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BACKGROUND: Health disparities in osteoarthritis (OA) outcomes exist both in the occurrence and treatment of functional limitation and disability for Mexican Americans. Although the effect of self-management of chronic illness is well established, studies demonstrate little attention to self-management of function or disability, despite the strong potential effect on both and, consequently, on patients' lives. OBJECTIVE: The purpose of this study pilot was to develop and test key variable relationships for a measure of disability self-management among Mexican Americans. METHODS: In this sequential, two-phased, mixed-methods, biobehavioral pilot study of Mexican American women and men with OA, a culturally tailored measure of disability self-management was created, and initial relationships among key variables were explored. RESULTS: First, a qualitative study of 19 adults of Mexican American descent born in Texas (United States) or Mexico was conducted. The Mexican American Disability Self-Management Scale was created using a descriptive content analysis of interview data. The scale was tested and refined, resulting in 18 items and a descriptive frequency of therapeutic management efforts. Second, correlations between study variables were estimated: Disability and function were negatively correlated. Disability correlated positively with social support and activity effort. Disability correlated negatively with disability self-management, pain, and C-reactive protein. Function was positively correlated with age, pain, and depression. Liver enzymes (alanine transaminase) correlated positively with pain and anxiety. DISCUSSION: This mixed-methods study indicates directions for further testing and interventions for disability outcomes among Mexican Americans.
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Pessoas com Deficiência , Americanos Mexicanos , Osteoartrite , Autogestão , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pessoas com Deficiência/estatística & dados numéricos , Pessoas com Deficiência/reabilitação , Americanos Mexicanos/estatística & dados numéricos , Americanos Mexicanos/psicologia , Osteoartrite/etnologia , Osteoartrite/terapia , Projetos Piloto , Pesquisa Qualitativa , Autocuidado/estatística & dados numéricos , Autocuidado/métodos , Autocuidado/psicologia , Autogestão/métodos , TexasRESUMO
PURPOSE: The purpose of the study was to explore the feasibility of using commonly available technology, such as text messaging, for diabetes prevention in rural Mexican American communities during COVID-19. METHODS: Participants were selected from a diabetes prevention study funded by the National Institutes of Health that, prior to COVID-19, involved in-person group intervention sessions. Participants were predominantly female adults born in Mexico and Spanish-speaking. A subsample (n = 140) was divided into 3 cohorts: (1) 50 who completed the initial in-person intervention prior to the COVID-19 research pause, (2) 60 who needed additional support sessions to complete the intervention and thus received 10 text messages with links to relevant online diabetes prevention videos (TM+), and (3) 30 who received enhanced usual care involving health guidance offered during data collection (control). Repeated measures analysis of covariance was used to evaluate cohort differences at 24 months post baseline. RESULTS: No significant cohort differences were found for depression, eating self-efficacy, alcohol intake, fat avoidance, or sedentary behaviors. Differences in A1C showed both in-person and TM+ cohorts having lower mean A1C levels (5.5%) than the control cohort (5.7%). The TM+ cohort had lower body mass index than other cohorts and a lower diabetes conversion rate (22.2%) compared to the control cohort (28%). Participants indicated preferences for in-person/TM+ combination interventions. The strongest positive feedback was for the TM+ intervention cooking demonstration videos. CONCLUSIONS: Augmented text messaging combined with in-person sessions had similar outcomes to the all in-person strategy and thus has the potential for expanding the reach of diabetes prevention to many Mexican American communities.
