Diabetes Treatments

A school based diabetes awareness and prevention program (DAPP) The proposed project, Diabetes Awareness & Prevention Program (DAPP), is a …

To: Jeff Grabill
Fr: Martine Rife
Re: Literature Review - Annotated Bibliography for the issue of
communicating with African Americans about diabetes What research is out
there?
Date: June 2, 2006

American Diabetes Association Research ongoing, etc 2006 Retrieved
June 1, 2006 from http://wwwdiabetesorg
Klein, David J, MD, MPH, Cincinnati Childrens Hospital Medical Center,
Cincinnati, OH
A school based diabetes awareness and prevention program DAPP
Description: The incidence of type 2 diabetes T2DM has increased
markedly in American youth during the past two decades in parallel with the
current obesity epidemic The increases have been much greater in African
American AA youth than white youth Studies have shown that lifestyle
interventions in at-risk adultsboth AA and Caucasiantargeting physical
activity and nutrition can reduce the development of T2DM The proposed
project, Diabetes Awareness Prevention Program DAPP, is a collaborative
effort between Cincinnati Childrens Hospital CCHMC, Hughes High School
for Health ProfessionsHSHP, students and faculty, a magnet program for
students aiming at careers in the health field, and the Urban League of
Greater CincinnatiULGC DAPP
will test the hypothesis that messages
related to changes in lifestyle can be delivered more effectively by AA
youth to middle school aged students when compared with health programs
delivered by adult teachers HSHP students will be trained as peer
counselors by staff from the collaborating institutions They will receive
comprehensive education in diabetes, epidemiology, nutrition, and exercise
physiology, as well as practical training in screening and activity
counseling techniques Outcome measures will include changes in students
knowledge, attitudes and behaviors about diabetes prevention, as well as
physiological risk indicators obesity, blood insulin, glucose, and lipid
levels The peer program will more effectively spread the diabetes
prevention message to AA youth and to the wider AA community

Naar-King, Sylvie, PhD, Wayne State University, Detroit, MI Adapting
multisystemic therapy to improve food choices and health outcomes in obese
African American youth
Description: Funded by ARAMARK Charitable Fund
Despite the dramatic increase in obesity and Type II Diabetes in
adolescents, documented effective treatments for obesity and the
consequential prevention of Type II
Diabetes are scarce Modification of
food and activity choices is the foundation of obesity treatment; however,
adolescents may find it difficult to follow recommended diet and exercise
programs The proposed home-based treatment will be an adaptation of a well-
established program for adolescents with entrenched problematic behaviors
Multisystemic Therapy MST targets change within the individual, family
and environmental context Thus, MST is well-suited to help teens overcome
systemic barriers to healthy food choices

48 obese BMI95th percentile African American adolescents ages 12-16
will participate in the study 24 will receive the MST intervention and 24
will receive a family group program Families will be recruited from the
only university-affiliated medical center in Detroit, Michigan Michigans
youth have higher rates of obesity, overweight, hypertension, and elevated
cholesterol compared to the national average, and Detroit has the highest
percentage of African Americans of any major city in the US Families will
complete measurements at the start of the treatment, at the end of the
treatment and one year after enrollment Thus, we will examine whether
changes in food choices,
activity levels, and weight remain after the
treatment has ended If successful, this intervention will provide
immediate assistance to a vulnerable population disproportionately affected
by obesity and Type II Diabetes

Young, Bessie Ann, MD, University of Washington, Seattle, WA Racial
differences in the epidemiology, treatment and progression of diabetic
nephropathy
Description: Kidney disease affects 20-40 of people with diabetes
Diabetic kidney disease is now the leading cause of kidney failure in the
United States African Americans are 2-4 times more likely to have diabetic
kidney disease than whites Also,, once diabetic kidney disease is present,
African Americans are almost five times more likely to require dialysis
compared to whites Reasons for these disparities are not well understood

One theory is that the level of diabetes care may be different for African
Americans compared to whites, and that even when equal access to diabetes
care is available, diabetic kidney disease is still more likely to affect
African Americans In order to address these issues, this study will focus
on the following:

1 Determine if differences in the management of high blood pressure,
high
glucose levels, and early protein in the urine occur between the African
Americans and whites
2 Determine if differences in the management of diabetes account for the
higher rate of diabetic kidney disease in African Americans
3 Determine if differences in the management of diabetes account for the
higher rate of kidney failure in African Americans

Clarification of the cause for these differences may suggest potential
interventions that will benefit all persons with diabetes

African Americans and Diabetes webspace within diabetesorg
Quote from the webspace:
Goals of the African American Initiative
Compared to the general population, African Americans are
disproportionately affected by diabetes To address this growing health
problem, the American Diabetes Association created a community-based
program called the African American Initiative It is an aggressive public
education campaign designed to increase awareness of the near-epidemic rate
of diabetes among African Americans The programs goals are:

To raise awareness in the African American community about the seriousness
of diabetes and its complications,

To raise awareness in the African American community about risk
factors
associated with diabetes,

To raise awareness about the importance of healthy eating and regular
exercise,

To raise awareness of those with the disease, that you can control your
diabetes

Anderson, Robert M , Martha M Funnell, Marilynn S Arnold, Patricia A
Barr, Gloria J Edwards, and James T Fitzgerald 2000 Assessing the
Cultural Relevance of an Education Program for Urban African Americans With
Diabetes The Diabetes Educator, March/April 2000; 26: 280 - 289 PDF
PURPOSE
This study was conducted to assess the cultural relevance of an education
program for urban African Americans with diabetes
METHODS
A set of 12 videotape vignettes were developed for use in diabetes
education for urban African Americans with diabetes Focus groups and
questionnaires were used to determine if patients and diabetes educators
would find the materials stimulating, culturally appropriate, and useful
RESULTS
The videotape and discussion guide were perceived as valuable by both
healthcare professionals and patients
CONCLUSIONS
This education program could be a valuable resource for diabetes educators
who want to provide culturally sensitive and relevant diabetes education
for urban African
Americans with diabetes

Anonymous Association targets diabetes in African Americans Diabetes
Forecast Alexandria: Jun 1998Vol51, Iss 6; pg 67, 2 pgs PDF
Due to the increasing numbers of African-Americans with diabetes, the
American Diabetes Association is working to raise awareness in the African-
American community about the seriousness of diabetes

