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 JovemAssuntos
Diabetes Mellitus Tipo 2/psicologia , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Autogestão/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Arizona/epidemiologia , Sistema de Vigilância de Fator de Risco Comportamental , Automonitorização da Glicemia/psicologia , Estudos Transversais , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , PercepçãoRESUMO
The incidence of skin cancer is raising in Hispanics/Latinos, which is a concern for Hispanics/Latinos living in Arizona, a state with a high amount of ultraviolet radiation exposure. There is a dearth of research on skin cancer prevention education for Hispanic/Latino adolescents in high school. Using a community-based participatory research (CBPR) framework, academic and community partners conducted a project to adapt an existing efficacious skin cancer prevention program, Project Students are Sun Safe (SASS) and the current SASS online training model, for dissemination to predominantly Hispanic/Latino students attending high schools in rural southeastern Arizona, located along the Arizona-Mexico border. We assessed the feasibility of training some of these students as peer educators (n = 16) to implement the "Border SASS" lesson to their peers in high school classrooms (n = 198). Border SASS training and the classroom lesson were feasible for, and highly acceptable to, peer educators and classroom students. These students significantly improved skin cancer prevention knowledge scores and self-reported skin cancer prevention behaviors over a 3- to 4-month period post training and the intervention implementation. Here we report on the following: (1) academic-community partnership and adaptation of the SASS training model for rural Hispanic high school students, (2) training of the high school peer educators, (3) administration of the SASS lesson by the trained peer educators to high school students, and (4) further evaluation of peer educator training and classroom student outcomes.
Assuntos
Educação em Saúde/métodos , Hispânico ou Latino , Grupo Associado , Serviços de Saúde Escolar , Neoplasias Cutâneas/prevenção & controle , Adolescente , Arizona , Pesquisa Participativa Baseada na Comunidade , Relações Comunidade-Instituição , Atenção à Saúde , Feminino , Humanos , Masculino , México , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , População Rural , Neoplasias Cutâneas/etnologia , EstudantesRESUMO
The purposes of this study were to examine the relationships among knowledge of and confidence in health care services (HHCS), acculturation, characteristics of family caregivers of Mexican descent, and differences by caregivers' relationship (spouse or adult child). A sample of Mexican-descent older adults and their caregivers was recruited (n = 74 dyads) in Arizona. Each participant completed questionnaires on knowledge, confidence, and acculturation. There were moderate but significant associations among higher Anglo Orientation with Knowledge and with Confidence. Fear of HHCS was positively associated with higher Anglo Orientation and English Language Preference; and negatively associated with Mexican Orientation and Spanish Language Preference. For Spouse caregivers, Fear of HHCS was positively correlated with higher Anglo Orientation and English Language Preference; for Offspring caregivers, Fear of HHCS was negatively correlated with Mexican Orientation and Spanish Language Preference. Results support assessing caregiver cohort and socio-cultural context to decrease HHCS use disparities by Mexican-descent caregiving families.
Assuntos
Aculturação , Cuidadores/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Disparidades em Assistência à Saúde/etnologia , Serviços de Assistência Domiciliar/estatística & dados numéricos , Americanos Mexicanos , Adulto , Arizona , Cuidadores/psicologia , Estudos de Coortes , Relações Familiares , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e QuestionáriosRESUMO
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
Despite common assumptions that non-paid family caregivers of Mexican descent benefit spiritually from their roles according to cultural familistic norms, there is also evidence of caregiver stress resulting in depression. Depression has the potential to seriously affect caregivers' health and their ability to continue to provide care. The current study's purpose was to examine the relationships among depression, stress, and mutuality (i.e., the quality of the caregiver-care recipient relationship) (N = 74 caregivers of Mexican descent in the southwestern United States). Multiple regression models and exploratory mediational analyses indicated that the stress-depression relationship can be significantly mediated by mutuality. Results support culturally appropriate interventions to decrease caregiver stress and depression by promoting mutuality. In addition, with changing trends in outside work roles and mobility of caregivers of Mexican descent, policy should make services truly accessible to support caregiving families of Mexican descent. [Res Gerontol Nurs. 2017; 10(3):106-113.].