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Diabetes Mellitus , Estado Pré-Diabético , Envio de Mensagens de Texto , Adulto , Feminino , Humanos , Masculino , COVID-19 , Diabetes Mellitus/prevenção & controle , Hemoglobinas Glicadas , Americanos Mexicanos , Estado Pré-Diabético/terapiaRESUMO
PURPOSE: The purpose of the study was to examine the influences of sex and acculturation on dietary behaviors, macronutrient intake, and dietary quality in participants enrolled in a diabetes prevention initiative in Starr County, Texas. METHODS: Baseline data from the Starr County diabetes prevention study (N = 300) were analyzed-acculturation (country of origin, years in Starr County, language and food preferences), depressive symptoms (Patient Health Questionnaire-9), healthy eating self-efficacy (Weight Efficacy Lifestyle Questionnaire-Short Form), diet quality (USDA Healthy Eating Index), fat avoidance (Fat Avoidance Scale, Spanish version), and macronutrients. Descriptive statistics and univariate analysis of covariance were used to examine differences based on acculturation, controlling for sex. RESULTS: Participants were predominantly female (73%) and, on average, 51 years of age. Language and food preferences favored Spanish language and Hispanic foods, respectively. The majority (71%) was born in Mexico but had resided in Starr County for 33 years, on average. Depressive symptoms were moderate, and eating self-efficacy scores suggested low confidence in making healthy food choices, particularly for saturated fats. Spanish language preference was associated with worse dietary habits. The mean dietary quality score was lower than the national average (54 vs 59 nationally); females had slightly higher dietary quality than males and a higher mean fat avoidance score, although differences were not clinically significant. Intakes of carbohydrate, saturated fats, and cholesterol were higher than recommended daily allowances. CONCLUSIONS: The overall preference for speaking Spanish and the influence of language on dietary intake should inform future dietary interventions. Accommodating cultural norms and food preferences remain major challenges to improving dietary quality among the diverse Hispanic ethnic groups.
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Americanos Mexicanos , Estado Pré-Diabético , Masculino , Humanos , Feminino , Texas/epidemiologia , Aculturação , Ingestão de Alimentos , DietaRESUMO
OBJECTIVES: Examine acculturation and psychological, lifestyle, and physiological factors based on gender and country of origin (U.S. vs. Mexico). METHODS: Baseline data from the Starr County diabetes prevention study (N = 300) were analyzed - acculturation (language), psychological factors (depression), lifestyle factors (sedentary behaviors), and diabetes-related physiological outcomes (insulin resistance). MANOVA and linear regression were used to examine variable relationships based on gender and country of origin and identify predictors of depression and insulin resistance. RESULTS: Participants were: predominantly female (73%); 51 years of age, on average; born in Mexico (71%); and Spanish-speaking. Individuals spent 11 of their waking hours (range = 0-18â h) in sedentary activities. Compared to females, more males spoke English and reported fewer hours in sedentary activities. Compared to participants born in Mexico, those born in the U.S. were more likely to: speak English; report depressive symptoms; and exhibit elevated BMI and insulin resistance rates. Two distinct models significantly predicted depression (R2 = 14.5%) and insulin resistance (R2 = 26.8%), with acculturation-language entering into both models. DISCUSSION: Significant gender and country-of-origin differences were found. Future research on diabetes prevention should examine other Hispanic subgroups and strategies for addressing individual differences, while employing cost-effective group interventions that incorporate these differences and reach more at-risk individuals.
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Diabetes Mellitus , Resistência à Insulina , Masculino , Humanos , Feminino , Americanos Mexicanos , Aculturação , Estilo de VidaRESUMO
Fatigue, pain, sleep difficulties, and depressive symptoms are common in people with type 2 diabetes (T2DM). However, most studies of diabetes symptoms are not conducted with Mexican- or Chinese Americans. We aim to compare the symptoms between the two ethnic groups and examine the predictors of fatigue. This is a secondary analysis of two datasets (72 Mexican Americans and 134 Chinese Americans with T2DM). The Theory of Unpleasant Symptoms guided variable selection. We used χ2 tests to compare symptoms (measured by the Illness Perception Questionnaire-Revised and CES-D) between the two ethnic groups, and logistic regression to predict fatigue. Compared to Chinese Americans, Mexican Americans reported more fatigue, sleep difficulties, and pain. Depressive symptoms (OR = 6.13, p < 0.001) and medium acculturation (OR = 2.45, p = 0.017) significantly predicted fatigue. The two ethnic groups demonstrated differences in symptoms. Fatigue and related symptoms should be further evaluated in Mexican- and Chinese Americans with T2DM.