AnonymousDiabetes Sunday targets African American community Diabetes
Forecast Alexandria: Apr 1998Vol51, Iss 4; pg 57, 2 pgs PDF
Diabetes Sunday is a program of the American Diabetes Association that
tries to reach African Americans at their places of worship Feb 1, 1998
and Feb 8, 1998 were this years Diabetes Sundays

Bailey, Eric J 2002 African American alternative medicine: using
alternative medicine to prevent and control chronic diseases Westport,
Conn: Bergin Garvey
This book is available in hard copy at MSU library The book can be
searched on amazoncom There is a section on diabetes The books does
discuss research on this issue

Batts, Marian L , Tiffany L Gary, Karen Huss, Martha N Hill, Lee Bone,
and Frederick L Brancati 2001 Patient Priorities and Needs for
Diabetes Care Among Urban African American Adults The Diabetes
Educator,
27: 405-412 PDF
PURPOSE
this study was conducted to determine diabetes care priorities and needs in
a group of urban African American adults with type 2 diabetes mellitus
METHODS
One hundred nineteen African American adults with type 2 diabetes, aged 35
to 75, received behavioral/educational interventions from a nurse case
manager, a community health worker, or both Priorities and needs were
assessed during 3 intervention visits
RESULTS
The most frequently reported priorities for diabetes care were glucose self-
monitoring 61, medication adherence 47, and healthy eating 36 The
most frequently addressed diabetes needs were glucose self-monitoring and
medication adherence Most of the intervention visits 77 addressed
nondiabetes-related health issues such as cardiovascular disease 36 and
social issues such as family responsibilities 30
CONCLUSIONS
Participants self-reported priorities for diabetes care directly reflected
the diabetes needs addressed Needs beyond the focus of traditional
diabetes care social issues and insurance are important to address in
urban African Americans with type 2 diabetes Interventions designed to
address comprehensive health and social needs
should be included in
treatment and educational plans for this population

Braithwaite, Ronald L, Sandra E Taylor, editors Health issues in the
black community [electronic resource] Publisher San Francisco, Calif :
Jossey-Bass, c 2001 Edition 2nd ed Available in MSUs net library
Chapter 12 is specifically focused on diabetes - definitions and defining
the research agenda
QUOTES:
Page 226 Diabetes mellitus is a major clinical and public health problem
in the African American community The impact of the problem in terms of
prevalence, quality of life, death, and disability is greatly magnified in
African American communities Diabetes mellitus was relatively uncommon
among African Americans at the beginning of this century It is now the
third leading cause of death from disease in African Americans According
to the US Bureau of the Census, African Americans constituted 122
percent of the US population in 1988, a 14 percent increase since 1980
By 2005, almost 50 percent of the population will be other than white-51
percent white; 26 percent Hispanic; 14 percent African American more than
thirty-four million people; and 8 percent Asian US Department of Health
and Human Services [DHHS],
1998

Page 235 Although the evidence for early detection of and intervention in
diabetes mellitus does not indicate that such detection is overwhelmingly
successful, it does suggest some benefits from community-based screening
Bennett Knowler, 1984; Hawthorne Crowe, 1984 Another study, the
Diabetes Control and Complications Trial DCCT, provides some definitive
data about the importance of screening for the effects of blood glucose
control on the complications of diabetic retinopathy and for early
detection of nephropathy DCCT Research Group, 1990

In recent years, several community-based diabetes intervention and study
programs were designed and implemented that focused upon such specific
areas as 1 decreasing the prevalence of untreated diabetic risk factors
and complications in the intervention population, 2 increasing knowledge
and changing attitudes and high-risk behaviors among the intervention
population, and 3 improving diabetes care including patient adherence and
compliance For example, the DCCT looked at diabetes nutrition education,
glucose monitoring, and insulin administration Results of this
intervention indicated the need for early detection through testing
and
screening of blood glucose, insulin adjustment, maintenance of normal
glucose without hypoglycemia, and glycosylated hemoglobin HgbA

Page 236 According to Hiss, Frey, and Davis 1986, persons with diabetes
see their physician about three times per year and each visit lasts
approximately twelve minutes Therefore, on the average, a person with
diabetes has thirty-six minutes of physician contact each year The
nonreimbursable nature of a lot of diabetes care such as education, the
lack of primary care physician time to deal with the complex aspects of
diabetes education and counseling, and the poor fit of diabetes in an acute
care health system collectively create a situation in which most persons
with diabetes are significantly undertreated Greene Kreuter, 1992

Several programs have documented the feasibility of conducting community-
based evaluation centers or programs for persons with diabetes Baker,
Vallbona, Pavlik, Armbruster, Higgins, 1991; McGill, Yue, Plehwe, Wiley,
Turtle, 1991 This is a model of how hospitals and primary care
physicians can share in diabetes management based on resource availability

Fink and Ross 1991 have also shown the effectiveness of
diabetes
education centers in Canada where the staff includes ophthalmologists in
order to screen for and control the risk factors for vision associated with
the diabetic complications

Fink and Ross 1991 and Deeb, Wolfe, Freeman, and Wise 1991 used a
standardized medical record as an evaluation-of-care instrument, entering
data from a systematic random sample of diabetics each quarter This form
of surveillance program can serve as a template for collecting data and
conducting an ongoing evaluation on a comprehensive system of care

Page 237 Numerous intervention programs have been applied to improve
patient management and treatment outcomes in diabetes mellitus Attempts to
provide information about diabetes generally have had little effect on
adherence-related behaviors Enhanced educational programs intended to
inform people about their treatment, either alone or in combination with
teaching behavioral strategies, have met with moderate success A number of
strategies to enhance patients involvement in their care have been
introduced

There is substantial evidence that patients have specific desires for
information and for involvement in clinical interaction Anderson,
DeVellis,
Boyles, Feussner, 1989 Moreover, patients report more
dissatisfaction with information given to them by physicians in the course
of the medical visit than with any other aspect of their medical care
Pendleton, 1983 Mason 1985 found that when patients perceptions of
their diabetes were in conflict with what they were told by the physician,
patients expressed considerable uncertainty and anxiety about the illness
and its management

DEramo-Mekus and Demas 1989 surveyed twenty-five patient-physician pairs
to assess the congruence of the participants perceptions of treatment
goals Patient participants were adults being treated in private practice
for non-insulin dependent diabetes mellitus More than one-half of the
patient-physician pairs did not agree on a single treatment goal The
largest discrepancy was found in perceptions of a defined weight loss goal;
patients were far less likely than physicians to believe that a specific
goal had been set

