Racial and Ethnic Disparities in Diabetes Complications in the Northeastern United States: The Role of Socioeconomic Status

The role of socioeconomic status (SES) in explaining racial/ethnic disparities in diabetes remains unclear. We investigated disparities in self-reported diabetes complications, and the role of macro (e.g., income, education) and micro (e.g., ‘owning a home’ or ‘having a checking account’) SES indicators in explaining these differences. The sample included individuals with a diagnosis of diabetes (N=795) who were on average 55 years old, and 55.6% non-Hispanic White, 25.0% African American, and 19.4% Hispanic. Approximately 8% reported nephropathy, 35% reported retinopathy, and 16% reported cardiovascular disease. There were significant disparities in the rates of complications among non-Hispanic White, African American and Hispanic participants, with Hispanics having the highest rates of nephropathy, retinopathy, and cardiovascular disease. Macro SES indicators (e.g., income) mediated racial differences (i.e., non-Hispanic Whites vs. African Americans) in self-reported retinopathy, a combination of macro and more micro SES indicators (e.g., education, income, and ‘owning a home’ or ‘having a checking account’) mediated racial/ethnic differences (i.e., non-Hispanic Whites vs. Hispanics) in self-reported cardiovascular disease, and only micro SES indicators (e.g., ‘owning a home’ or ‘having a checking account’) mediated differences between lower income SES racial/ethnic minority groups (i.e., African Americans vs. Hispanics) in self-reported retinopathy and cardiovascular disease. Findings underscore that indicators of SES must be sensitive to the outcome of interest and the racial/ethnic groups being compared

Diabetes and Co-morbid Depression Among Racially Diverse, Low-Income Adults

Background Research suggests individuals with diabetes are twice as likely as those without diabetes to be clinically depressed. Still unknown is the relationship between diabetes and depression in socioeconomically disadvantaged populations. Purpose We examined the relationship between diabetes and depressive symptoms in a large, racially diverse, low-income cohort in the southeastern USA. Methods A total of 69,068 adults were recruited from community health centers in 12 southeastern states. A fully adjusted polytomous logistic regression model tested the relationship between demographics, lifestyle behaviors, antidepressant use, body mass index, diabetes diagnosis, diabetes duration, diabetes medication compliance, and depressive symptoms using the Centers for Epidemiological Studies Depression scale. Results Diabetes was present in 21.7% of sample. While a diabetes diagnosis was associated with having severe depressive symptoms (AOR, 1.24; 95% CI, 1.14–1.34), demographics, lifestyle behaviors, body mass index and antidepressant use were more strongly associated with severe depressive symptoms than a diabetes diagnosis. Conclusions Having diabetes was associated with the presence and severity of depressive symptoms in a large, low-income sample of racially diverse adults. However, the relationship between diabetes and depressive symptoms was weaker than in other studies with higher socioeconomic groups

Development and evaluation of a medication counseling workshop for physicians: can we improve on ‘take two pills and call me in the morning’?

Physicians often do not provide adequate medication counseling.To develop and evaluate an educational program to improve physicians’ assessment of adherence and their medication counseling skills, with attention to health literacy.We compared internal medicine residents’ confidence and counseling behaviors, measured by self-report at baseline and one month after participation in a two-hour interactive workshop.Fifty-four residents participated; 35 (65%) completed the follow-up survey. One month after training, residents reported improved confidence in assessing and counseling patients (p<0.001), including those with low health literacy (p<0.001). Residents also reported more frequent use of desirable behaviors, such as assessing patients’ medication understanding and adherence barriers (p<0.05 for each), addressing costs when prescribing (p<0.01), suggesting adherence aids (p<0.01), and confirming patient understanding with teach-back (p<0.05).A medication counseling workshop significantly improved residents’ self-reported confidence and behaviors regarding medication counseling one month later