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Diabetes Mellitus Tipo 2 , Transtornos do Sono-Vigília , Asiático , Depressão , Fadiga , Humanos , Americanos Mexicanos , DorRESUMO
AIMS: Type 2 diabetes mellitus (T2DM), serious and increasingly prevalent among Mexican Americans, produces symptoms related to high and low glucose levels, medication side effects, and long-term complications. This secondary analysis explored symptom prevalence, differences among symptom burden levels, and how symptoms clustered. METHODS: Clinical measurements and survey data (demographic, quality of life, and the symptom subscale of the Diabetes Symptom Self-Management Inventory) collected from Mexican American adults with T2DM (nâ¯=â¯71) were analyzed for symptom prevalence, differences across levels of symptom burden, and symptom clusters. Agglomerative hierarchical and k-means clustering analyses were performed on a Gower matrix. Internal validation methods and rank aggregation were used to identify the best clustering method of the two techniques and to identify symptoms that clustered together. RESULTS: Participants reported meanâ¯=â¯14 symptoms; tiredness and trouble sleeping were most prevalent. People with high symptom burden had significantly lower quality of life and perceptions of worse diabetes severity. Hierarchical clustering produced three symptom clusters: cluster 1â¯=â¯9 symptoms (e.g. intense thirstiness, dry mouth); cluster 2â¯=â¯9 symptoms (e.g., itching skin, weight gain, noise or light sensitivity); cluster 3â¯=â¯13 symptoms (e.g., nervous, headache, trouble concentrating, and memory loss). CONCLUSION: Mexican Americans with T2DM report several co-occurring symptoms. Quality of life is significantly worse for people with high symptom burden. Three distinct symptom clusters were identified. Studies with larger samples are needed to further diabetes symptom science. Clinicians should assess and address patients' co-occurring symptoms as a potential means of decreasing symptom burden and improving quality of life.
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Efeitos Psicossociais da Doença , Diabetes Mellitus Tipo 2/etnologia , Diabetes Mellitus Tipo 2/epidemiologia , Americanos Mexicanos/estatística & dados numéricos , Adulto , Idoso , Análise por Conglomerados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Inquéritos e Questionários , Síndrome , Estados Unidos/epidemiologia , Estados Unidos/etnologiaRESUMO
Purpose The purpose of the study was to conduct focus groups with Mexican Americans in an impoverished rural community on the Texas-Mexico border to identify current barriers to adopting healthier lifestyles and to obtain recommendations for diabetes prevention. Methods Three separate 2-hour focus groups were led by an experienced bilingual Mexican American moderator. Interviews included questions about cultural factors and barriers that influence lifestyle behaviors, aspects of previous diabetes self-management interventions that were helpful for motivating behavioral change, and recommendations for diabetes prevention. Results Twenty-seven participants attended a focus group session; each session involved 7 to 12 informants. Individuals were diagnosed with prediabetes or type 2 diabetes mellitus; most were female, foreign born, and Spanish speaking. Interviews documented the cultural importance of food. Informants raised priority issues for diabetes prevention, including the need to learn how to prepare healthier foods and track caloric intake. Major barriers to healthier lifestyles included high costs of healthy foods, fatigue from busy schedules and working multiple jobs, a cultural view that exercise is a waste of valuable time, and fear of deportation. Conclusions Cultural influences and barriers to implementing healthy lifestyles should be assessed regularly and strategies implemented to overcome them. Such factors may change as environmental, sociocultural, and political environments change.
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Diabetes Mellitus Tipo 2/psicologia , Americanos Mexicanos/psicologia , Adulto , Idoso , Cultura , Diabetes Mellitus Tipo 2/etnologia , Diabetes Mellitus Tipo 2/prevenção & controle , Feminino , Grupos Focais , Humanos , Estilo de Vida/etnologia , Masculino , México/etnologia , Pessoa de Meia-Idade , Serviços Preventivos de Saúde , Pesquisa Qualitativa , População Rural , TexasRESUMO
OBJECTIVES: Studies of social support in diabetes have focused on the effects of support on the person with type 2 diabetes. We explored diabetes prevention effects of a culturally tailored diabetes self-management intervention in individuals without diabetes who were supporters of intervention participants. METHODS: This is a secondary analysis of data from a randomized clinical trial that involved 256 Mexican Americans with diabetes. Each study participant designated a supporter-spouse, relative, friend-who attended intervention sessions and assisted participants in attaining effective diabetes self-management. Supporter's glycosylated hemoglobin (A1C) data were tracked for 1 year to determine diabetes conversion rates in supporters without diabetes at baseline. RESULTS: Fewer individuals in the intervention group (n = 9) converted to an A1C above the 7% threshold, compared to the 1-year wait-listed control group (n = 16). We found a statistically significant difference (p = .021) at 12 months in the number of individuals whose A1C was ⩽8%, with fewer supporters above threshold in the intervention group (reduction of 48%). Supporters in the intervention group with prediabetes, based on baseline A1C, experienced a slight reduction in A1C, while control group supporters with prediabetes experienced an increase. DISCUSSION: The results suggest that there are potential benefits for family members and other supporters of persons with diabetes who participated in diabetes self-management programs.
