Health Literacy Changes in a Technology-Enhanced Diabetes Prevention Program

Background: In 2001, the Diabetes Prevention Program was published evaluating the efficacy of a pharmaceutical intervention, Metformin, and a behavioral lifestyle intervention (LI) to reduce incidence of Type 2 diabetes mellitus. The LI was observed to reduce the incidence of the disease by 58% relative to 31% in the medication treatment. Amongst technology based LIs, little has been done to address different health literacy populations. Objectives: This dissertation evaluated how teach-back and teach-to-goal can influence the uptake of information obtained in each health education lesson, behaviors and its influence on engagement and weight loss. Methods: Four hundred forty-two participants were analyzed in study #1, and only 425 were maintained for study #2 and #3. General regression modeling with White’s Standard Error heteroskedacity adjustments was performed assessing the differences in engagement and comprehension performance by health literacy level and modality. Results: In a teach-back/teach-to-goal call, differences in reverse score performance (DVD-15.4±2.5; Class-14.8±2.6; F(3, 425)= 13.72, p\u3c0.001), number of teach-back rounds (DVD-1.9±0.7; Class-2.1±0.7; F(3, 425)=5.98, p\u3c0.001) and number of round 1 questions (DVD-4.2±1.6; Class-3.4±1.8; F(3,425)=20.95, p\u3c0.001) was observed. While not significant, 38.7% of LHL participant completed all 22 lessons vs. 28.7% of HHL. Mean overall comprehension average scores improved 0.8±1.1 to 1.2±0.3 and 0.7±1.0 to 1.5±1.1 for those LHL and HHL participants completing only 1 call versus all 22 calls, respectively, as did physical activity and muscle strengthening minutes per week. Models evaluating IVR-reported weight change against engagement and overall comprehension average revealed engagement had an indirect relationship (β= -0.59, p\u3c0.01) with magnitude of weight change (R²=0.13, F(3, 420)=20.8, p\u3c0.001), and a direct relationship with aerobic physical activity, muscle strengthening and fruit and vegetable intake. Conclusions: Amongst high and low health literacy groups, both groups benefited from teach-back and teach-to-goal health literacy techniques to improve patient comprehension, which in turn, improved engagement rates, especially in the low health literacy population. Reinforcement strategies to promote information uptake is necessary to allow for behavior uptake lending to greater weight loss

A randomized controlled trial to test the effectiveness of two technology-enhanced diabetes prevention programs in primary care: The DiaBEAT-it study

ObjectiveTo evaluate the effectiveness of two technology-enhanced interventions for diabetes prevention among adults at risk for developing diabetes in a primary care setting.MethodsThe DiaBEAT-it study employed a hybrid 2-group preference (Choice) and 3-group randomized controlled (RCT) design. This paper presents weight related primary outcomes of the RCT arm. Patients from Southwest Virginia were identified through the Carilion Clinic electronic health records. Eligible participants (18 and older, BMI ≥ 25, no Type 2 Diabetes) were randomized to either Choice (n = 264) or RCT (n = 334). RCT individuals were further randomized to one of three groups: (1) a 2-h small group class to help patients develop a personal action plan to prevent diabetes (SC, n = 117); (2) a 2-h small group class plus automated telephone calls using an interactive voice response system (IVR) to help participants initiate weight loss through a healthful diet and regular physical activity (Class/IVR, n = 110); or (3) a DVD with same content as the class plus the same IVR calls over a period of 12 months (DVD/IVR, n = 107).ResultsOf the 334 participants that were randomized, 232 (69%) had study measured weights at 6 months, 221 (66%) at 12 months, and 208 (62%) at 18 months. Class/IVR participants were less likely to complete weight measures than SC or DVD/IVR. Intention to treat analyses, controlling for gender, race, age and baseline BMI, showed that DVD/IVR and Class/IVR led to reductions in BMI at 6 (DVD/IVR −0.94, p < 0.001; Class/IVR −0.70, p < 0.01), 12 (DVD/IVR −0.88, p < 0.001; Class/IVR-0.82, p < 0.001) and 18 (DVD/IVR −0.78, p < 0.001; Class/IVR −0.58, p < 0.01) months. All three groups showed a significant number of participants losing at least 5% of their body weight at 12 months (DVD/IVR 26.87%; Class/IVR 21.62%; SC 16.85%). When comparing groups, DVD/IVR were significantly more likely to decrease BMI at 6 months (p < 0.05) and maintain the reduction at 18 months (p < 0.05) when compared to SC. There were no differences between the other groups.ConclusionsThe DiaBEAT-it interventions show promise in responding to the need for scalable, effective methods to manage obesity and prevent diabetes in primary care settings that do not over burden primary care clinics and providers.Registrationhttps://clinicaltrials.gov/ct2/show/NCT02162901, identifier: NCT02162901

Does coal production contribute to chronic disease mortality when controlling for socio-economic status, risk factors and health access

Environmental impacts of coal mining in Central Appalachia have been associated with poor health yet there are many factors to be considered. Coal production has been the basis of the economy in Central Appalachia where high rates of poverty, unemployment, poor health services and low levels of education have persisted for decades. The objective of this current study was to determine whether coal production contributes to higher likelihoods of dying from several chronic diseases, after controlling county socio-economic status (SES), risk factors and health access. Data were obtained from existing agency sources, i.e., Appalachian Regional Commission, Virginia Department of Health and County Rankings and Road Maps from 1999 to 2012. The economic model included coal production, individual data, i.e., age, gender, marital status, education, primary cause of death, and regional data on health care factors. The health care variables were selected from available data that characterized the health care providers and facilities, including the numbers and types of physicians, allied health professionals and hospitals. Those chosen reflected the best qualitative and quantitative information available to provide an effective model to study the effects of the economy on health in coal and non-coal counties in Virginia. This study was partially funded by the Appalachian Research Initiative for Environmental Science (ARIES). Information about ARIES can be found at http://www.energy.vt.edu/ARIES