Diabetes and Co-morbid Depression Among Racially Diverse, Low-Income Adults

Research suggests individuals with diabetes are twice as likely as those without diabetes to be clinically depressed. Still unknown is the relationship between diabetes and depression in socioeconomically disadvantaged populations

Using the IMB model of health behavior change to promote self-management behaviors in Puerto Ricans with diabetes

Most published diabetes intervention studies concerning Hispanics focus on Mexican Americans. However, Puerto Ricans have the highest prevalence of type 2 diabetes and are more likely to be hospitalized for complications than other Hispanic groups. The goal of this research was to test the efficacy of a brief, culturally sensitive, theory-driven intervention to promote self-management behaviors among Puerto Ricans with diabetes. The Information-Motivation-Behavioral Skills (IMB) model was the chosen theoretical framework. ^ A total of 118 patients from a hospital in Hartford, CT completed pretest measures, and were randomly assigned to a brief intervention (N = 59) or the standard of care control group (N = 59). Participants were reassessed 3-months later. Findings revealed that at posttest the intervention group was reading food labels and adhering to diet recommendations significantly more than the control group. The intervention group was also more physically active than the control group, but the difference was not statistically significant. Behavior change was not qualified by weight loss, but was partially qualified by decreased HbA1c. HbA1c decreased in both groups, but the intervention group experienced a greater reduction than the control group. ^ Structural equation modeling tested IMB model predictions. Overall, the IMB models of diet and exercise fit the data. The IMB constructs accounted for a moderate proportion of the variance in both diet and exercise behavior. Diet information was directly related to diet behavior. Consistently, the intervention increased both diet knowledge and diet behavior. Previous interventions with Hispanics that have increased knowledge have also reduced HbA1c, suggesting that improvements in knowledge and behavior may have contributed to the steeper HbA1c decline observed in the intervention group relative to the control group.

Getting a technology-based diabetes intervention ready for prime time: a review of usability testing studies.

Consumer health technologies can educate patients about diabetes and support their self-management, yet usability evidence is rarely published even though it determines patient engagement, optimal benefit of any intervention, and an understanding of generalizability. Therefore, we conducted a narrative review of peer-reviewed articles published from 2009 to 2013 that tested the usability of a web- or mobile-delivered system/application designed to educate and support patients with diabetes. Overall, the 23 papers included in our review used mixed (n = 11), descriptive quantitative (n = 9), and qualitative methods (n = 3) to assess usability, such as documenting which features performed as intended and how patients rated their experiences. More sophisticated usability evaluations combined several complementary approaches to elucidate more aspects of functionality. Future work pertaining to the design and evaluation of technology-delivered diabetes education/support interventions should aim to standardize the usability testing processes and publish usability findings to inform interpretation of why an intervention succeeded or failed and for whom

The Design, Usability, and Feasibility of a Family-Focused Diabetes Self-Care Support mHealth Intervention for Diverse, Low-Income Adults with Type 2 Diabetes

Family members’ helpful and harmful actions affect adherence to self-care and glycemic control among adults with type 2 diabetes (T2D) and low socioeconomic status. Few family interventions for adults with T2D address harmful actions or use text messages to reach family members. Through user-centered design and iterative usability/feasibility testing, we developed a mHealth intervention for disadvantaged adults with T2D called FAMS. FAMS delivers phone coaching to set self-care goals and improve patient participant’s (PP) ability to identify and address family actions that support/impede self-care. PPs receive text message support and can choose to invite a support person (SP) to receive text messages. We recruited 19 adults with T2D from three Federally Qualified Health Centers to use FAMS for two weeks and complete a feedback interview. Coach-reported data captured coaching success, technical data captured user engagement, and PP/SP interviews captured the FAMS experience. PPs were predominantly African American, 83% had incomes <$35,000, and 26% were married. Most SPs (n=7) were spouses/partners or adult children. PPs reported FAMS increased self-care and both PPs and SPs reported FAMS improved support for and communication about diabetes. FAMS is usable and feasible and appears to help patients manage self-care support, although some PPs may not have a SP