Assuntos
Cuidadores/psicologia , Relações Familiares/etnologia , Relação entre Gerações/etnologia , Americanos Mexicanos/psicologia , Adaptação Psicológica , Relações Familiares/psicologia , Humanos , Estados UnidosRESUMO
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/psicologiaRESUMO
BACKGROUND: Transitional care, assisting patients to move safely through multiple health care settings, may be insufficient for older Hispanic patients. PURPOSE: Describe home health care services referral rates for Hispanic and non-Hispanic White (NHW) patients and factors that influence case managers' (CMs') discharge planning processes. DESIGN: Organized by the Ethno-Cultural Gerontological Nursing Model, health records were reviewed ( n = 33,597 cases) and supplemented with qualitative description ( n = 8 CMs). FINDINGS: Controlling for gender, insurance type, age, and hospital length of stay, NHW older adults received more home health care services referrals (odds ratio = 1.23). Insurance coverage was the most frequent determinant of CMs' post-hospital care choices, rather than patients' being Hispanic. NHW older adults were more likely to have insurance than Hispanic older adults. IMPLICATIONS: Insurance coverage being CMs' primary consideration in determining patients' dispositions is a form of systems-level discrimination for Hispanic vulnerable groups, which combined with other hospital-level constraints, should be addressed with policy-level interventions.
Assuntos
Geriatria/normas , Qualidade da Assistência à Saúde/normas , Racismo/estatística & dados numéricos , Cuidado Transicional/normas , Idoso , Feminino , Geriatria/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Cobertura do Seguro/normas , Cobertura do Seguro/estatística & dados numéricos , Masculino , Americanos Mexicanos/estatística & dados numéricos , Pessoa de Meia-Idade , Pesquisa Qualitativa , Qualidade da Assistência à Saúde/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Cuidado Transicional/estatística & dados numéricos , População Branca/estatística & dados numéricosRESUMO
A two-group randomized controlled trial tested a telenovela intervention (i.e., a culturally congruent videotaped dramatization with guided dialogue) to increase Mexican American older adults' and family caregivers' awareness of and confidence in home health care services (HHCS), thereby increasing use of HHCS and improving older adult and caregiver outcomes. Both groups had significant increases in awareness of and confidence in HHCS. The intervention group used HHCS more than the control group (91.1% versus 71.2% of total visits authorized); however, this was not a statistically significant difference (p = 0.18). Use of HHCS was associated with increased older adult and caregiver mutuality (i.e., the quality of the older adult-caregiver relationship) and decreased caregiving burden and depression. The predictive role and measurement of awareness and ways to improve the intervention are discussed. Findings are especially important with today's focus on transitional care to keep older adults at home and prevent unnecessary readmissions.
Assuntos
Cuidadores/educação , Avaliação Educacional , Serviços de Assistência Domiciliar/estatística & dados numéricos , Americanos Mexicanos/educação , Televisão , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Estados UnidosRESUMO
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/epidemiologiaRESUMO
Minority group members' participation in clinical research is essential for eliminating health disparities. Early recruitment procedures for a randomized control trial involving minority elder adults at local hospitals were unsuccessful, with challenges at the hospital and individual levels. These challenges included referrals for home health care being written late during hospitalization, hospital staff being reluctant to assist recruiters, ill minority elder adults, and protective or unavailable caregivers. We met these challenges with evidence-based strategies, including changing inclusion criteria, increasing study staff, branding our study, using a consistently respectful manner, and pacing our process. After revising our approaches in various ways, we recruited close to our goal, with relatively good retention. Participants reported that benefiting the community, rather than monetary reward, was a strong motivator to join the study. Unexpected recruitment expenditures exceeded the recruitment budget. Our experiences include strategies that can be more cost effective in future studies at both hospital and individual levels.
