Changes of some Health Indicators in Patients with Type 2 Diabetes: A Prospective Study in three Community Pharmacies in Sharjah, United Arab Emirates

Aim: The study aimed to examine changes in some health indicators in people with type 2 diabetes mellitus, namely: reported self-care activity, health related quality of life, and patient opinion of the services provided by three community pharmacies in Sharjah, UAE. Method: A group of patients was followed over 24 months. Patients under investigation received reminders packages during the first three months of the study. No reminders were sent after 3 months after the study was underway. Repeated measures ANOVA were used to test differences between means over different periods. Results: All patients included in this study were found to have poor diet and exercise behavior at baseline. Three months into the study, more than 27% of the patients had acceptable diet, exercise, foot care and self-testing behavior. However, evaluation at six months and 24-months show that mean scores had almost returned to baseline levels. There were significant differences between the mean values of initial (baseline data) and final (at the end of the study) scores for general health (5.86, p = 0.001), vitality (5.25, p < 0.001), and role physical scales (3.81, p = 0.02). There was a significant (p < 0.001) 25% increase in the patients' perception of the ability of the pharmacist to assist in decreasing blood glucose level. Conclusion: Ongoing reminder packages are needed for continued progress in self-care activities and for achieving lasting changes in the behavior. Implementation of such a strategy through community pharmacies could help to improve patients' views of the quality of services received from these pharmacies and patient's quality of life, which should improve patient's drug therapy and reduce complications of diabetes

Reliability of pedometer data in samples of youth and older women

BACKGROUND: Pedometers offer researchers a convenient and inexpensive tool for objective measurement of physical activity. However, many unanswered questions remain about expected values for steps/day for different populations, sources of variation in the data, and reliability of pedometer measurements. METHODS: This study documented and compared mean steps/day, demographic predictors of steps/day, and pedometer reliability in two longitudinal investigations, one involving a population-based youth sample (N = 367) and the other targeting postmenopausal women with type 2 diabetes (N = 270). Individuals were asked to wear pedometers (Yamax model SW-701) at the waist for 7 days and record steps/per day. They were also asked to record daily physical activities, duration, and perceived intensity (1 = low/light, 2 = medium/moderate, 3 = high/hard) for the same 7 days. In addition, survey data regarding usual physical activity was collected. Analyses of variance (ANOVA) were conducted to determine whether there were significant differences in pedometer results according to sex, age, and body mass index. Repeated measures ANOVAs were used to examine potential differences in results among differing numbers of days. RESULTS: Mean steps/day were 10,365 steps in the youth sample and 4,352 steps in the sample of older women. Girls took significantly fewer steps than boys, older women took fewer steps than younger women, and both youth and women with greater body mass took fewer steps than those with lower body mass. Reliability coefficients of .80 or greater were obtained with 5 or more days of data collection in the youth sample and 2 or more days in the sample of older women. Youth and older women were more active on weekdays than on weekends. Low but significant associations were found between step counts and self-report measures of physical activity in both samples. CONCLUSION: Mean steps/day and reliability estimates in the two samples were generally consistent with previously published studies of pedometer use. Based on these two studies, unsealed pedometers were found to offer an easy-to-use and cost-effective objective measure of physical activity in both youth and older adult populations

Validation of the Chinese Version of the Problem Areas in Diabetes (PAID-C) Scale

OBJECTIVE To examine the psychometric properties of a Chinese version of the Problem Areas In Diabetes (PAID-C) scale.\ud \ud RESEARCH DESIGN AND METHODS The reliability and validity of the PAID-C were evaluated in a convenience sample of 205 outpatients with type 2 diabetes. Confirmatory factor analysis, Bland-Altman analysis, and Spearman's correlations facilitated the psychometric evaluation.\ud \ud RESULTS Confirmatory factor analysis confirmed a one-factor structure of the PAID-C (χ2/df ratio = 1.894, goodness-of-fit index = 0.901, comparative fit index = 0.905, root mean square error of approximation = 0.066). The PAID-C was associated with A1C (rs = 0.15; P < 0.05) and diabetes self-care behaviors in general diet (rs = −0.17; P < 0.05) and exercise (rs = −0.17; P < 0.05). The 4-week test-retest reliability demonstrated satisfactory stability (rs = 0.83; P < 0.01).\ud \ud CONCLUSIONS The PAID-C is a reliable and valid measure to determine diabetes-related emotional distress in Chinese people with type 2 diabetes

