Adherence to diabetes self-care behaviors in English- and Spanish-speaking Hispanic men

We conducted a qualitative study to elicit attitudes, attributions, and self-efficacy related to diabetes self-care in both English- and Spanish-speaking Hispanic men. Transcripts from six focus groups (three in English and three in Spanish) were reviewed by the authors to extract principal and secondary themes. Participants could describe their medication and lifestyle regimens and were aware of whether they were adherent or nonadherent to physician recommendations. Lack of skills on how to incorporate diet and regular physical activity into daily living, lack of will power, and reluctance to change culturally rooted behaviors emerged as significant barriers to diabetes self-management. Medication adherence is for some men the principal diabetes self-care behavior. Nonadherence appeared to fit two profiles: 1) intentional, and 2) nonintentional. In both instances low self-efficacy emerged as a significant influence on attainment and maintenance of diabetes self-care goals. Participants also expressed a strong sense of fatalism regarding the course of their disease, and seemed to have little motivation to attempt long-term dietary control. Educational and counseling messages should stress that a diagnosis of diabetes is not a death sentence, and full functional capacity can be maintained with good control

Psychosocial Contributors to Depressive Symptoms in Hispanic Patients With Type 2 Diabetes

Purpose The purpose of this study is to identify psychosocial factors associated with depressive symptoms in Hispanic patients with diabetes and explore the extent to which their effects may vary by gender and acculturation. Methods The authors completed a secondary analysis of data from 247 Hispanic adults with type 2 diabetes. Gender and language groups were compared using chi-square and t tests. Hierarchical multiple regression was used to examine associations of depressive symptoms with perceived support, diabetes-related distress, and social and personal factors. Results Women reported less support than men. English speakers reported more depressive symptoms than Spanish speakers. When adjusting for age, gender, and acculturation, psychosocial factors significantly associated with depressive symptoms included less support received, greater emotional burden, and less ability to socialize or pursue normal activities because of diabetes. Conclusions Social support provided by family among less acculturated Hispanics may play an important role in reducing emotional burden and lowering the risk of comorbid depression. The quality of interpersonal relationships and the ability to continue normal activities may also be important. More acculturated Hispanic women with diabetes may be at greater risk for comorbid depression and worse health outcomes. Screening for depression and assessment of support needs is warranted for Hispanic women. </jats:sec

Gender Differences in Self-Efficacy for Diabetes Self-Management Among Hispanics: The Mediating Role of Perceived Support and Depressive Symptoms

Purpose The purpose of this study is to examine the extent to which perceived support and depressive symptoms might interfere with Hispanic patients’ ability to manage their diabetes and whether these effects vary by gender. Methods Data were collected from a cohort of 232 Hispanic men and women with type 2 diabetes mellitus (T2DM). Conditional process analysis was used to test a moderated mediation model of the time-lagged processes associating gender, diabetes support, and depressive symptoms with reported self-efficacy after 3 months. Results Increased depressive symptoms were associated with lower self-efficacy, but the conditional effects varied among men and women. The index of moderated mediation was significant, indicating that among women, the indirect effect of depressive symptoms on self-efficacy was contingent on lower levels of perceived support. Among men, increased depressive symptoms were directly associated with declines in self-efficacy and were not conditional on perceived support. Conclusions Results of the study have important implications for gender health equity. Mental health screening and an assessment of support needs may be important for determining appropriate complementary therapies when treating Hispanic women with chronic conditions such as diabetes. Attention to possible differences in gender-specific mental health needs could lead to improved self-management, better glycemic control, and more equitable health outcomes. </jats:sec

Abstract A27: Using community theater to educate the underserved about cancer screening and prevention

Abstract Background: In an effort to engage the lay community around issues related to colorectal and cervical cancer prevention and screening, we formed the Community Network for Cancer Prevention Forum Theater Project, a three-year funded program bringing together collaborators from several disciplines. The goal of the project is to foster communication and understanding of colorectal and cervical cancer risks and prevention strategies among target populations by discovering and addressing barriers to care. This will be accomplished by using an interactive form of community theater in a campaign that addresses health disparities and inequities. Drawing on a method that creates theater in direct collaboration with the community, we are using Forum Theater as a platform for developing colorectal and cervical cancer screening messages to be communicated at performances. Experimental Procedures: As part of the project, we have trained the first group of Community Health Workers (CHWs) to implement the theater project in Spanish-speaking Hispanic communities. The training took place once a week for seven weeks, with 16 people in attendance. A faculty member from the School of Allied Health conducted the first session, which was an evidence-based cervical and colorectal cancer content session; another faculty member from the School of Allied Health attended most of the sessions not only as an expert on behavioral psychology but as a participant in the Forum Theater training. The remaining six weeks focused in depth on Forum Theater methods and techniques, such as trust exercises, improvisation, building dramatic scenes, rehearsal techniques, maintaining effective dramatic flow, and encouraging audience participation. Throughout the training, participants developed their skills for addressing barriers and myths related to cancer screening and prevention, as well as how to address these issues with community members. Once CHWs are trained, their tasks are to identify and coordinate locations for performances, encourage participation from the communities that they serve, and to facilitate the production of linguistically and culturally appropriate performances. Expected Results and Conclusions: All of the participants completed a pre-post knowledge and attitudes survey of the content session and a self-administered questionnaire at the end of the seven weeks of training. Results of the pre-post tests indicate that the content session was effective in increasing knowledge levels and improving attitudes about the efficacy of screening and prevention for underserved populations. Findings from the questionnaire, which asked about leadership confidence, skill development, self-efficacy, and satisfaction with the program, suggest that the training program provided CHWs with the necessary tools to implement a successful community theater program for cancer prevention and screening. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A27.</jats:p