Advocates of patient consumerism encourage patient involvement in medical
interactions and more active participation in medical care in general
Although there is no clear consensus on the effect of this involvement,
when patients are more
active in their medical interactions they generally
tend to be more satisfied with their care As a result a number of
interventions have focused upon coaching patients to be more assertive
through asking more questions of their provider or disclosing more
information about their own needs Anderson Sharpe, 1991; Greenfield,
Kaplan, Ware, Yano, Frank, 1988

Some studies suggest that physicians who are warm and friendly are
preferred by patients, although other studies indicate that physicians who
are serious and intense have more satisfied patients Anderson Sharpe,
1991 In general, patients appear to be more consistently satisfied when
interacting with physicians who are perceived as being involved in the
interaction and who appear to be concerned about them Pendleton, 1983
Another approach to improving diabetes care is to provide patients with
good problem-solving skills so they can cope better with ongoing barriers
to adherence

Page 238 Despite the belief of many primary care physicians that
preventive measures should be performed on a regular basis, in many
settings they are not performed as recommended Romm, Fletcher, Hulka,
1981 Several studies have shown that
computer-generated reminders
Ornstein, Garr, Jenkins, Rust, Arnon, 1991; Harris, OMalley, Fletcher,
Knight, 1990; McDonald et al, 1984; Tierney, Hui, McDonald, 1986,
nurse-initiated reminders Davidson, Fletcher, Retchin, Duh, 1984;
Mandel, Franks, Dickerson, 1985, health promotion checklists Cohen,
Littenberg, Wetzel, Neuhauser, 1982, flow sheets Madlon-Kay, 1987,
mailed reminders Thompson, Michnich, Gray, Friedlander, Gilson, 1986,
and administrative changes Frame, Kowlich, Liewellyn, 1984 can result
in improved adherence and compliance to preventive services recommended by
physicians In addition, reminders to patients Brimberry, 1988 improved
adherence and compliance to preventive service recommendations in primary
care settings However, as indicated by Belcher 1990, campaigns directed
at patients encouraging them to ask for services are not likely to be
effective unless reinforced and encouraged in practice settings

Brashers, Dale Department of Speech Communication, University of
Illinois, Urbana-Champaign Book Review Health Communication, 2002, Vol
14, No 1, Pages 135-138 Explaining Illness: Research, Theory, and
Strategies Bryan B Whaley, Mahwah, NJ: Lawrence Erlbaum
Associates, Inc,
2000 PDF
Quote: Explaining illness is a primary and, perhaps, most important
function of health
communication Illness explanations occur in interactions between health
care providers
eg, physicians, nurses, or pharmacists and patients, between parents
and
children, or between health educators and audience members These
interpretations
help us understand what it means when we experience symptoms of illness,
how to
avoid disease and discomfort, why certain treatments may be more or less
effective,
and how illness might shape our identities and relationships For example,
in their interactions with patients, physicians and other health care
providers develop a diagnosis by conducting physical examinations and
interviewing patients about their symptoms and subsequently by comparing
those observations with their understanding of physiology and disease
Naming the illness and describing its features to the patient
are two important parts of illness explanation These explanations might
include the
etiology causes, pathophysiology physical effects, symptomology
symptom
patterns, and treatment modalities options associated with the illness
Delivering
the explanation maybe
complicated by numerous factors eg, the
seriousness of the
illness or incongruent expectations about the provider-patient
relationship p 135

Brody, Gene H, Leonard Jack, Jr, Velma McBride Murry, Melissa Landers-
Potts, and Leandris Liburd Heuristic Model Linking Contextual Processes to
Self-Management in African American Adults With Type 2 Diabetes
The Diabetes Educator 27: 685-693 PDF
PURPOSE
This article examines the influence of various environmental factors on the
diabetes self-care practices of African American adults with type 2
diabetes
METHODS
A heuristic model was developed that considers how community barriers and
supports, availability and use of insurance, diabetes education, medical
provider-patient relationships, extended family processes, and
psychological functioning may indirectly affect metabolic control through
the patients ability to regulate diabetes
RESULTS
The proposed model offers a framework to demonstrate the complexity of
diabetes management that may be unique to the African American experience
CONCLUSIONS
A comprehensive view of the environmental context will lead to new and more
effective approaches in diabetes education and counseling for
African
American adults with type 2 diabetes

Burnet, Deborah, Andrea Plaut, Rachel Courtney, and Marshall H Chin
A Practical Model for Preventing Type 2 Diabetes in Minority Youth
The Diabetes Educator, September/October 2002; 28: 779 - 795 PDF
PURPOSE
This article proposes a model grounded in behavioral theory and empirical
evidence for use when developing a program to prevent type 2 diabetes in
highrisk minority youth
METHODS
The model is based on key concepts of 4 behavioral theories: the Health
Belief Model, Social Learning Theory, the Theory of Planned Behavior, and
the Ecological Model Determinants of behavior to target for change are
selected based on their theoretical link to behavior change, their success
in changing behavior in past programs, and through thorough formative
research in the target community
RESULTS
Diabetes prevention in children requires modifying a complex set of
behavior patterns Social norms and the environment are especially
important in children in whom cognitive processes have not fully developed
Family and community involvement is essential for developing a health
program and providing a supportive environment in which to change behavior
and
ongoing reinforcement to maintain behavior changes
CONCLUSIONS
Behavioral theory informs the selection of factors to target in a
behavioral intervention Special considerations apply when working with
children A program to target risk must be based in behavioral theory,
supported by practical data, and tailored to the needs and beliefs of the
target community

Burns, Dorothy, Anne H Skelly African American Women with Type 2 Diabetes:
Meeting the Daily Challenges of Self Care Journal of Multicultural Nursing
Health Chautauqua: Fall 2005 Vol 11, Iss 3; p 6 5 pages PDF
The purpose of this study was to describe the experience of living with
type 2 diabetes in a sample of African American women METHODS: A
convenience sample of nine 9 women was recruited through referral
physician offices Interviews with participants were audio taped with their
permission RESULTS: The mean age of participants was fifty-seven 57
and the mean length of time since diagnosis was six 6 years Symptoms of
and reactions to initial diagnosis, diabetes education, concerns, self-
management of food intake, things that enhanced self-management, and things
that hindered self-management were themes that emerged from
analysis of the
interviews For this group of women living with diabetes was a daily
challenge CONCLUSIONS: An overall concern was the possibility of limb
amputation Diabetes self-care education most often occurred at initial
diagnosis in the form of pamphlets and instructions to cut back on certain
foods However, no instructions were given on how to cut back Only one of
the participants had an exercise plan In addition, they did not feel that
the health care providers had time to talk to them about their diabetes