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The Texas-Mexico border incidence rate of tuberculosis (TB) is 10 times the rate of TB in the United States. Additionally, this area is plagued by antibiotic-resistant TB at a rate that is 70% higher among those living along the border than among nonborder residents. Both the high rate of TB and the emergence of drug-resistant TB increases the importance of controlling TB along the U.S.-Mexico border. Men have higher rates of TB than women, which can be attributed to biological differences and increased environmental exposure. The purpose of this article is to describe the experience of TB for Mexican American men living on the Texas-Mexico border. This a qualitative descriptive study, using participants from a larger study. A purposeful sample was recruited through two south Texas TB clinics. Interviews were audio recorded, transcribed, and translated into English. Data analysis consisted of line-by-line coding, labeling, organizing, and discovering common codes to describe participants' experience of TB and TB treatment. The participants include 13 Mexican American men. Ages ranged from 22 to 76 years. Only one participant was employed during treatment. Years of education ranged from no school to an associate's degree. Five themes were discovered: misinformation, delayed diagnosis, stigma, depression, and loss of community. Participants without social support were further isolated and felt a greater burden of treatment. Two participants contemplated suicide and two others told their families to leave them because they were a burden and infectious. The burden of treatment on the patient is great, especially for Hispanic men.
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Conhecimentos, Atitudes e Prática em Saúde/etnologia , Americanos Mexicanos/psicologia , Determinantes Sociais da Saúde/etnologia , Isolamento Social/psicologia , Estigma Social , Tuberculose/etnologia , Adulto , Idoso , Diagnóstico Tardio , Depressão/etiologia , Humanos , Incidência , Entrevistas como Assunto , Masculino , Americanos Mexicanos/estatística & dados numéricos , Pessoa de Meia-Idade , Pesquisa Qualitativa , Determinantes Sociais da Saúde/economia , Texas/epidemiologia , Tempo para o Tratamento , Tuberculose/diagnóstico , Tuberculose/psicologia , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Resistente a Múltiplos Medicamentos/etnologia , Tuberculose Resistente a Múltiplos Medicamentos/psicologia , Adulto JovemRESUMO
This pilot study evaluated an innovative diabetes symptom awareness and self-management educational program for Mexican Americans, a fast growing minority population experiencing a diabetes epidemic. Patients with diabetes need assistance interpreting and managing symptoms, which are often annoying and potentially life-threatening. A repeated measures randomized controlled trial was conducted with 72 Mexican Americans aged 25-75 years with type 2 diabetes. Experimental condition participants received eight weekly, in-home, one-on-one educational and behavior modification sessions with a registered nurse focusing on symptom awareness, glucose self-testing and appropriate treatments, followed by eight biweekly support telephone sessions. Wait-listed control condition participants served as comparisons at three time points. Hierarchical linear modeling was used to evaluate the effects of the intervention between- and within groups on psychosocial, behavioral and clinical outcomes. Participants were predominantly female, middle-aged, moderately acculturated and in poor glycemic control. Experimental group participants (n = 39) significantly improved glycemic control, blood pressure, symptoms, knowledge, self-efficacy, empowerment and quality of life. Post intervention focus groups reported satisfaction with the symptom focus. Addressing symptoms led to clinical and psychosocial improvements. Symptoms seem to be an important motivator and a useful prompt to engage patients in diabetes self-management behaviors to relieve symptoms and prevent complications.