Long-term effects of the Mediterranean lifestyle program: a randomized clinical trial for postmenopausal women with type 2 diabetes

BACKGROUND: Multiple-risk-factor interventions offer a promising means for addressing the complex interactions between lifestyle behaviors, psychosocial factors, and the social environment. This report examines the long-term effects of a multiple-risk-factor intervention. METHODS: Postmenopausal women (N = 279) with type 2 diabetes participated in the Mediterranean Lifestyle Program (MLP), a randomized, comprehensive lifestyle intervention study. The intervention targeted healthful eating, physical activity, stress management, smoking cessation, and social support. Outcomes included lifestyle behaviors (i.e., dietary intake, physical activity, stress management, smoking cessation), psychosocial variables (e.g., social support, problem solving, self-efficacy, depression, quality of life), and cost analyses at baseline, and 6, 12, and 24 months. RESULTS: MLP participants showed significant 12- and 24-month improvements in all targeted lifestyle behaviors with one exception (there were too few smokers to analyze tobacco use effects), and in psychosocial measures of use of supportive resources, problem solving, self-efficacy, and quality of life. CONCLUSION: The MLP was more effective than usual care over 24 months in producing improvements on behavioral and psychosocial outcomes. Directions for future research include replication with other populations

Patient–provider perceptions of diabetes and its impact on self-management: a comparison of African-American and White patients

Aims  To compare patient–provider differences in diabetes-related perceptions between African-American and White patients and to examine its association with self-care behaviours. Methods  One hundred and thirty patient–provider pairs were recruited from the greater Detroit area. Patients and providers completed a survey assessing perceptions about diabetes-related concepts and demographic background. The Diabetes Semantic Differential Scale was used to measure diabetes-related perceptions. Patients also reported the frequency of performing self-care behaviours, including following a healthy eating plan, engaging in physical activity, blood glucose monitoring, and taking medication and/or insulin. Results  There were a greater number of patient–provider differences in diabetes-related perceptions for the African-American patients (nine of 18 concepts) compared with the White patients (four of 18 concepts). Stepwise regression analyses found patients’ semantic differential scores to be significantly associated with five self-care behaviours for African-American patients and two self-care behaviours for White patients. Providers’ semantic differential scores emerged as predictors of self-care behaviours for African-American patients, but not for White patients. Conclusions  Our findings suggest that compared with White patients, African-Americans differ in a greater number of diabetes-related perceptions than their providers. Patients’ and providers’ perceptions of diabetes care concepts have a significant impact on a greater number of self-care behaviours for African-American patients than White patients. Diabet. Med. 25, 341–348 (2008)Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72171/1/j.1464-5491.2007.02371.x.pd

Self-Efficacy, Problem Solving, and Social-Environmental Support Are Associated With Diabetes Self-Management Behaviors

OBJECTIVE — To evaluate associations between psychosocial and social-environmental variables and diabetes self-management, and diabetes control. RESEARCH DESIGN AND METHODS — Baseline data from a type 2 diabetes self-management randomized trial with 463 adults having elevated BMI (M 34.8 kg/m2) were used to investigate relations among demographic, psychosocial, and social-environmental variables; dietary, exercise, and medication-taking behaviors; and biologic outcomes. RESULTS — Self-efficacy, problem solving, and social-environmental support were indepen-dently associated with diet and exercise, increasing the variance accounted for by 23 and 19%, respectively. Only diet contributed to explained variance in BMI ( 0.17, P 0.0003) and self-rated health status ( 0.25, P 0.0001); and only medication-taking behaviors contrib-uted to lipid ratio (total–to–HDL) (0.20, P 0.0001) and A1C (0.21, P 0.0001). CONCLUSIONS — Interventions should focus on enhancing self-efficacy, problem solving, and social-environmental support to improve self-management of diabetes. Diabetes Care 33:751–753, 2010 D iabetes management requires coor-dination between the patient andthe primary care team. Given the lifestyle changes required for self-management success, patient, social, and environmental factors, including health care (1) and community support (2), are increasingly recognized as important. Un-derstanding relations among demo-graphic, psychosocial, and social-environmental variables, and multiple health risk behaviors is critical to devel-oping interventions that will sustain health behavior changes. RESEARCH DESIGN AND METHODS — Baseline data were col-lected as part of a patient randomized trial to evaluate the impact of an interactive, multimedia diabetes self-management program relative to “enhanced ” usual car