Centers for Disease Control 2006 Retrieved June 1, 2006 from
http://wwwcdcgov
The CDC has various research/education projects ongoing that address
diabetes and race/ethnicity issues Below is one example

REACH 2010 projects to eliminate disparities in health status
experienced by racial and ethnic minority populations REACH is an acronym
for racial and ethnic approaches to community health

Of the 32 community coalitions funded during the first-year planning
phase, 15 selected diabetes as one of the target health priority areas CDC
staffers participate in monthly REACH meetings and provide technical
expertise as needed

The racial and ethnic groups targeted by REACH
2010 are African Americans,
American Indians, Alaska Natives, Asian Americans, Hispanic Americans, and
Pacific Islanders REACH 2010 is a two-phase, 5-year demonstration project
that supports community coalitions in designing, implementing, and
evaluating community-driven strategies to eliminate health disparities

Chin, Marshall H, Tamar S Polonsky, Valencia D Thomas, and Michael P
Nerney 2000 Developing a Conceptual Framework for Understanding Illness
and Attitudes in Older, Urban African Americans With Diabetes The Diabetes
Educator, 26: 439-449 PDF
PURPOSE
This study was conducted to better understand how older African Americans
with diabetes view their illness, and to develop a conceptual framework for
approaching their care
METHODS
Researchers conducted interviews of 19 African American patients 65 years
or older who attended clinics at an urban academic medical center The mean
age of the patients was 73 years, 58 were female, 63 had a complication
from diabetes, and 58 were taking insulin Patients were asked open-ended
questions about how diabetes affected their lives and their attitudes
toward treatment Data were analyzed through a grounded-theory
perspective

RESULTS
Patients showed variation in the degree to which they believed that
diabetes affected their lives and how aggressive they wished treatment to
be Themes included issues of quality of life, health beliefs, and the
social context Paradoxical, contradictory statements were common,
expressing ambivalence and uncertainty regarding the effect of the illness
and the treatment
CONCLUSIONS
Wide variation exists in the attitudes of older African Americans toward
their diabetes and treatment Patients frequently expressed ambivalence
toward the care of their illness Providers should explore these issues and
help patients resolve their ambivalence if patient preferences are to be
respected in the overall treatment plan

Cline, Rebecca J Welch Henry N Young 2004 Marketing Drugs,
Marketing Health Care Relationships: A Content Analysis of Visual Cues in
Direct-to-Consumer Prescription Drug Advertising Health Communication,
Vol 16, No 2: pages 131-157 PDF
Abstract: Proponents and opponents of direct-to-consumer advertising DTCA
of prescription drugs argue that it promotes greater participation in
health care by consumers with significant implications for public health
and
health care outcomes This article a proposes a social cognitive
theoretical framework to explain DTCAs effects,
and b reports the first in a series of studies on DTCAs observational
learning
functions that may influence consumer behavior and the physician-patient
relationship This investigation addresses visual features of print DTCA
Results
focus on the prevalence and nature of models featured in the ads and how
visual
cues may offer identity and relational motivators while reinforcing the
value of
prescription drug treatments Further, DTCA may market disenfranchising
images
that increase disparity in health care information and access, despite
their argued
educational function

African Americans were likely to appear disproportionately more often in
ads for only two conditions, HIV/AIDS 484, 336 and diabetes 333,
289p144

Coleman, Lenore ThreadgillBeating the odds: The African-American womans
guide to diabetes drugs Diabetes Forecast Alexandria: Aug 2001Vol54,
Iss 8; pg 57, 4 pgs PDF
Coleman discusses ways that African-American women with type 2 diabetes
can control their disease Many drugs are now available, as well as the
traditional treatment with diet and exercise

Cox, Ruby
H; John Paul Carpenter; Franklin A Bruce; Kathleen P Poole;
Clark K Gaylord Characteristics of low-income African-American and
Caucasian adults that are important in self-management of type 2 diabetes
Journal of Community Health, April 2004 v29 i2 p15516 PDF

Incidence of type 2 diabetes has greatly increased in the US, with over 90
percent having type 2 A cross-sectional, self-report survey was conducted
for the purpose of assessing characteristics associated with self-
management of type 2 diabetes attitudes, certain behaviors, and perceived
knowledge among low-income Caucasian and African-American adults enrolled
in the Food Stamp Nutrition Education Program FSNEP At the time of the
study, almost 11 percent of FSNEP adult participants 457 individuals
throughout the state had type 2 diabetes Among 196 subjects interviewed
for the study, 86 were Caucasian 44 and 100 51 were African-American
Results indicated that over three-fourths of subjects had been counseled on
diet and exercise, but less that half were following dietary
recommendations and only one-fourth were getting adequate exercise No
significant differences were found between the two race groups on
assessed
characteristics or among subjects grouped by place of residence p [less
than or equal to] 001 Significant correlations were found among
subjects characteristics, including perceived health status, perceived
knowledge of diabetes, attitudes towards diabetes, meal-plan adherence,
perceived barriers to physical activity, and reported diabetes control p
[less than or equal to] 00001 Findings imply that a self-management
education for type 2 diabetes does not need to be different for African-
Americans vs Caucasians in southern states and b best disease control is
achieved when those with type 2 diabetes have a high degree of knowledge of
diabetes, positive attitudes, good meal plan adherence, and few perceived
barriers to physical activity

Delamater, Alan M Improving Patient Adherence Clinical Diabetes
Alexandria: Spring 2006Vol24, Iss 2; pg 71, 5 pgs PDF
To improve patients diabetes self-management behaviors, health care
providers should cultivate patient-centered relationships that respect
patient autonomy; organize their clinic or office to be patient-friendly;
provide continuity of care with interim telephone contacts; talk
collaboratively with patients about treatment
rationales and goals;
brainstorm and problem-solve with their patients; gradually implement and
tailor the regimen; provide written instructions; use self-monitoring,
social supports and reinforcement, and behavioral contracts; and routinely
refer patients to behavioral health specialists