Assuntos
Cuidadores , Hospitalização , Pacientes Internados , Americanos Mexicanos , Seleção de Pacientes , Idoso , Humanos , Justiça SocialRESUMO
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 QuestionáriosRESUMO
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 UnidosRESUMO
Mexican American (MA) elders are more functionally impaired at younger ages than other elders yet use home care services (HCS) less. To determine the possible reasons, nine questionnaires were completed in Spanish or English by MA elders and caregivers living in southern Arizona (N = 280). Contextual, personal, and attitudinal factors were significantly associated with the use of HCS, and cultural/ethnic factors were significantly associated with confidence in HCS. Interventions should be designed and tested to increase the use of HCS by MA elders by increasing service awareness and confidence in HCS while preserving the expectations of familism and reducing caregiving burden.
Assuntos
Serviços de Assistência Domiciliar/estatística & dados numéricos , Americanos Mexicanos , Idoso , Arizona , Cuidadores , HumanosRESUMO
BACKGROUND: Translation of data collection instruments, paying careful attention to equivalency between the source and the target language, is important to obtain valid data collection instruments. OBJECTIVE: To translate the Summary of Diabetes Self-Care Activities (SDSCA) questionnaire (English) into Spanish and to evaluate the reliability and validity of the Spanish version. METHODS: Translation and back-translation were used to develop the Spanish version of the SDSCA. The Spanish version of the SDSCA was reviewed by an expert panel for conceptual and content equivalence to the English version. Psychometric properties were assessed further by combining data from three studies that used the Spanish version as a data collection instrument. RESULTS: Correlation of each item of the Spanish and English version of the SDSCA instrument ranged from .78 to 1.00, with no variability in the responses of 2 of the 12 items. Test-retest correlations for the SDSCA ranged from .51 to 1.00. Internal consistency (Cronbach's alpha) for the Spanish version was .68. Items loaded on three factors, with the factors accounting for 61% of the variance in SDSCA. DISCUSSION: The findings for the psychometric properties of the Spanish version of the SDSCA questionnaire suggest that it has conceptual and content equivalency with the original English version and is valid and reliable. However, further testing with larger samples is required.
Assuntos
Diabetes Mellitus/etnologia , Americanos Mexicanos , Autocuidado , Inquéritos e Questionários , Adulto , Idoso , Características Culturais , Diabetes Mellitus/terapia , Análise Fatorial , Feminino , Humanos , Idioma , Masculino , México/etnologia , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estados UnidosRESUMO
Latinos, the fastest growing minority group in the United States, are among the hardest hit by diabetes. Among Latinos, Mexican Americans have the highest rate (23.9%) of diabetes. Good self-management can improve glycemic control and decrease diabetes complications but can be challenging to achieve. The purpose of this study was to test the feasibility and examine the effects of a culturally tailored intervention for Mexican Americans with type 2 diabetes on outcomes of self-management. The study used a pretest/posttest control group design with 10 participants in each group (N = 17). Feasibility and acceptability of the tailored diabetes self-management program was assessed by examining ease of recruitment and retention rates. The behavioral outcomes of self-efficacy, diabetes knowledge and self-care measures, and the biologic outcomes of weight, body mass index, HbA1C, and blood glucose were used to examine intervention effectiveness. Successful recruitment of participants came from personal referrals from providers or the promotora. Retention rates were 100% for the intervention group and 80% for the control group. Findings suggest that the intervention had a positive clinical and statistical effect on diabetes knowledge, weight, and body mass index. Improvements were also noted in self-efficacy scores, blood glucose, and HbA1C, but these changes did not reach statistical significance. A culturally tailored diabetes self-management program may result in improved outcomes for Mexican Americans with type 2 diabetes.
Assuntos
Diabetes Mellitus Tipo 2/etnologia , Diabetes Mellitus Tipo 2/terapia , Promoção da Saúde/métodos , Educação de Pacientes como Assunto/métodos , Autocuidado/métodos , Adulto , Idoso , Glicemia , Índice de Massa Corporal , Características Culturais , Estudos de Viabilidade , Feminino , Hemoglobinas Glicadas/metabolismo , Humanos , Masculino , Americanos Mexicanos , Pessoa de Meia-IdadeRESUMO
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