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Diabetes Mellitus Tipo 2/etnologia , Diabetes Mellitus Tipo 2/terapia , Americanos Mexicanos , Educação de Pacientes como Assunto/organização & administração , Autocuidado , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Poder Psicológico , Inquéritos e QuestionáriosRESUMO
BACKGROUND: The purpose was to describe patterns of home self-monitoring of blood glucose (SMBG) in Mexican Americans with type 2 diabetes mellitus enrolled in a diabetes self-management education protocol. Research questions were as follows: (1) What were the patterns and rates of home glucose self-monitoring over the 6-month course of the study? (2) What were the differences in monitoring rates between experimental and control groups? (3) What were the relationships between rates of monitoring and glycosylated hemoglobin (A1C), gender, and years with diabetes? SUBJECTS AND METHODS: We used a randomized (by group) repeated-measures pretest/posttest control group design. Glucometer data from an experimental group (diabetes self-management education plus nurse case management) and a comparison group (diabetes self-management education only) were analyzed. Data were collected at baseline and at 3 and 6 months. RESULTS: Overall average SMBG rates were low. Experimental and control group monitoring levels were not significantly different. More females than males never monitored glucose values, but more females than males checked at least one time per week. Those participants who checked their glucose levels more than once per week had diabetes for a longer period of time. Rates of monitoring were not strongly associated with A1C levels at 3 and 6 months, but at 6 months A1C levels were statistically significantly different based on whether or not individuals monitored their glucose levels (P=0.03, n=71). CONCLUSIONS: SMBG rates were low in this study despite SMBG education and access to free glucometers and test strips. The lower rates of SMBG may reflect the effects of unexpected environmental challenges, but exact causes remain unclear. Reasons for low rates of SMBG need to be explored further, especially in underserved communities.
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Automonitorização da Glicemia/estatística & dados numéricos , Glicemia/metabolismo , Serviços de Saúde Comunitária/organização & administração , Diabetes Mellitus Tipo 2/epidemiologia , Hemoglobinas Glicadas/metabolismo , Americanos Mexicanos/estatística & dados numéricos , Autocuidado/estatística & dados numéricos , Automonitorização da Glicemia/psicologia , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/psicologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Cooperação do Paciente/estatística & dados numéricos , Educação de Pacientes como Assunto , Pesquisa Qualitativa , Qualidade de Vida , População Rural , Autocuidado/psicologia , Inquéritos e Questionários , Texas/epidemiologiaRESUMO
PURPOSE: This article evaluates the Spoken Knowledge in Low Literacy in Diabetes (SKILLD) questionnaire, a measure of essential knowledge for type 2 diabetes self-management, after it was modified for English- and Spanish-speaking Mexican Americans. METHOD: We collected surveys (SKILLD, demographic, acculturation) and blood for A1C analysis from 72 community-recruited participants to analyze the SKILLD's internal consistency, interrater reliability, item analysis, and construct validity. Clinical experts evaluated content validity. RESULTS: The SKILLD demonstrated low internal consistency but high interrater reliability and content and construct validity. There were significant correlations in expected directions between SKILLD scores and acculturation, education, and A1C and significant differences in SKILLD scores between and within groups after an educational intervention and between high- and low-acculturated participants. CONCLUSION/IMPLICATIONS: The SKILLD generates useful information about Mexican Americans' diabetes knowledge. Lower SKILLD scores suggest less diabetes knowledge, lower health literacy, and participants' difficulties understanding items. Further modifications should improve use with low-acculturated Mexican Americans.
