RESUMO

PURPOSE: The purpose of the study is to test the effects of a culturally tailored family-based self-management education and social support intervention on family social capital with Mexican American (MA) adults with type 2 diabetes (T2DM) and their family member. METHODS: Using a 2-group, experimental repeated-measures design, 157 dyads were randomly assigned to an intervention (group education and social support, home visits, and telephone calls) or a wait list control group. Data were collected at baseline, immediately postintervention (3 months), and 6 months postintervention. A series of 2 × 3 repeated-measures analyses of variance with interaction contrasts were used to test the hypotheses regarding the differential effects on family social capital. RESULTS: Social capital outcomes included social integration, social support, and family efficacy. Social integration scores, high for family members and friends and low for community engagement, did not change over time for participants or family members. Participants perceived high support from family for physical activity with an immediate increase postintervention and moderate sabotage for healthy eating with no change over time. A sustained intervention effect was noted for family efficacy for general health and total family efficacy in participants and family members. CONCLUSIONS: This family-based culturally tailored intervention demonstrated the potential to improve social capital, specifically social support for physical activity and family efficacy for diabetes management for MA adults with T2DM. Ongoing research that examines the family as a critical context in which T2DM self-management occurs and that targets strategies for sustained family social capital outcomes for T2DM is needed.

Assuntos

Diabetes Mellitus Tipo 2/psicologia , Diabetes Mellitus Tipo 2/terapia , Terapia Familiar/métodos , Americanos Mexicanos/psicologia , Autogestão/educação , Capital Social , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Diabetes Mellitus Tipo 2/etnologia , Exercício Físico/psicologia , Família/psicologia , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Apoio Social , Resultado do Tratamento , Adulto Jovem

RESUMO

Type 2 diabetes mellitus (T2DM) is one of the leading causes of death from worldwide non-communicable diseases. The prevalence of diabetes in the Mexico (MX)-United States border states exceeds the national rate in both countries. The economic burden of diabetes, due to decreased productivity, disability, and medical costs, is staggering and increases significantly when T2DM-related complications occur. The purpose of this study was to use a modified behavioral risk factor surveillance system (BRFSS) to describe the T2DM self-management behaviors, diabetes care, and health perception of a convenience sample of adults with T2DM in Monterrey, MX. This cross-sectional study design, with convenience sampling, was conducted with a convenience sample (n = 351) of adults in the metropolitan area of Monterrey, MX who self-reported a diagnosis of T2DM. Potential participants were recruited from local supermarkets. Twenty-six diabetes and health-related items were selected from the BRFSS and administered in face-to-face interviews by trained data collectors. Data analysis was conducted using descriptive statistics. The mean age was 47 years, and the mean length of time with T2DM was 12 years. The majority was taking oral medication and 34% required insulin. Daily self-monitoring of feet was performed by 56% of the participants; however, only 8.8% engaged in blood glucose self-monitoring. The mean number of health-care provider visits was 9.09 per year, and glycated hemoglobin level (HbA1c) was assessed 2.6 times per year. Finally, only 40.5% of the participants recalled having a dilated eye exam. We conclude the modified BRFSS survey administered in a face-to-face interview format is an appropriate tool for assessing engagement in T2DM self-management behaviors, diabetes care, and health perception. Extension of the use of this survey in a more rigorous design with a larger scale survey is encouraged.

RESUMO

Purpose The purpose of the study was to investigate the effects of a family-based self-management support intervention for adults with type 2 diabetes (T2DM). Methods Using a 2-group, experimental repeated measures design, 157 dyads (participant with T2DM and family member) were randomly assigned to an intervention (education, social support, home visits, and telephone calls) or a wait list control group. Data were collected at baseline, postintervention (3 months), and 6 months postintervention. A series of 2 × 3 repeated measures ANOVAs were used to test the hypotheses with interaction contrasts to assess immediate and sustained intervention effects. Results Significant changes over time were reported in diet self-management, exercise self-management, total self-management, diabetes self-efficacy for general health and total diabetes self-efficacy, physician distress, regimen distress, interpersonal distress, and total distress. There were likewise sustained effects for diet self-management, total self-management, diabetes self-efficacy for general health, total self-efficacy, physician distress, regimen distress, and interpersonal distress. Conclusions Results support and extend prior research documenting the value of culturally relevant family-based interventions to improve diabetes self-management and substantiate the need for intensive, longer, tailored interventions to achieve glycemic control.