Diabetes Control; Pharma company and Georgia health center launch
culturally appropriate diabetes education program Diabetes Week Atlanta:
Mar 6, 2006 pg 25 PDF
Amigos en Salud, which translates to Friends in Health, is a culturally
appropriate diabetes self-management program that addresses cultural
perceptions and lifestyles The Amigos en Salud program is designed to help
patients with diabetes understand their condition, encourage and sustain
behavior change, support development of self-management skills, and provide
ongoing community support - in the context of individual cultures

Diabetes Education; Company launches redesigned diabetes website for
consumers, health professionals Diabetes Week Atlanta: Aug 8, 2005 pg
16 PDF
The site still includes the online library; information about Joslins
multicultural health clinics, including the Latino Diabetes Initiative, the
Asian Clinic and
services to the African American community; and discussion
boards for adults with diabetes, parents of kids with diabetes, and teens
with diabetes

Eakin, Elizabeth G Sheana S Bull, Russell E Glasgow, Mondi Mason
2002 Reaching those most in need: a review of diabetes self-management
interventions in disadvantaged populations Diabetes/Metabolism Research
and Reviews,
Volume 18, Issue 1, Date: January/February, Pages: 26-35 PDF
Summary: There has been increased recognition of the importance of
developing
diabetes self-management education DSME interventions that are effective
with under-served and minority populations Despite several recent studies
in this area, there is to our knowledge no systematic review or synthesis
of what has been learned from this research An electronic literature
search identified five formative evaluations and ten controlled DSME
intervention trials focused on under-served low-income, minority or aged
populations The RE-AIM Reach, Efficacy, Adoption, Implementation,
Maintenance evaluation framework was used to evaluate the controlled
studies on the dimensions of reach, efficacy, adoption, implementation, and
maintenance Fifty percent
of the studies
identified reported on the percentage of patients who
participated, and the percentages were highly variable The methodological
quality of the articles was generally good and the short-term results were
encouraging, especially on behavioral outcomes Data on adoption
representativeness of settings and clinicians who participate and
implementation were almost never reported Studies of modalities in
addition to group meetings are needed to increase the reach of DSME with
under-served
populations The promising formative evaluation work that has been
conducted needs to be extended for more systematic study of the process of
intervention implementation and adaptation with special populations
Studies that explicitly address the community context and that address
multiple issues related to public health impact of DSME interventions are
recommended to enhance long-term results

Table 2 on page 30 contains a review of studies in diabetes self-
management Two of ten of the studies listed had a focus at least in part
on African Americans - other studies were focused on various underserved
groups and minority populations

Quotes:
Page 26 There have been a growing number of studies and programs
in the
past
15 years that have attempted to transfer diabetes self-management efforts
to
racial and ethnic minority communities

Page 27 There are multiple efforts underway to reduce health disparities
between racial/ethnic groups and socially advantaged and disadvantaged
groups In the US, the
National Diabetes Education Program NDEP is a collaboration between the
National Institutes of Health NIH, the Centers for Disease Control and
Prevention CDC and over 200 private, public, and voluntary groups to
promote early diagnosis of diabetes and improvement of treatment for those
with both type 1 and type 2 diabetes [29] The CDC is also sponsoring a
program called Racial and Ethnic Approaches to Community
Health REACH, which is an effort to distribute funds to communities
throughout the US to increase efforts to promote prevention of chronic
illness, including diabetes, among racial and ethnic minority groups Also
sponsored by the CDC are the Prevention Research Centers, a network of
research and community collaborations to improve disparities in health
outcomes that include centers focused on diabetes care and prevention
wwwcdcgov/prc/pdf/facts_allpdf

Page 28 Electronic MEDLINE
searches for the years 1987 to 2001 were
conducted using the National Library of Medicines PubMed search engine
The keywords used for searching included diabetes plus the following:
self-management, programs, initiatives, projects, African Americans,
Asians, Latinos, Hispanics, older adults, elderly, under-served, and low-
income The search was limited to publications in the English language

Page 33 While work with special populations is critically important, we
need to be able to document who within these populations is being reached
by these efforts to be able to speak to the generalizability or external
validity of study outcomes

None of the studies reported on adoption - the percentage and
representativeness of healthcare providers or organizations willing to take
part in delivering the intervention Much more research is needed on
intervention agent and clinic characteristics associated with adoption The
representativeness of the settings and providers delivering diabetes self-
management interventions is equally important as the representativeness of
the patients studied Only one study reported on implementation
or whether the intervention was delivered as intended

Page 34
Despite the moderate outcomes seen in the studies reviewed here,
it is important for this work to continue, as it is critical to addressing
growing health disparities As part of this work, we need to expand the
systematic evaluation of social-ecological factors impacting upon health in
disadvantaged communities and be sure that
interventions take these factors into account In particular, both
qualitative and quantitative research is needed on factors related to why
different providers and settings
serving disadvantaged populations do or do not adopt DSME interventions

Ford Marvella E,Suzanne L Havstad, Bobbi L Brooks, Barbara C Tilley
Perceptions of Diabetes Among Patients in an Urban Health Care
SystemEthnicity and Health Publisher: Routledge, part of the Taylor
Francis Group, Volume 7, Number 4 / 2002, Pages: 243 - 254 No PDF
Objectives A major problem facing health care providers today is
adherence to treatment regimens by patients Adherence is of even greater
significance for patients with diabetes who shoulder a great deal of
responsibility in their disease management Perceptions of diabetes have
been found to play a major role in adherence The effects of race
and
socioeconomic status on the disease perceptions remain unclear This
exploratory study encompassed two themes: 1 assessing perceptions of
diabetes among African American and white American adults with diabetes who
were patients in 1994 in a large Midwestern urban health care system and
2 examining the psychometric properties of the measurement instruments
used to study perceptions

Design A stratified random sampling scheme by race and socioeconomic
status SES was used Diabetes perceptions were measured using three
scales from the Meaning of Illness Questionnaire assessing the impact loss
and stress associated with diabetes Perceptions of physician efficacy were
also measured The study population consisted of 50 68 response rate
African American and white American patients aged 18-65 years

