Facilitators and Barriers to Type 2 Diabetes Self-Management Among Rural African American Adults

Purpose: The purpose of this study was to identify facilitators and barriers to self-management of type 2 diabetes mellitus (T2DM) among African American adults living in rural communities. Research indicates that African Americans experience higher rates of T2DM and diabetes-related complications than other ethnic groups. In Kentucky, diabetes is now the fourth leading cause of death by disease among African Americans. Methods: Twenty-two African American adults with T2DM were recruited from three churches in rural communities in Kentucky. Three focus groups were conducted to identify factors that made managing diabetes easier (facilitators) and factors that made managing diabetes more difficult (barriers). Demographic data were collected using a 15-item survey, focused on the participants’ personal, social and medical history related to T2DM. Results: Support was the primary facilitator of self-management. Support from family, friends, and health care providers which encouraged them to seek information and adhere to diet and medications helped with management. Identified barriers to self-management included fear, perceived beliefs about their health status, and difficulty making lifestyle changes. Discussion and Conclusion: T2DM is a serious health problem in the African American population. Interventions should be designed that focus on providing support for African Americans with T2DM. Additionally, interventions should focus on overcoming the identified barriers to assist them in taking control and feeling empowered to effectively self-manage T2DM

Relationships of Sociodemographic Characteristics with Glycemic Control and Dietary Adherence in Adults with Type 2 Diabetes

Background: Previous studies supported that sociodemographic characteristics are significantly associated with dietary adherence and glycemic control in adults with T2D. The American Diabetes Association (ADA) recommends that individually designed nutritional plans consider the sociodemographic characteristics of the patients. Few studies were conducted to examine the impact of sociodemographic characteristics on adherence to the ADA dietary guidelines and A1C in adults with T2D. Aim: The study aimed to examine the relationships of sociodemographic characteristics with adherence to ADA dietary guidelines and glycated hemoglobin (A1C) in adults with type 2 diabetes (T2D). Methods: A cross-sectional study used data for 1,401 adults that were extracted from the National Health and Nutrition Examination Survey conducted between 2007 and 2012. Results: A large percentage of the sample was non-Hispanic White and female. Sex, race/ethnicity, marital status, education, and income were significantly related to A1C. Race/ethnicity and marital status were significantly related to adherence to ADA dietary guidelines. Single participants were at greater odds of being non-adherent compared to married participants. Furthermore, non-Hispanic Whites had much lower odds of non-adherence to ADA dietary guidelines compared to Hispanics. Conclusion: Individualizing patients’ nutritional plans based on sociodemographic characteristics is crucial for improving glycemic control and health outcomes in patients with T2D

Development of a supported self-management intervention for adults with type 2 diabetes and a learning disability

Background: Although supported self-management is a well-recognised part of chronic disease management, it has not been routinely used as part of healthcare for adults with a learning disability. We developed an intervention for adults with a mild or moderate learning disability and type 2 diabetes, building on the principles of supported self-management with reasonable adjustments made for the target population. Methods: In five steps, we: 1. Clarified the principles of supported self-management as reported in the published literature 2. Identified the barriers to effective self-management of type 2 diabetes in adults with a learning disability 3. Reviewed existing materials that aim to support self-management of diabetes for people with a learning disability 4. Synthesised the outputs from the first three phases and identified elements of supported self-management that were (a) most relevant to the needs of our target population and (b) most likely to be acceptable and useful to them 5. Implemented and field tested the intervention Results: The final intervention had four standardised components: (1) establishing the participant’s daily routines and lifestyle, (2) identifying supporters and their roles, (3) using this information to inform setting realistic goals and providing materials to the patient and supporter to help them be achieved and (4) monitoring progress against goals. Of 41 people randomised in a feasibility RCT, thirty five (85%) completed the intervention sessions, with over three quarters of all participants (78%) attending at least three sessions. Twenty-three out of 40 (58%) participants were deemed to be very engaged with the sessions and 12/40 (30%) with the materials; 30 (73%) participants had another person present with them during at least one of their sessions; 15/41 (37%) were reported to have a very engaged main supporter, and 18/41 (44%) had a different person who was not their main supporter but who was engaged in the intervention implementation. Conclusions: The intervention was feasible to deliver and, as judged by participation and engagement, acceptable to participants and those who supported them. Trial registration: Current Controlled Trials ISRCTN41897033 (registered 21/01/2013)

