Careyva, Beth, M.D.

Hansen, Susan E, MA

Johnson, Melanie B, MPA

Shaak, Kyle, BS

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of Family MedicineHealth Beliefs of Hispanic Patientswith Prediabetesin the Lehigh ValleySusan E. Hansen MALehigh Valley Health Network, Susan_E.Hansen@lvhn.orgMelanie B. Johnson MPALehigh Valley Health Network, Melanie_B.Johnson@lvhn.orgKyle Shaak BSLehigh Valley Health Network, Kyle.Shaak@lvhn.orgBeth Careyva M.D.Lehigh Valley Health Network, beth_a.careyva@lvhn.orgFollow this and additional works at: https://scholarlyworks.lvhn.org/family-medicineThis Presentation is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works byan authorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtHansen, S. Johnson, M. Shaak, K. Careyva, B. (2018, May). Health Beliefs of Hispanic Patientswith Prediabetes in the Lehigh Valley.Presentation Presented at: The Society of Teachers of Family Medicine Annual Conference, Washington DC.© 2018 Lehigh Valley Health NetworkHealth Beliefs of Hispanic Patientswith Prediabetes in the Lehigh ValleyA Qualitative ExaminationMay 9, 2018 Susan Hansen, MAMedical Education Evaluation Specialist, Family Medicine Residency ProgramWho We Are: A Complete Health NetworkOverview▪ Purpose of Study▪ Theoretical Context▪ Methods▪ Findings▪ Conclusions▪ QuestionsPurpose of Study: A Need for Intervention▪ Hispanic patients with prediabetesat greater risk of diabetes▪ What else could physicians be doing?▪ Patients likely have insightsthey’re not sharing in clinical settingResearch objective: Explore how Hispanic adults with prediabetes perceive current health status and risk for progression to diabetesTheoretical Context: Health Belief ModelAdapted from Janz NK, Becker MH. The health belief model: a decade later. Health Educ Behav. 1984;11(1):1-47.Perceived SUSCEPTIBILITY/SEVERITYDEMOGRAPHIC(age, sex) and SOCIOPSYCHOLOGICAL VARIABLESPERCEIVED THREAT(to Self) of DiseaseCUES TO ACTION(how one receives information)PERCEIVED BENEFITS of PREVENTION minus PERCEIVED BARRIERS to ACTIONLIKELIHOODof TAKING PREVENTIVE ACTIONINDIVIDUAL PERCEPTIONSMODIFYING FACTORS RESPONSEStudy Aims through Lens of Health Beliefs Model▪ Aim 1: How Hispanic adults with prediabetes view personal risk of progression to diabetes (PERCEIVED SEVERITY/ SUSCEPTIBILITY)▪ Aim 2: How participants interpret glucose-related biomarkers in relation to health status (CUES TO ACTION-CLINICAL INFORMATION)▪ Aim 3: Understand health beliefsaround prediabetes(CUES TO ACTION – OTHER INFLUENCES)Methods▪ Phase 2 of 4-phase intervention study•Phase 1 = Mailed survey•Phase 2 = Individual interviewswith subgroup of respondents   •Phase 3 = PASAC to refine toolfor shared decision making•Phase 4 = Clinical pilot testingof decision aid/graphicMethods▪Semi-structured interview guide▪One-on-one interviews▪ Infographic on prediabetes▪Analysis: Individual and consensuscoding of transcripts • a priori and emergent themes relevant to Health Belief Model• Kappa scores and member checking utilized for validationResults-Demographics▪ 18 interviews conducted• 8 in English, 10 in Spanish• 14 female, 4 male• Ages 40-70– Employment: FT-2; PT-1; Disabled-6; UE-8; Not in Market-1– Education levels ranged from some middle school to bachelor’s degree• Majority not born in US (4 US, 4 Puerto Rico; 10 other)Results – Interpretation of Biomarkers▪All participants aware of diagnosis▪Low level of understandingabout illness• Blurred line between prediabetes and diabetes▪Familiar with terms “A1c level,” “glucose,” “blood sugar”Results-Exemplar quotes“Glucose is like what is in the blood, and that’s what gradually causes diabetes, I think.”“Something about your insulin not making enough of –something that had to – I don’t remember.”“When the people have the glucose over the normal number – this is between 5.5 to 6 – is prediabetic. Over 6 is diabetic.”Results-Risk of Progression▪Severity• Described as “Serious,” “Bad,” “Scary”▪Susceptibility• Recognize role of dietand activity choices • Family history frequently cited• Spirituality: God as healerand/or source of strengthResults-Exemplar quotesFamily History: “I’m going to be diabetic no matter what, because my mom, my dad, and my sister, my uncle, my grandma, so I know it’s coming.”Spirituality: “God is probably telling me, ‘You got to eat healthy, you got to be watching what you eat - rice, the carbs, the sugar - and exercise.’ ”“He is our doctor of doctors. I ask Him every day to heal this illness since I don’t want to suffer.” Results-Health Beliefs about Prediabetes▪ Sources of knowledge• Social interactions with family/friends most impactful• Physicians diagnose, check blood values, offer nonspecific Tx’s• Other health care professionals frequently cited as helpful• Technology-savvy participants searched for info on ownResults-Exemplar Quotes: Family/Friends“What my sister used to do, she washes those beans. All that stuff that preserves them. She wash them until clear water runs down then she makes beans so I think that's really – she takes care herself good.”“My mom gives me some advice…such as eating pickles or using the Napa cabbage. She already knows. She does many smoothies to help, and it has helped her so far.” “I have four girls…they need me.”▪ Overestimated patient grasp of illness•For many, prediabetes = diabetes•Sugar/lack of exercise/family history •Minimal self-efficacy▪ Clinician takeaways•Delivery of diagnosis not enough•Health literacy (not language barrier) •Clues in spiritual beliefs/social world▪ Next steps• Complete phases 3 & 4 of project• Collaboration opportunities• Explore educational opportunitiesfor patients and cliniciansReferences▪ Janz NK, Becker MH. The health belief model: a decade later. Health Educ Behav. 1984;11(1):1-47.▪ Shaak, K., Johnson, M.B., Marsh, J.K. et al. J Community Health (2018). https://doi.org/10.1007/s10900-018-0512-2  available at: https://rdcu.be/LiLF. Accessed April 21, 2018 Acknowledgments▪ Beth Careyva, MD, principal investigator▪ Kyle Shaak, MPH, study coordinator▪ Alicia Rivera, BS, Spanish-language interviewer & study team member▪ Melanie Johnson, MPA, study team member▪ Jessacae Marsh, PhD, consultant ▪ Brian Stello, MD, consultant ▪ Funding provided by LVHN Network Office of Research and InnovationContact Information:Susan Hansen, MADepartment of Family Medicine Residency ProgramSusan_E.Hansen@lvhn.org484-862-3076

Health Beliefs of Hispanic Patientswith Prediabetes in the Lehigh Valley

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Health Beliefs of Hispanic Patientswith Prediabetes in the Lehigh Valley

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