Social Determinants of Health Effecting Chronic Health Mortality and Death Due to Injury in Virginia Coal Counties

Recent publications have associated the environmental impacts of mountain top coal mining in Appalachia with increased prevalence of chronic conditions such as obesity, diabetes mellitus, heart diseases, cancers, and kidney diseases as well as deaths due to injury. Our previous review and subsequent study findings on chronic health conditions in coal communities in Central Appalachia indicated regional differences in lifestyle behaviors and sociodemographic factors. Programs targeting specific geographic areas can benefit using evidence based knowledge to implement interventions with measureable goals to reduce localized and persistent rates of chronic diseases. The objective of this cross-sectional study was to identify distinguishing social determinants of health affecting chronic health conditions in coal producing counties in Virginia (VA). Sociodemographic data on various factors were obtained from County Health Rankings (2015) for the year 2012 for coal producing counties in VA. An analysis of external causes of death served as a control for chronic health conditions. Differences in VA county averages for coal production, chronic health conditions, population, income, unemployment, poverty, persons over age 65, rurality, annual health care costs, and smoking were reported. In conclusion, health disparities continue to persist in coal production counties. Two factors identified were unemployment and smoking cessation as the most likely factors to include in future intervention programs to benefit health in coal counties in VA. Education with a focus on health literacy was also identified as a factor to address to improve health in VA coal communities. Our findings add support for multidisciplinary health care teams to engage local residents in prevention and self-managed care in communities with persistent health disparities. Funding source: This study was sponsored by the Appalachian Research Initiative for Environmental Science (ARIES). ARIES is an industrial affiliates program at Virginia Tech, supported by members that include companies in the energy sector. The research under ARIES is conducted by independent researchers in accordance with the policies on scientific integrity of their institutions. The views, opinions and recommendations expressed herein are solely those of the authors and do not imply any endorsement by ARIES employees, other ARIES-affiliated researchers or industrial members. Information about ARIES can be found at http://www.energy.vt.edu/ARIES. Co-authored by Susan Meacham, Dalia Meisha, Cody Goessl. Presented by Meacham and Goess

Tracking social determinants of health in electronic health records in rural communities in Virginia

The health disparities in Central Appalachian have persisted over time at elevated rates compared to other regions in the US. In Virginia increased rates of diabetes mellitus (T2DM), metabolic conditions (MC), or mental disorders (MI) occure in coal dependent counties compared to rates reported for counties in other parts of Virginia. Previous reports have implicated coal production in these areas as the primary causal factor for elevated chronic health conditions. Since 1990 rates of heart diseases and cancer deaths have improved, yet declines were better in men than in women. The majority of individuals with the most direct environmental contact with coal production are miners, mostly men, contradicting common perceptions. In order to study other potential risk factors for elevated chronic conditions we reviewed electronic health records in coal dependent communities. The objective of this study was to determine if there were differences by occupation for selected lifestyle behaviors; physical activity, tobacco use, alcohol use and illicit drug use. Medical records were obtained from three hospitals in coal producing regions. The preliminary findings revealed that within coal communities coal miners and non-coal miners both had similar prevalence rates of DM, MC and MI. Coal miners reported lower rates of selected lifestyle behaviors; tobacco and alcohol use, compared to other occupation groups; tobacco (29.4% vs 33.1%, p\u3c0.05) and current alcohol use (3.4% vs 9.9%, p\u3c0.05). There were too few responses to provide meaningful data regarding illicit drug use. To conclude, when comparing coal miners to other occupations, both had similar prevalence rates of DM, MC and MI with differences in smoking and alcohol use. However, data on self-reported lifestyle factors were not well documented in medical records. Providers should educate patients on lifestyle behaviors as a part of a cost-effective prevention and treatment plan and improve documentation to support future lifestyle intervention programs in areas of rural Virginia with health disparities and limited resources. Funding: This study is sponsored by Appalachian Research Initiative for Environmental Science (ARIES). Information about ARIES can be found at http://www.energy.vt.edu/ARIES

Prevalence of Chronic Lung Diseases in Communities in Rural Areas of Southern Virginia

Appalachia is known for its health disparities and low socioeconomic status. The economic base in many Appalachian communities is coal mining. Chronic lung diseases in coal miners are a primary concern because of the documented exposure to particulate matter in the air. In an effort to determine the effects of coal mining on residents in communities the following study compared the prevalence of lung conditions in residents in southwestern coal areas of the state to disease rates of residents in communities in adjacent mountainous areas, the piedmont region and eastern coastal areas of Virginia. State department mortality data, other agency data on health behaviors and de-identified electronic health record data from participating hospitals were collected. Health records were selected using systematic randomization from hospital admissions in 2011-2012 and extracted data recorded in survey software (Qualtrics, LLC, (Qualtrics, Provo, UT). Statistical analyses provided preliminary findings on lung cancers, and non-neoplastic conditions; asthma, chronic bronchitis, and emphysema. In this study individuals in coal mining communities were at no greater risk for developing chronic lung diseases when compared to non-coal producing regions of Virginia. The state data reports prevalence rates of lung cancers higher in women than men. With our EHR preliminary data no differences were detected by occupation between coal miners and other occupations. Smoking and other socioeconomic factors in health disparity areas were also assessed. This study is sponsored by Initiative for Environmental Science (ARIES). Information about ARIES can be found at http://www.energy.vt.edu/ARIES