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Diabetes Mellitus Tipo 2/etnologia , Conhecimentos, Atitudes e Prática em Saúde , Letramento em Saúde/normas , Americanos Mexicanos , Reprodutibilidade dos Testes , Adulto , Idoso , Feminino , Humanos , Idioma , Masculino , Pessoa de Meia-Idade , Inquéritos e QuestionáriosRESUMO
PURPOSE: The purpose of the study was to (1) characterize leptin in Mexican Americans with poorly controlled type 2 diabetes, (2) examine relationships among leptin and indicators of diabetes status (body mass index and A1C), and (3) explore the effects of a culturally tailored diabetes self-management education intervention on leptin. METHODS: In Starr County, an impoverished Texas-Mexico border community, 252 Mexican Americans with type 2 diabetes were recruited to test a diabetes self-management education intervention culturally tailored in terms of language, dietary recommendations, social emphasis, family participation, and incorporation of cultural health beliefs. Groups of 8 participants were randomized to experimental or wait-listed control conditions. Outcomes were measured at 3, 6, and 12 months; by 12 months, 109 had complete leptin data. RESULTS: Most participants were women and, on average, 55 years of age, diagnosed with diabetes for 8 years, obese, and in poor glycemic control. Three variables-body mass index, sex, A1C-explained 36% of the variance in baseline leptin; there were no intervention effects on leptin. Sex, time, and gender × time interaction effects on leptin were statistically significant; greater increases in leptin over time occurred in women compared to men. In women, fasting blood glucose changes from baseline to 12 months significantly predicted leptin changes from baseline to 12 months; in men, body mass index changes predicted leptin change. CONCLUSIONS: With increasing obesity rates, further research is warranted to determine if leptin is a useful intervention target in type 2 diabetes.
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Glicemia/metabolismo , Serviços de Saúde Comunitária , Diabetes Mellitus Tipo 2/terapia , Hemoglobinas Glicadas/metabolismo , Leptina/sangue , Americanos Mexicanos , Autocuidado , Adulto , Índice de Massa Corporal , Serviços de Saúde Comunitária/organização & administração , Características Culturais , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/etnologia , Diabetes Mellitus Tipo 2/prevenção & controle , Feminino , Comportamentos Relacionados com a Saúde/etnologia , Promoção da Saúde/organização & administração , Humanos , Masculino , México , Pessoa de Meia-Idade , Educação de Pacientes como Assunto/organização & administração , Autocuidado/estatística & dados numéricos , TexasRESUMO
There is little debate about the importance of preparing nursing graduates to provide culturally sensitive care to an increasingly diverse society. However, it is difficult for nurse educators to fit learning experiences that help students develop cultural competence into already full programs and create mechanisms to evaluate the results. This article describes a study to assess the impact of a study abroad program on developing cultural competence, including cultural awareness, sensitivity, knowledge, and skills. Results from the Cultural Awareness Survey, reflective journals, and interviews illustrate how the study abroad experience influenced the development of components of cultural competence and might influence clinical practice. Results suggest effective teaching strategies to assist students in becoming culturally competent are experiential in nature and include role modeling, reflective activities, and group discussion.
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Competência Cultural/educação , Bacharelado em Enfermagem , Conhecimentos, Atitudes e Prática em Saúde , Intercâmbio Educacional Internacional , Adulto , Feminino , Humanos , Masculino , México , Multilinguismo , Avaliação de Programas e Projetos de Saúde , TexasRESUMO
Survey data are compromised when respondents do not interpret questions in the way researchers expect. Cognitive interviews are used to detect problems respondents have in understanding survey instructions and items, and in formulating answers. This paper describes methods for conducting cognitive interviews and describes the processes and lessons learned with an illustrative case study. The case study used cognitive interviews to elicit respondents' understanding and perceptions of the format, instructions, items, and responses that make up the Diabetes Symptom Self-Care Inventory (DSSCI), a questionnaire designed to measure Mexican Americans' symptoms of type 2 diabetes and their symptom management strategies. Responses to cognitive interviews formed the basis for revisions in the format, instructions, items, and translation of the DSSCI. All those who develop and revise surveys are urged to incorporate cognitive interviews into their instrumentation methods so that they may produce more reliable and valid measurements.
