Community to clinic navigation to improve diabetes outcomes

Rural residents experience rates of Type 2 Diabetes Mellitus (T2DM) that are considerably higher than their urban or suburban counterparts. Two primary modifiable factors, self-management and formal clinical management, have potential to greatly improve diabetes outcomes. “Community to Clinic Navigation to Improve Diabetes Outcomes,” is the first known randomized clinical trial pilot study to test a hybrid model of diabetes self-management education plus clinical navigation among rural residents with T2DM. Forty-one adults with T2DM were recruited from two federally qualified health centers in rural Appalachia from November 2014–January 2015. Community health workers provided navigation, including helping participants understand and implement a diabetes self-management program through six group sessions and, if needed, providing assistance in obtaining clinic visits (contacting providers\u27 offices for appointments, making reminder calls, and facilitating transportation and dependent care). Pre and post-test data were collected on T2DM self-management, physical measures, demographics, psychosocial factors, and feasibility (cost, retention, and satisfaction). Although lacking statistical significance, some outcomes indicate trends in positive directions, including diet, foot care, glucose monitoring, and physical health, including decreased HbA1c and triglyceride levels. Process evaluations revealed high levels of satisfaction and feasibility. Due to the limited intervention dose, modest program expenditures (~$29,950), and a severely affected population most of whom had never received diabetes education, outcomes were not as robust as anticipated. Given high rates of satisfaction and retention, this culturally appropriate small group intervention holds promise for hard to reach rural populations. Modifications should include expanded recruitment venues, sample size, intervention dosage and longer term assessment

The Relationship between Neighborhood Food Environment and Food Store Choice on Purchasing Habits among SNAP and Lower Income Households, USDA FoodAPS Data

The objective of the study was to determine relationship between neighborhood food store availability, store choice and food purchasing habits among Supplemental Nutrition Assistance Program (SNAP) participating households. The study sample consisted of SNAP households (n=1581) and low income households participating in the USDA\u27s National Household Food Acquisition and Purchase Survey (FoodAPS) a nationally representative cross-sectional survey of American households with household food purchases and acquisitions data. Main Outcomes: 1) Food purchasing choices (sugar-sweetened beverages, fruits and vegetables, snacks, water, and milk) obtained from store receipts over a one-week period; 2) food shopping activities was obtained from a log book of where food was purchased over a one-week period. Key findings indicated those SNAP households within 1 mile of a supermarket had higher odds of shopping at a supermarket (2.05 OR [95% CI 1.34, 3.15]) compared to those without a supermarket. Shopping at a supermarket was associated with greater odds of purchasing water and low-calorie beverages (OR 1.69 [95% CI 1.12, 2.54]) and fruits and vegetables (OR 2.50 (95% CI 1.52, 4.11]) compared to not shopping at supermarket among SNAP households. Additionally, a fractional multinomial logit analysis (n=4,664) similarly found that close proximity to superstores or supermarkets increases the share of weekly food purchases made there, and that car access increases purchases made at restaurants while decreasing purchases made at other food shopping venues. Findings suggest that policies aiming to improve food purchasing habits among SNAP need to consider how to situate stores where SNAP households will choose to shop

Digital Storytelling: A Tool for Health Promotion and Cancer Awareness in Rural Alaskan Communities

BACKGROUND: The purpose of this study was to learn community members\u27 perspectives about digital storytelling after viewing a digital story created by a Community Health Aide/Practitioner (CHA/P). METHODS: Using a qualitative research design, we explored digital storytelling likeability as a health-messaging tool, health information viewers reported learning and, if viewing, cancer-related digital stories facilitated increased comfort in talking about cancer. In addition, we enquired if the digital stories affected how viewers felt about cancer, as well as if viewing the digital stories resulted in health behaviour change or intent to change health behaviour. FINDINGS: A total of 15 adult community members participated in a 30-45 minute interview, 1-5 months post-viewing of a CHA/P digital story. The majority (13) of viewers interviewed were female, all were Alaska Native and they ranged in age from 25 to 54 years with the average age being 40 years. Due to the small size of communities, which ranged in population from 160 to 2,639 people, all viewers knew the story creator or knew of the story creator. Viewers reported digital stories as an acceptable, emotionally engaging way to increase their cancer awareness and begin conversations. These conversations often served as a springboard for reflection, insight, and cancer-prevention and risk-reduction activities

Overcoming the COVID-19 Pandemic for Dementia Research: Engaging Rural, Older, Racially and Ethnically Diverse Church Attendees in Remote Recruitment, Intervention and Assessment

Background: Access to cognitive screening in rural underserved communities is limited and was further diminished during the COVID-19 pandemic. We examined whether a telephone-based cognitive screening intervention would be effective in increasing ADRD knowledge, detecting the need for further cognitive evaluation, and making and tracking the results of referrals. Method: Using a dependent t-test design, older, largely African American and Afro-Caribbean participants completed a brief educational intervention, pre/post AD knowledge measure, and cognitive screening. Results: Sixty of 85 eligible individuals consented. Seventy-percent of the sample self-reported as African American, Haitian Creole, or Hispanic, and 75% were female, with an average age of 70. AD knowledge pre-post scores improved significantly (t (49) = −3.4, p \u3c .001). Of the 11 referred after positive cognitive screening, 72% completed follow-up with their provider. Five were newly diagnosed with dementia. Three reported no change in diagnosis or treatment. Ninety-percent consented to enrolling in a registry for future research. Conclusion: Remote engagement is feasible for recruiting, educating, and conducting cognitive screening with rural older adults during a pandemic