Assuntos

Assistência à Saúde Culturalmente Competente/métodos , Diabetes Mellitus Tipo 2/terapia , Terapia Familiar/métodos , Americanos Mexicanos/psicologia , Autogestão/métodos , Adulto , Assistência à Saúde Culturalmente Competente/etnologia , Diabetes Mellitus Tipo 2/etnologia , Diabetes Mellitus Tipo 2/psicologia , Dieta para Diabéticos/etnologia , Dieta para Diabéticos/psicologia , Feminino , Humanos , Masculino , Projetos de Pesquisa , Autoeficácia , Autogestão/psicologia , Apoio Social , Estresse Psicológico/etnologia , Estresse Psicológico/psicologia

RESUMO

PURPOSE: The purpose of this study was to refine and expand a culturally tailored individual-level diabetes self-management intervention to a family-level intervention. METHODS: Using community-based participatory research principles, Mexican American adults (n = 12) with type 2 diabetes mellitus (T2DM) and family members (n = 12) in the United States-Mexico border region participated in 6 focus group interviews, conducted by bilingual, bicultural facilitators. Facilitators and barriers to T2DM management were identified. Transcripts were analyzed using qualitative content analysis. RESULTS: Through an iterative analysis process, 5 categories represented participants with T2DM: (1) strategies my family can use to support our managing T2DM, (2) be sensitive to my challenges, (3) stop telling me what to eat or do, (4) how can we peacefully coexist, and (5) I feel supported. Categories identified by family members were (1) changing behaviors together, (2) sharing not controlling, (3) supporting positive behaviors, and (4) your behaviors frustrate me. CONCLUSIONS: The family was reinforced as a major influence for successful T2DM management. Family support requires that families value and develop knowledge and skills for T2DM management. This family intervention builds on family assets and relationships, shifting from traditional externally motivated individual models to create a shared commitment to manage T2DM among Mexican American adults.

Assuntos

Assistência à Saúde Culturalmente Competente/métodos , Diabetes Mellitus Tipo 2/psicologia , Família/psicologia , Americanos Mexicanos/psicologia , Autogestão/psicologia , Adulto , Idoso , Pesquisa Participativa Baseada na Comunidade , Diabetes Mellitus Tipo 2/etnologia , Feminino , Grupos Focais , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Autogestão/métodos , Estados Unidos

RESUMO

PURPOSE: The purpose of this study is to describe and compare personal characteristics, health care access and utilization, and self-management behaviors of Hispanic American adults diagnosed with diabetes who reside in 3 US-Mexico border counties in Arizona, New Mexico, and Texas. This study also examines the status of this population in attaining Healthy People (HP) 2020 diabetes target goals. METHODS: Data were extracted from the 2005-2009 Selected Metropolitan/Micropolitan Area Risk Trends (SMART): Behavioral Risk Factor Surveillance System (BRFSS) to analyze behavioral and health system factors associated with diabetes management among Hispanic American adults who reside in the border counties (N = 600). Data were analyzed using descriptive statistics and compared using chi-square and one-way analysis of variance. RESULTS: There were significant differences in health care access and utilization and in 1 self-management behavior (daily feet checks) across the counties. The majority of participants (83.4%) had a care provider, however the HP 2020 diabetes target goals for A1C monitoring or foot exams conducted by a care provider were not met. Participants in all counties met the target goal for dilated eye exams. CONCLUSIONS: Improvement of diabetes management among this population should focus on border health system barriers to attaining HP 2020 diabetes target goals.

Assuntos

Diabetes Mellitus Tipo 2/epidemiologia , Comportamentos Relacionados com a Saúde , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Hispânico ou Latino , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Autocuidado , Análise de Variância , Arizona/epidemiologia , Sistema de Vigilância de Fator de Risco Comportamental , Estudos Transversais , Diabetes Mellitus Tipo 2/psicologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação das Necessidades , New Mexico/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Serviços Preventivos de Saúde , Assunção de Riscos , Autocuidado/psicologia , Autocuidado/estatística & dados numéricos , Inquéritos e Questionários , Texas/epidemiologia

RESUMO

OBJECTIVES: To pilot test the efficacy of a culturally tailored diabetes self-management social support intervention for Mexican American adults with Type 2 diabetes (T2DM) living in the U.S.-Mexico border region and to test the feasibility of recruiting and training promotoras to participate in intervention delivery. DESIGN AND SAMPLE: This study used a single-group pretest and posttest design. The convenience sample consisted of 21 Mexican American adults with T2DM. The setting for the study was a community in the Arizona-Sonora, Mexico border region. INTERVENTIONS: A bilingual, bicultural certified diabetes educator (CDE) and a nurse researcher developed the intervention to improve T2DM self-management activities for Mexican Americans. Data were collected using self-report questionnaires, glycosolated hemoglobin (HbA(1c)), and anthropometric measures. RESULTS: Intervention efficacy was demonstrated by an increase in participants' diabetes self-management activities and diabetes knowledge and a decrease in diabetes-related distress and sedentary behaviors. There were no significant changes in physiologic outcomes. Feasibility of recruitment and training of 2 promotoras who participated in intervention delivery was established. CONCLUSIONS: Promotoras, in collaboration with a CDE, successfully delivered a culturally tailored diabetes self-management social support intervention for Mexican American adults with T2DM. This intervention positively affected diabetes self-management behaviors.