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Cognição , Letramento em Saúde , Inquéritos Epidemiológicos , Entrevistas como Assunto/métodos , Americanos Mexicanos , Inquéritos e Questionários , Diabetes Mellitus Tipo 2/enfermagem , Humanos , Americanos Mexicanos/psicologia , México/etnologia , Estudos de Casos Organizacionais , Psicometria , Reprodutibilidade dos Testes , Autocuidado , Estados UnidosRESUMO
OBJECTIVES: Culturally tailored diabetes self-management education (DSME) improves glycemic control and other health outcomes in Mexican Americans but sociocultural barriers to health improvements remain. This study explored the feasibility of adding a nurse case manager (NCM) to DSME to foster DSME attendance and increase utilization of other available health care services. DESIGN, SETTING AND PARTICIPANTS: The setting was a rural community on the Texas-Mexico border in one of the poorest counties in the United States. Using a repeated measures pretest, post-test control group design, we enrolled 165 Mexican American adults into: 1) an experimental group that received a DSME intervention plus access to a NCM; or 2) a control group that received DSME only. RESULTS: Both experimental and control groups received the DSME intervention, reported positive changes in diet and physical activity, and showed improved clinical outcomes; there were no significant group differences. A statistically significant reduction in body mass index was seen in women compared to men, regardless of group or number of NCM contacts. For individuals having the most NCM contacts, DSME attendance rates were greater. Participants expressed acceptance of the NCM; they preferred face-to-face contact rather than by telephone. CONCLUSIONS: Our previously tested, culturally tailored DSME continues to be an effective strategy for improving glycemic control in Mexican Americans. This feasibility study provided partial support for the NCM model for underserved border communities, but additional research is needed on resource utilization and the nature of NCM contacts.
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Administração de Caso , Diabetes Mellitus Tipo 2/enfermagem , Americanos Mexicanos , Educação de Pacientes como Assunto/organização & administração , Autocuidado , Apoio Social , Adulto , Idoso , Diabetes Mellitus Tipo 2/etnologia , Diabetes Mellitus Tipo 2/terapia , Estudos de Viabilidade , Feminino , Humanos , Masculino , México/etnologia , Pessoa de Meia-Idade , Cooperação do Paciente , Serviços de Saúde Rural , TexasRESUMO
CONTEXT: Type 2 diabetes is prevalent throughout the world. In previous studies of Mexican Americans with type 2 diabetes, 95%-97% of those sampled reported having symptoms they believe were caused by diabetes and most self-treated their symptoms. To more accurately capture Mexican Americans' symptom prevalence and their self-treatments, the Diabetes Symptom Self-Care Inventory (DSSCI) was adapted from the Diabetes Self-Care Instrument. OBJECTIVES: This article describes the modification process used to perfect the DSSCI for use in improving self-care among people with type 2 diabetes. METHODS: This instrumentation study used qualitative and quantitative methods. The study was completed in four phases that used focus groups, cognitive interviews, and survey administration. Four convenience samples were drawn from community-dwelling Mexican American adults, aged 25-75 years, with type 2 diabetes in an urban area and a rural location in Texas. RESULTS: Phase I: Seven focus groups (n=45) generated data for revising items. Phase II: Cognitive interviews with 16 participants were used to evaluate four revisions of the questionnaire. Phase III: Surveys were administered to 81 participants. Total number of symptoms on the DSSCI correlated with scores on the Centers for Epidemiological Studies-Depression scale (r=0.65, P<0.001), Illness Perception Questionnaire-Revised Diabetes Symptom subscale (r=0.57, P<0.001), and Audit of Diabetes-Dependent Quality of Life scale (r=-0.42, P<0.001). Minor revisions followed. Phase IV: Test-retest stability was demonstrated (n=44). CONCLUSION: The DSSCI is a culturally relevant, sound measure of Mexican Americans' diabetes symptoms and the actions they take to address them.
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Diabetes Mellitus Tipo 2/psicologia , Diabetes Mellitus Tipo 2/terapia , Psicometria , Autocuidado , Adulto , Idoso , Coleta de Dados , Depressão/psicologia , Feminino , Humanos , Entrevista Psicológica , Masculino , Americanos Mexicanos , Pessoa de Meia-Idade , Qualidade de Vida , Reprodutibilidade dos Testes , TexasRESUMO
OBJECTIVE: This paper explores the contribution of personal, cultural, and disease characteristics, diabetes knowledge, number of symptoms, and 2 specific clinics to the explained variance in glycosylated hemoglobin (A1c) and quality of life among Mexican Americans with type 2 diabetes. DESIGN: This descriptive correlational study used hierarchical multiple regression analysis. SAMPLE: 87 Mexican American patients with type 2 diabetes were recruited from 2 clinics, 1 hospital-affiliated and 1 free clinic, that served a primarily minority and indigent population. MEASUREMENTS: A language-based acculturation scale, the Diabetes Knowledge Questionnaire-24, Diabetes Symptom Self-Care Inventory, and Self-Anchoring Striving Scale were administered in one-on-one interviews. Medical records were reviewed for recent A1c and health history. RESULTS: The participants' clinic explained an additional 13% of the variance in A1c and 6% of the variance in quality of life after controlling for gender, acculturation, time since diagnosis, number of diabetes medications, diabetes knowledge, and number of symptoms. Clinics differed in patient characteristics, beyond the variables entered in the regression model, and in their care delivery. CONCLUSIONS: Clinic characteristics and their influence on diabetes outcomes should be explored to maximize patients' abilities to steer the course of their diabetes away from complications.