Community Leadership Institute of Kentucky

The Community Leadership Institute of Kentucky(CLIK) aims to improve community research capacity to address health disparities in communities, particularly Appalachia. Established in 2014, through a partnership of the UK Center of Excellence in Rural Health, the UK Center for Clinical and Translational Science Community Engagement Program, and the Kentucky Office of Rural Health, the intensive four-week training provides: Training in research and leadership Funding for community research projects Technical support for up to one year as participants implement community research projects Up to 12 slots are available annually, with priority given to leaders from Appalachian Kentucky and to projects related to key areas of research interest, including: Cancer prevention (e.g., nutrition, physical activity, smoking cessation) Reducing obesity and sedentary lifestyle Prevention and management of chronic diseases (e.g., diabetes and cardiovascular disease) Prevention and treatment of substance abus

Body Image Among Older, Rural, African-American Women with Type 2 Diabetes

Type 2 diabetes and obesity co-occur in high prevalence among African-American women. The positive value placed on large body size has both historic and contemporary biosocial relevance. The maintenance of weight at medically recommended levels is a cornerstone of both prevention and treatment of Type 2 diabetes. This study of overweight, elderly, rural African-American women with Type 2 diabetes found they generally preferred smaller body sizes compared to previous studies. Normal to slim body images as presented in a photographic array were selected as being more attractive, less likely to have diabetes and hypertension, healthier and to be more medically compliant than obese, grossly obese or very thin images. Body image is a psychosocial variable that should be included in weight control initiatives

Mental Health Treatment Seeking Patterns and Preferences of Appalachian Women with Depression

This qualitative study explored social-cultural factors that shape treatment seeking behaviors among depressed rural, low-income women in Appalachia—a region with high rates of depression and a shortage of mental health services. Recent research shows that increasingly rural women are receiving some form of treatment and identifying their symptoms as depression. Using purposive sampling, investigators recruited 28 depressed low-income women living in Appalachian Kentucky and conducted semistructured interviews on participants’ perceptions of depression and treatment seeking. Even in this sample of women with diverse treatment behaviors (half reported current treatment), participants expressed ambivalence about treatment and its potential to promote recovery. Participants stressed that poor treatment quality—not merely access—limited their engagement in treatment and at times reinforced their depression. While women acknowledged the stigma of depression, they indicated that their resistance to seek help for their depression was influenced by the expectation of women’s self-reliance in the rural setting and the gendered taboo against negative thinking. Ambivalence and stigma led women to try to cope independently, resulting in further isolation. This study’s findings reiterate the need for improved quality and increased availability of depression treatment in rural areas. In addition, culturally appropriate depression interventions must acknowledge rural cultural values of self-reliance and barriers to obtaining social support that lead many women to endure depression in isolation

Promoting Culturally Respectful Cancer Education Through Digital Storytelling

Cancer is the leading cause of mortality among Alaska Native people. Over half of Alaska Native people live in rural communities where specially trained community members called Community Health Aides/Practitioners (CHA/Ps) provide health care. In response to CHA/Ps’ expressed desire to learn more about cancer, four 5-day cancer education and digital storytelling courses were provided in 2014. Throughout each course, participants explored cancer information, reflected on their personal experiences, and envisioned how they might apply their knowledge within their communities. Each course participant also created a personal and authentic digital story, a methodology increasingly embraced by Indigenous communities as a way to combine storytelling traditions with modern technology to promote both individual and community health. Opportunities to learn of CHA/Ps’ experiences with cancer and digital storytelling included a 3-page end-of-course written evaluation, a weekly story-showing log kept for 4 weeks post-course, a group teleconference held 1–2 weeks post-course, and a survey administered 6 months post-course. Participants described digital storytelling as a culturally respectful way to support cancer awareness and education. Participants described the process of creating digital stories as supporting knowledge acquisition, encouraging personal reflection, and sparking a desire to engage in cancer risk reduction activities for themselves and with their families and patients. As a result of creating a personalized digital story, CHA/Ps reported feeling differently about cancer, noting an increase in cancer knowledge and comfort to talk about cancer with clients and family. Indigenous digital stories have potential for broad use as a culturally appropriate health messaging tool

Pharmacy Staff Perspectives on Alcohol and Medication Interaction Prevention Among Older Rural Adults

Older adults are at high risk for alcohol and medication interactions (AMI). Pharmacies have the potential to act as ideal locations for AMI education, as pharmacy staff play an important role in the community. This study examined the perspectives of pharmacy staff on AMI prevention programming messaging, potential barriers to and facilitators of older adult participation in such programming, and dissemination methods for AMI prevention information. Flyers, telephone calls, and site visits were used to recruit 31 pharmacy staff members who participated in semistructured interviews. A content analysis of interview transcriptions was conducted to identify major themes, categories, and subcategories. The main categories identified for AMI prevention messaging were Informational, Health Significance, and Recommendations. Within barriers to participation, the main categories identified were Health Illiteracy, Personal Attitudes, and Feasibility. The main categories identified for program facilitators were Understanding, Beneficial Consequences, and Practicality. Multimethod dissemination strategies were commonly suggested. This study found positive pharmacy staff perspectives for the planning and implementation of AMI prevention programming, and future development and feasibility testing of such programming in the pharmacy setting is warranted