Assuntos

Diabetes Mellitus Tipo 2 , Promoção da Saúde/organização & administração , Americanos Mexicanos , Educação de Pacientes como Assunto/organização & administração , Autocuidado , Apoio Social , Arizona , Agentes Comunitários de Saúde/educação , Agentes Comunitários de Saúde/organização & administração , Competência Cultural , Currículo , Diabetes Mellitus Tipo 2/etnologia , Diabetes Mellitus Tipo 2/prevenção & controle , Estudos de Viabilidade , Feminino , Comportamentos Relacionados com a Saúde/etnologia , Humanos , Masculino , Americanos Mexicanos/educação , Americanos Mexicanos/etnologia , Pessoa de Meia-Idade , Pesquisa em Avaliação de Enfermagem , Seleção de Pessoal , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Autocuidado/métodos , Autocuidado/psicologia , Inquéritos e Questionários

RESUMO

Caregiving burden has been shown to predict use of home care services among Anglo Americans. In a previous study, only one of two dimensions of caregiving burden predicted such use among Mexican American caregivers. Because acculturation and familism may affect burden, we conducted analyses to test three hypotheses: increased acculturation decreases familism; decreased familism increases burden; and increased burden increases use of home care services. Among 140 Mexican American family caregivers, acculturation was positively correlated with familism; familism was not significantly correlated with burden; objective burden was positively correlated with use of home care services, and objective and subjective burden significantly interacted in their effect on the use of home care services. Targeted interventions may be needed to increase use of home care services and preserve the well-being of Mexican American elders and caregivers.

Assuntos

Serviços de Saúde para Idosos/normas , Americanos Mexicanos , Aculturação , Idoso , Efeitos Psicossociais da Doença , Família , Feminino , Serviços de Saúde para Idosos/economia , Serviços de Assistência Domiciliar/economia , Humanos , Masculino , Responsabilidade Social , Estados Unidos

RESUMO

Mexican immigrants living in the U.S.-Mexico border region are confronted with different national explanations about latent tuberculosis infection (LTBI) and preventive treatment. The purpose of this study was to explore how a group of Mexican immigrant women (N = 8) at risk of LTBI treatment failure interpreted and ultimately resisted LTBI preventive treatment. A critical ethnographic methodology, grounded in asymmetrical power relations that are historically embedded within the U.S.-Mexico border culture, was used to examine the encounters between the participants and the health care provider. The study findings are discussed from the perspective of women who experienced oppression and resistance in the U.S.-Mexico border region, providing an account of how Mexican immigrant women become entangled in U.S.-Mexico TB health policies and through resistance manage to assert control over health care choices. In the context of the U.S.-Mexico border region, health care professionals must be skilled at minimizing asymmetrical power relations and use methods that elicit immigrant voices in reconciling differences in health beliefs and practices.

Assuntos

Antituberculosos/uso terapêutico , Americanos Mexicanos , Cooperação do Paciente/etnologia , Tuberculose/prevenção & controle , Adulto , Antropologia Cultural , Arizona , Vacina BCG/imunologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , México/etnologia

RESUMO

Multiple and complex health-illness transitions are required for successful diabetes self-management. Diabetes health-illness transitions influence the daily lives and interactions of Mexican immigrant women with diabetes. This article reports the findings from an intervention study designed to facilitate the health-illness transition in Mexican immigrant women with type 2 diabetes who reside in the Arizona-Sonora region of the US-Mexico border. There was a significant (P<0.001) increase from preintervention to postintervention in diabetes knowledge and diabetes self-efficacy and a significant decrease (P

Assuntos

Diabetes Mellitus Tipo 2/psicologia , Emigração e Imigração , Conhecimentos, Atitudes e Prática em Saúde , Americanos Mexicanos/psicologia , Adaptação Psicológica , Adulto , Idoso , Diabetes Mellitus Tipo 2/etnologia , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Acontecimentos que Mudam a Vida , Pessoa de Meia-Idade , Autoeficácia , Apoio Social