, study participants (n = 15) completed a semi-structured interview in their preferred language (English or Spanish). Sample was stratified by amount of time individual had been enrolled as a participant of the Salud y Vida program: newly, currently, or long-term. Interviews assessed religious beliefs, beliefs concerning the cause(s) of diabetes, perceived relationship between religiosity and fatalistic beliefs with T2DM management, and the appropriateness of discussing such topics with a health professional. Interview responses were analyzed using ATLAS.ti 8. Results: Themes identified included: perceived autonomy over diabetes prognosis, motivators for self-care, discussions of personal beliefs in the healthcare setting, and the church's role in diabetes management. Conclusions: Among this sample, religiosity and religious fatalism played a complex role in coping with and managing diabetes. Long-term enrolled and male participants expressed beliefs of divine control over health, and a connection between religiosity and health behavior. Long-term enrolled participants felt religious and fatalistic beliefs may be suitable and beneficial to discuss in the healthcare setting.
Assuntos
Diabetes Mellitus Tipo 2 , Americanos Mexicanos , Adulto , Diabetes Mellitus Tipo 2/terapia , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Religião , AutocuidadoRESUMO
BACKGROUND: Open streets initiatives provide an opportunity to engage in physical activity (PA) freely by temporarily closing streets to motorized traffic. METHODS: Route counting estimation and event intercept surveys (n = 682) were conducted across 4 CycloBia events in Brownsville, TX, in 2015 to determine sociodemographics, PA engagement at the event, event awareness, and past CycloBia attendance. RESULTS: Cycling was the most commonly observed activity along the route (73.6%) followed by walking (22.9%). Attendees self-reported a median of 120 minutes in PA with 17.3% of attendees meeting recommended weekly PA guidelines at the event. Significant predictors of meeting PA guidelines via event PA engagement were past event attendance, sex, age, and Hispanic ethnicity. CONCLUSIONS: Findings suggest that CycloBia reached a large, low-income, predominantly Hispanic population and may be effective in promoting PA. Results help understand the effect of an open streets initiative on attendees living in a midsize, border city.