Results No differences in SES were found between the African American and
white American participants p 044 However the African Americans in
the study indicated a greater sense of loss associated with diabetes than
the white Americans in the study p 005 In the combined racial group
the reliability coefficients as measured by Cronbachs alpha were 076 078
068 and 068 for the Impact Loss
Stress and Perceptions of Physician
Efficacy scales respectively However the results of within-racial-group
analyses tell a different story The Impact scale fitted the African
American and white American subgroups although there was some item
variation by racial group The Loss scale did not fit the white American
subgroup and the Stress and Perceptions of Physician Efficacy scales did
not fit the African American subgroup

Gary, Tiffany L, Felicia Hill-Briggs, Marian Batts-Turner, and Frederick
L Brancati
Translational Research Principles of an Effectiveness Trial for Diabetes
Care in an Urban African American Population The Diabetes Educator 31: 880-
889 PDF
Purpose
Large-scale effectiveness trials designed to translate evidence-based
diabetes care to community settings are few Studies describing these
methods among high-risk minority populations are particularly limited
Methods
The authors describe Project Sugar, a randomized controlled trial conducted
in 2 phases: Project Sugar 1 1994-1999, which piloted a 4-arm clinic and
home-based intervention using nurse case management and community health
workers in 186 urban African Americans with type 2 diabetes, and Project
Sugar 2
2000-2005, which examined effectiveness of this intervention
among 542 diabetic, urban African Americans
Results and Conclusions
Project Sugar had success with regard to recruitment and retention, both in
phase 1 80 rate at 24 months and phase 2 90 at 24 months Using the
RE-AIM framework, planning and research design for Project Sugar 2 is
described in detail for elements that contributed to the reach,
effectiveness, adoption, implementation, and maintenance of this study
within a minority community setting In addition to successful strategies,
challenges to conducting effectiveness trials in an inner-city African
American community are identified

Gassner, Heidi L, Stephen E Gitelman Case study: Type 1 and type 2, too?
Clinical Diabetes Alexandria: Summer 2003 Vol 21, Iss 3; p 140PDF
Gassner and Gitelman discusses a case study on RM, a 17-year-old African-
American girl with new-onset diabetes, presumed to be type 2 diabetes
African-American adolescents with new-onset type 1 diabetes have up to a
fourfold greater chance of exhibiting no autoantibodies, which may prove
misleading in making therapy decisions For RM, they elected to continue
her subcutaneous low-dose insulin regimen
at 04 units/kg/day during the
honeymoon phase, but may consider adding metformin therapy in the future

Gavin III, James E Beating the odds: African Americans at risk Diabetes
Forecast Alexandria: Aug 2001Vol54, Iss 8; pg 43, 4 pgs PDF
Diabetes has reached near-epidemic levels in the Africa-American
population, having tripled in the past 30 years Gavin discusses the
importance of spreading the word among African-Americans and educating
others about the symptoms of diabetes

Gavin III, James R Changing the Way Diabetes is Treated With Information
and Resources Clinical Diabetes Alexandria: Winter 2006 Vol 24, Iss 1;
p 14 3 pagesPDF
In recognition of the fact that dia- betes disproportionately affects
several special populations, many NDEP campaign materials and tools have
been adapted for high-risk audiences, including older adults, African
Americans, American Indians, and Alaska Natives Second, the Behavioral
Risk Factor Surveillance System survey shows a dramatic improvement in
blood glucose testing among people with diabetes between 1997 and 2002,
with 39 of people with diabetes testing at least once a day in 1997 and
55 testing at least once a day in 20023 Figure 3

Gerber,
Ben S, Irwin G Brodsky, Kimberly A Lawless, Louanne I Smolin, et
al Implementation and Evaluation of a Low-Literacy Diabetes Education
Computer Multimedia Application Diabetes Care Alexandria: Jul 2005 Vol
28, Iss 7; p 1574 7 pages PDF
Page 1574: The objective was to evaluate a clinic-based multimedia
intervention for diabetes education targeting individuals with low health
literacy levels in a diverse population The research and design methods
were as such Five public clinics in Chicago participated Kiosks in
waiting rooms were installed 245 subjects with diabetes were randomized to
receive either supplemental computer multimedia use intervention or
standard of care only control The intervention included audio visual
sequences that addressed various issues of diabetes Data was collected
over 1 year

Results - Complete 1-year data were available for 183 subjects 75,
Overall, there were no significant differences in change in A1C, weight,
blood pressure, knowledge, self-efficacy, or self-reported medical care
between intervention and control groups However, there was an increase in
perceived susceptibility to diabetes complications in the intervention
group This effect was greatest
among subject with lower health literacy
Within the intervention group, time spent on the computer was greater for
subjects with higher health literacy

Conclusion-Access to multimedia lessons resulted in an increase in
perceived susceptibility to diabetes complications, particularly in
subjects with lower health literacy Despite measure to improve
informational access for individuals with lower health literacy, there was
relatively less use of the computer among these participants
See Table 1 on page 1578 for demographics of group While the study did not
focus particularly on African Americans, some of the participants were
African American

Gesler, Wilbert M, Molly Dougherty, Thomas A Arcury, Anne H Skelly, Sally
Nash The importance of obtaining information from assessment of community
service providers for a disease prevention program Journal of
Multicultural Nursing Health Chautauqua: Summer 2003 Vol 9, Iss 2; p
14 PDF
This paper demonstrates the importance of gathering information from
community service providers as part of a community assessment focused on
preventing a specific disease This study is part of a project to prevent
diabetes among low income African Americans,
Latinos, and European
Americans Methods: Twelve community service providers from 11 social and
health service institutions that represented various community groups were
interviewed using a semi-structured questionnaire Results: Results showed
a wide range of perceptions about the prevalence and seriousness of
diabetes in their community and the adequacy of current services
Interviews led to changes in the survey for the target population

Conclusions: We conclude that a successful diabetes prevention intervention
program requires educating service providers, improving and coordinating
diabetes-related services, and selecting appropriate intervention sites
This community service provider assessment can be applied to the prevention
of a wide range of chronic diseases and utilized in a variety of places