Nurses’ Perceptions of Family-Witnessed Resuscitation

Advantages and disadvantages of family presence during resuscitation (FPDR) continues to be debated among nurses and healthcare providers (HCP). Few hospitals have a written protocol for when this type of event occurs. It is important to understand and identify the risks and benefits of FPDR along with the HCP perception of FPDR. To determine: (1) nurses’ perceptions of selfconfidence, risks, and benefits concerning FPDR, and (2) explore differences by: years of experience, number of resuscitations attended, and number of times family members invited to patient’s room during a resuscitation. Design: Cross-sectional survey of registered nurses (RN) at a metropolitan hospital. Instrument: Participants completed two valid and reliable scales: Family Presence Risk-Benefit Scale (FPR-BS) and Family Presence Self-Confidence Scale (FPS-CS) as well as demographic data. Participants. The majority of the 154 survey participants were Caucasian female nurses. More than half were between the ages of 25 and 55 years old (73.5%) and had more than six years’ of experience (68%) as an RN. Work units of the participants varied, but the most prevalent unit was transitional care unit (27%). Over three-fourths were trained in Advanced Cardiac Life Support and had participated in a mock code. Most (54.5%) had been involved in over 10 resuscitations but only 38% had ever invited a family member to be present during a resuscitation. Analysis: Data analysis is ongoing. Descriptive statistics will be used to describe the FPR-BS and the FPR-CS results. Differences between groups will be assessed using t-tests and ANOVA

Relationships of Depression, Anxiety, and Stress with Adherence to Self-Management Behaviors and Diabetes Measures in African American Adults with Type 2 Diabetes

This study examines the relationships of depression, anxiety, and stress with adherence to self-management behaviors and diabetes measures in 42 African American adults with type 2 diabetes (T2D). Participants were recruited from an outpatient clinic located in an urban area of a midsized city in the southeastern USA. The mean age of the sample was 54.9 years (SD = 9.9) and the majority of the participants were female (73.2%), high school graduates (55.3%), unemployed (70.7%), and publicly insured (77.8%). Each participant completed a demographic survey and the Depression, Anxiety and Stress Scale 21. Adherence to self-management behaviors (physical activity, diet, and medication use) was assessed using surveys and self-reports. Glycated hemoglobin (A1c) and body mass index (BMI) were obtained from participants’ medical records at the time of the participants’ clinic visits. Depression, anxiety, and stress were not significantly correlated with self-management behaviors. Depression (r = 0.38, p = 0.03), anxiety (r = 0.56, p = 0.001), and stress (r = 0.36, p = 0.04) were positively correlated with A1c. The greater the dietary risk assessment score, the higher the A1c (r = 0.34, p = 0.05). Anxiety was the strongest correlate of A1c followed by depression, stress, and dietary risk assessment. Future studies to confirm this study’s findings in a larger sample are warranted. Interventions to mitigate the effects of these correlates should be designed and tested to improve health outcomes in African American adults with T2D

Relationships of Depression, Anxiety, and Stress with Adherence to Self-Management Behaviors and Diabetes Measures in African American Adults with Type 2 Diabetes

This study examines the relationships of depression, anxiety, and stress with adherence to self-management behaviors and diabetes measures in 42 African American adults with type 2 diabetes (T2D). Participants were recruited from an outpatient clinic located in an urban area of a midsized city in the southeastern USA. The mean age of the sample was 54.9 years (SD = 9.9) and the majority of the participants were female (73.2%), high school graduates (55.3%), unemployed (70.7%), and publicly insured (77.8%). Each participant completed a demographic survey and the Depression, Anxiety and Stress Scale 21. Adherence to self-management behaviors (physical activity, diet, and medication use) was assessed using surveys and self-reports. Glycated hemoglobin (A1c) and body mass index (BMI) were obtained from participants’ medical records at the time of the participants’ clinic visits. Depression, anxiety, and stress were not significantly correlated with self-management behaviors. Depression (r = 0.38, p = 0.03), anxiety (r = 0.56, p = 0.001), and stress (r = 0.36, p = 0.04) were positively correlated with A1c. The greater the dietary risk assessment score, the higher the A1c (r = 0.34, p = 0.05). Anxiety was the strongest correlate of A1c followed by depression, stress, and dietary risk assessment. Future studies to confirm this study’s findings in a larger sample are warranted. Interventions to mitigate the effects of these correlates should be designed and tested to improve health outcomes in African American adults with T2D

Self-Management as a Mediator of the Relationship between Social Support Dimensions and Health Outcomes of African American Adults with Type 2 Diabetes

Social support promotes behavior change and self-management that leads to improved health outcomes. The purpose of this study was to evaluate the role of self-management in mediating the relationship between social support dimensions and health outcomes of African Americans with type 2 diabetes (T2D). Cross-sectional data were collected from 102 African Americans with T2D at an outpatient clinic. The majority of the participants were female, single, unemployed, and having low income. Functional support, the quality of the primary intimate relationship, and the number of support persons were negatively correlated with depression. Functional support and satisfaction with support explained a significant small amount of the variance in self-management. However, self-management did not mediate the relationships between social support dimensions and the health outcomes. The results of this study shed the light on the unique relationships of social support dimensions with health outcomes of African Americans with T2D