Use of RE-AIM to develop a multi-media facilitation tool for the patient-centered medical home

<p>Abstract</p> <p>Background</p> <p>Much has been written about how the medical home model can enhance patient-centeredness, care continuity, and follow-up, but few comprehensive aids or resources exist to help practices accomplish these aims. The complexity of primary care can overwhelm those concerned with quality improvement.</p> <p>Methods</p> <p>The RE-AIM planning and evaluation model was used to develop a multimedia, multiple-health behavior tool with psychosocial assessment and feedback features to facilitate and guide patient-centered communication, care, and follow-up related to prevention and self-management of the most common adult chronic illnesses seen in primary care.</p> <p>Results</p> <p>The <it>Connection to Health </it>Patient Self-Management System, a web-based patient assessment and support resource, was developed using the RE-AIM factors of reach (<it>e.g</it>., allowing input and output via choice of different modalities), effectiveness (<it>e.g</it>., using evidence-based intervention strategies), adoption (<it>e.g</it>., assistance in integrating the system into practice workflows and permitting customization of the website and feedback materials by practice teams), implementation (<it>e.g</it>., identifying and targeting actionable priority behavioral and psychosocial issues for patients and teams), and maintenance/sustainability (<it>e.g</it>., integration with current National Committee for Quality Assurance recommendations and clinical pathways of care). <it>Connection to Health </it>can work on a variety of input and output platforms, and assesses and provides feedback on multiple health behaviors and multiple chronic conditions frequently managed in adult primary care. As such, it should help to make patient-healthcare team encounters more informed and patient-centered. Formative research with clinicians indicated that the program addressed a number of practical concerns and they appreciated the flexibility and how the <it>Connection to Health </it>program could be customized to their office.</p> <p>Conclusions</p> <p>This primary care practice tool based on an implementation science model has the potential to guide patients to more healthful behaviors and improved self-management of chronic conditions, while fostering effective and efficient communication between patients and their healthcare team. RE-AIM and similar models can help clinicians and media developers create practical products more likely to be widely adopted, feasible in busy medical practices, and able to produce public health impact.</p

Clinical and Behavioral Correlates of Achieving and Maintaining Glycemic Targets in an Underserved Population With Type 2 Diabetes

OBJECTIVE—In an underserved Latino area, we established a disease-management program and proved its effectiveness. However, many patients still remained above target. This study was designed to evaluate which factors are associated with reaching program goals

Telecare motivational interviewing for diabetes patient education and support : a randomised controlled trial based in primary care comparing nurse and peer supporter delivery

Background: There is increasing interest in developing peer-led and 'expert patient'-type interventions, particularly to meet the support and informational needs of those with long term conditions, leading to improved clinical outcomes, and pressure relief on mainstream health services. There is also increasing interest in telephone support, due to its greater accessibility and potential availability than face to face provided support. The evidence base for peer telephone interventions is relatively weak, although such services are widely available as support lines provided by user groups and other charitable services. Methods/Design: In a 3-arm RCT, participants are allocated to either an intervention group with Telecare service provided by a Diabetes Specialist Nurse (DSN), an intervention group with service provided by a peer supporter (also living with diabetes), or a control group receiving routine care only. All supporters underwent a 2-day training in motivational interviewing, empowerment and active listening skills to provide telephone support over a period of up to 6 months to adults with poorly controlled type 2 diabetes who had been recommended a change in diabetes management (i.e. medication and/or lifestyle changes) by their general practitioner (GP). The primary outcome is self-efficacy; secondary outcomes include HbA1c, total and HDL cholesterol, blood pressure, body mass index, and adherence to treatment. 375 participants (125 in each arm) were sought from GP practices across West Midlands, to detect a difference in self-efficacy scores with an effect size of 0.35, 80% power, and 5% significance level. Adults living with type 2 diabetes, with an HbA1c > 8% and not taking insulin were initially eligible. A protocol change 10 months into the recruitment resulted in a change of eligibility by reducing HbA1c to > 7.4%. Several qualitative studies are being conducted alongside the main RCT to describe patient, telecare supporter and practice nurse experience of the trial. Discussion and implications of the research: With its focus on self-management and telephone peer support, the intervention being trialled has the potential to support improved self-efficacy and patient experience, improved clinical outcomes and a reduction in diabetes-related complications