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Instituições de Assistência Ambulatorial/organização & administração , Atitude Frente a Saúde/etnologia , Diabetes Mellitus Tipo 2/etnologia , Americanos Mexicanos/etnologia , Ambulatório Hospitalar/organização & administração , Qualidade de Vida/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/prevenção & controle , Feminino , Hemoglobinas Glicadas/metabolismo , Conhecimentos, Atitudes e Prática em Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Americanos Mexicanos/educação , Pessoa de Meia-Idade , Pesquisa Metodológica em Enfermagem , Avaliação de Resultados em Cuidados de Saúde , Análise de Regressão , Inquéritos e Questionários , TexasRESUMO
PURPOSE: The purpose of this study was to compare 2 culturally competent diabetes self-management interventions designed for Mexican Americans: an original extended program (24 hours of education, 28 hours of support groups) versus a shorter, more resource-efficient compressed strategy (16 hours of education, 6 hours of support groups). The effects of the interventions on health beliefs are compared. METHODS: The authors recruited 216 persons between 35 and 70 years of age diagnosed with type 2 diabetes for at least 1 year. Intervention groups of 8 participants and 8 support persons were randomly assigned to 1 of the interventions. RESULTS: Mean health belief scores on each subscale improved for both intervention groups. Both intervention groups reported significant improvements in perceptions of control of their diabetes. Improvements in health beliefs were more sustained at 12 months for individuals in the longer, extended program. The health belief subscale control was the most significant predictor of HbA1c levels at 12 months. CONCLUSIONS: Both culturally competent diabetes self-management education interventions were effective in promoting more positive health beliefs. These findings on health beliefs indicate a dosage effect of the intervention and support the importance of ongoing contact through support groups to attain more sustainable improvements in health beliefs.
Assuntos
Atitude Frente a Saúde , Diabetes Mellitus Tipo 2/psicologia , Autocuidado , Aculturação , Adulto , Idoso , Diabetes Mellitus Tipo 2/etnologia , Diabetes Mellitus Tipo 2/reabilitação , Hemoglobinas Glicadas/análise , Comportamentos Relacionados com a Saúde , Humanos , Americanos Mexicanos , Pessoa de Meia-Idade , TexasRESUMO
PURPOSE: The purpose of this study was to examine the prevalence of diabetes-related symptoms among Mexican Americans with type 2 diabetes, their perceptions of symptom seriousness, treatments used to self-manage the symptoms, and ratings of treatment effectiveness. METHODS: As part of a larger descriptive correlational study conducted with 87 Mexican American adults in a southwest metropolitan area, data were collected during one-on-one interviews during outpatient visits using the Diabetes Symptom Self-care Inventory and analyzed with descriptive methods, t tests, and chi(2)s. RESULTS: Participants experienced 4.9 diabetes-related symptoms in a 30-day period and used a variety of treatments to self-manage the symptoms. Many of the self-management strategies were not appropriate for the most common causes of the symptoms. Few people tested their blood glucose levels in response to symptoms even though most owned glucometers. CONCLUSIONS: Most people who experience diabetes symptoms used self-care to treat the symptoms, did not verify the cause of the symptom, and perceived their treatments as effective. The appropriateness of the treatments used cannot be evaluated without knowing the etiology of the symptom for a particular person and time. Clinicians must assess symptoms and their treatments to best develop effective individualized treatments.