Groot, Mary de PhD, Wendy Auslander, PhD,James Herbert Williams,
PhD,Michael Sherraden, PhD, Debra Haire-Joshu, PhD Health Depression
and Poverty Among African American Women at Risk for Type 2 Diabetes
Annals of Behavioral Medicine 2003, Vol 25, No 3, Pages 172-181 PDF
Abstract: Poverty is associated with negative health outcomes, including
depression Little is known about the
specific elements of poverty that
contribute to depression, particularly among African American women at risk
for type 2 diabetes This study examined the relationships of economic and
social resources to depression among African American women at high risk
for the development of type 2 diabetes N 181 using the Conservation of
Resources theory as a conceptual framework Women were assessed at 3 time
points in conjunction with a dietary change intervention At baseline, 40
of women reported clinically significant depression, and 433 were below
the poverty line Depressed women reported fewer economic assets and
greater economic distress than nondepressed peers Multivariate logistic
regression analyses indicated that nonwork status, lack of home ownership,
low appraisal of ones economic situation, low self-esteem, and increased
life events were significantly associated with depression at baseline
Longitudinal multivariate logistic regression models indicated that income,
home ownership, future economic appraisal, life events, and self-esteem
predicted depression trajectories at Time 3 These results speak to the
multifaceted sources of stress in the lives of poor African American
women
Interventions that address the economic and social factors associated with
depression are needed

Harvey, Carolyn, Belinda Deal, Rebecca Fountain, Carla Hairston, et al
Visible messenger model Journal of Multicultural Nursing Health
Chautauqua: Summer 2003 Vol 9, Iss 2; p 22 PDF
To increase preventative health behaviors regarding hypertension and
diabetes for individuals in the African American Community by utilizing a
mentoring approach and to compare the health outcomes of clients who
participated in the mentoring program with those who did not participate in
the program Methods: After gathering information that supported the use
of acquaintances as the source for health information, flyers were
distributed asking subjects if they wanted to participate in a new program
for controlling diabetes and hypertension Researchers set up a
collaborative relationship with mentors or lay health advocates to help the
subject monitor their blood pressure and blood sugar The subjects kept
logs to monitor progress Results: Participants demonstrated lower blood
sugars and decreased blood pressures Conclusions: The Visible Messenger
Model was an effective approach to health promotion
utilizing lay health
advocates in underserved communities Two dominant communication styles -
linear and cyclical- are compared in the model

Hayes, Risa P Annette M Bernard, Wrenn Slocum, Imad EI-Kebbi, David
Ziemer, Daniel Gallina, and Lawrence S Phillips 2000 Diabetes in Urban
African Americans: Assessment of Diabetes-Specific Locus of Control in
Patients With Type 2 Diabetes The Diabetes Educator 26: 121-128 PDF
PURPOSE
This study was conducted to examine the applicability and relationship to
glycemic control of the Diabetes Locus of Control DLC Scales in a low-
literacy, economically deprived, African American population with type 2
diabetes
METHODS
The DLC Scales were administered orally to African American patients with
type 2 diabetes who had been referred to the diabetes unit of a large urban
public hospital Reliability, interscale correlations, and associations
with patient characteristics were compared with those originally obtained
for a better educated, predominately Caucasian population
RESULTS
The structure and correlates of the DLC Scales in the African American
population were more similar than different from those originally obtained
from a primarily
well-educated, Caucasian population However,
comprehension of some items was difficult for up to 10 of the low-literacy
population A significant relationship was found between belief in chance
and both glycemic control at the 6-month follow-up and the change in
glycemic control over time
CONCLUSIONS
Although the DLC Scales operate similarly in an urban African American
population with limited education, further modification is needed to
enhance the prediction of glycemic control and provide direction for
developing targeted interventions

Hecht, Jacki, Belinda Borrelli, Rosemary K R Breger, Carol DeFrancesco,
Denise Ernst, Ken Resnicow 2005 Motivational Interviewing in Community-
Based Research: Experiences From the Field Annals of Behavioral Medicine,
Vol 29, No 2, suppl: pages 29-34 PDF
Abstract: Motivational Interviewing MI has been established as an
effective psychotherapeutic treatment for problem drinking in clinical
settings Consequently, there is a growing interest in applying MI to
facilitate change across other health behaviors, such as tobacco use,
eating habits, and physical activity in a variety of community-based
research settings These extended applications pose new
challenges
regarding implementation and evaluation For instance, investigators must
consider how best to train intervention counselors; implement strategies
for preserving the MI spirit, despite limited client contact time;
incorporate adjunctive strategies that support brief MI sessions; and
develop a plan for monitoring and evaluating MI treatment fidelity This
article highlights specific examples of how several behavior change
research projects applied MI across a variety of settings and populations,
provides lessons learned from our experience as a collaborative workgroup,
and offers strategies for consideration in future community-based research

The lead author is Jacki Hecht, RN, MSN of the Weight Control and
Diabetes Research Center, The Miriam Hospital/Brown Medical School

Quote, page 33:
LESSONS LEARNED FROM THE MI WORKGROUP
There are several take-home lessons learned from our experience as a BCC
workgroup
The Collaboration That Occurred Among Investigators With Similar Research
Interests Facilitated a Type of Academic Sharing That Is Rarely Afforded
Despite differences in research designs and underlying theoretical
rationales, workgroup members were united in their
application of MI as a
method for interacting with research participants and collaborated to
enhance scientific understanding of these new applications Investigators
with common goals were able to establish collegial relationships; discuss
study design, implementation, and evaluation issues; and share study
materials by conducting biannual meetings and regular conference calls The
wealth of knowledge and experience among the MI workgroup members helped
each of the projects gain expert consultation and guidance while receiving
valuable feedback on
various study procedures Funding agencies would benefit from fostering
similar collaborative models in the future We did not take advantage of
the potential benefit of establishing standardized MI training, whereby a
core group of trainers provided similar
MI workshops across the study sites This shared training model was one of
the strengths of the Smoke-Free Families

Hendricks, Leo E and Rosetta T Hendricks, The Effect of Diabetes Self-
Management Education With Frequent Follow-Up on the Health Outcomes of
African American Men The Diabetes Educator 26: 995-1002 PDF
PURPOSE
This study was conducted to determine whether objective
clinical, patient
performance, quality-of-life, and subjective outcomes are significantly
different among African American men with type 2 diabetes who received
follow-up at either monthly or 3-month intervals after participating in a
structured diabetes self-management education program
METHODS
Prior to the diabetes self-management education program, 30 African
American men with type 2 diabetes were randomly assigned to 2 groups to
receive telephone follow-up at either monthly or 3-month intervals over a 6-
month period Information obtained at follow-up contact included HbA1c
level, perception of general health, and present diabetes knowledge In
addition, daily foot care, dietary, exercise, and medication compliance
measures were assessed postprogram
RESULTS
There were no significant differences between the participants who received
follow-up at monthly and 3-month intervals on any measures of the selected
clinical, patient performance, quality-of-life, and subjective outcomes
CONCLUSIONS
This cross-sectional study showed that telephone follow-up at 3 month
intervals following a structured program of diabetes self-management
education may be just as effective in contributing to
favorable diabetes
health outcomes as monthly follow-up

Jeanfreau, Scharalda G, Margaret Tennyson Collaboration in the provision
of health care to low socioeconomic people of New Orleans Journal of
Multicultural Nursing Health Chautauqua: Winter 2003Vol9, Iss 1; pg
27 PDF
A collaborative relationship was established between a faith-based health
center and a state supported school of nursing for the provision of disease
state management and obstetrical services to low socioeconomic residents of
New Orleans, Louisiana The health center contracted family nurse
practitioner and midwifery services through the School of Nursings faculty
practice plan The disease state management program provides an organized
structured approach for the comprehensive management of Type 2 diabetes
Whereas, the purpose of the obstetric services is to provide women-
centered, culturally sensitive safe and quality care for childbearing
women The collaborative effort undertaken by these two organizations has
accomplished a great deal in the provision of selected health care services
to poor and medically underserved of New Orleans Nevertheless, each
collaborative program recognizes the need for improvement
and long-term
expansion of services Continued and expanded collaborative efforts will
influence the health status of this medically underserved population

Kemper, Phyllis, Christine Savage, Paula Niederbaumer, Jean Anthony
2005 A Study of the Level of Knowledge About Diabetes Management of Low-
Income Persons With Diabetes Journal of Community Health Nursing, Vol 22,
No 4: pages 231-239 PDF
Abstract: Diabetes education has proven to be an effective intervention for
the management of diabetes Persons with lower education levels, the
majority of whom have low incomes, receive less diabetes self-management
education DSME than their peers This study compared the diabetes
knowledge level of low-income adults who did not have a high school diploma
or general equivalency diploma with those who did We conducted a survey
among residents of 4 low-income neighborhoods in Cincinnati, Ohio, using a
cross-sectional descriptive design Surveys included information related to
diabetes self-management and level of education The only questions for
which there was a significant difference between the 2 groups were those
pertaining to the causes and treatment of hypoglycemia Survey results were
used
to validate the need for a DSME program for low-income adults in
Cincinnati, Ohio A DSME program was developed specifically for persons
with low literacy

QUOTE page 231-232:Persons with diabetes who are able to manage the
disease decrease the risk of complications eg, hypoglycemia, foot
ulcers, and hypertension; US Department of Health and Human Services
[USDHHS], 2000 However, the populations at highest risk for diabetes
African Americans, Hispanics, lower socioeconomic populations, and senior
citizens received less formal diabetes education in 1998 than those at
lesser risk Only 26 of persons who were not high school graduates
received formal diabetes education USDHHS, 2000

Keyserllng, Thomas C, Alice S Ammerman, Carmen D Samuel-Hodge, Allyson
F Ingram, Anne H Skelly, Tom A Elasy, Larry F Johnston, Anne S Cole,
and Carlos F Henriquez-Rolddn 2000 A Diabetes Management Program for
African American Women With Type 2 Diabetes The Diabetes Educator, 26: 796-
805 PDF
PURPOSE
this paper describes a clinic and community-based diabetes intervention
program designed to improve dietary, physical activity, and self-care
behaviors of older African American women with type 2 diabetes It
also
describes the study to evaluate this program and baseline characteristics
of participants
METHODS
The New Leaf Choices for Healthy Living With Diabetes program consists
of 4 clinic-based health counselor visits, a community intervention with 12
monthly phone calls from peer counselors, and 3 group sessions A
randomized, controlled trial to evaluate the effectiveness of this
intervention is described
RESULTS
Seventeen focus groups of African American women were used to assessed the
cultural relevance/acceptability of the intervention and measurement
instruments For the randomized trial, 200 African American women with type
2 diabetes were recruited from 7 practices in central North Carolina Mean
age was 59, mean diabetes duration was 10 years, and participants were
markedly overweight and physically inactive
CONCLUSIONS
Participants found this program to be culturally relevant and acceptable
Its effects on diet, physical activity, and self-care behaviors will be
assessed in a randomized trial

Kidney Disease; African Americans unaware of high kidney disease risk; [2]
Diabetes Week Atlanta: Mar 29, 2004 pg 21 PDF
While 90 of African Americans surveyed by the National Kidney
Disease
Education Program NKDEP had heard about kidney disease, only 15 felt
their personal risk for developing the disease was higher than average and
fewer knew specifically how to prevent it This gap in awareness raises
serious concern, especially because 44 of them had at least one major risk
factor for kidney disease - diabetes, high blood pressure or a blood
relative with the disease

Kulkarni, Karmeen D Food, Culture, and Diabetes in the United States
Clinical Diabetes Alexandria: Fall 2004Vol22, Iss 4; pg 190, 3 pgs
PDF
Things have changed in the US as the population has grown to include many
different ethnic and cultural groups, and this has resulted in diverse food
preferences and eating habits–each ethnic group has its own culturally
based foods and food habits Thus, the American diet is a combination of
many cultures and cuisines Here, Kulkarni examines the ethnic and regional
food practices of three larges segments of the US population: African
Americans, Asian Indians and Mexican Americans, all groups with a high
incidence of type 2 diabetes

Landrine, Hope Elizabeth A Klonoff, guest editors 1997 Black Womens
Health Hillsdale, NJ: Lawrence Erlbaum
Book is available
hard copy at MSUs library It does contain information
on research on diabetes and African American women The book gives the
state of research as of the date on black women and health Includes some
discussion on diabetes research The book is not searchable on amazoncom
Also not searchable on google books

Loue, Sara 1999 Gender, Ethnicity, and Health research New York:
Kluwer Academic/Plenum Publishers
Chapter 6 outlines African American health research issues There isnt a
big focus on diabetes - this book is available in MSUs library hard copy
only and on Amazoncom it can be searched and pages can be reviewed

Mazzuca, Kathleen Barr, Nancy A Farris, Joyce Mendenhall, Robin A Stoupa
1997 Demonstrating the Added Value of Community Health Nursing for
Clients With Insulin-Dependent Diabetes Journal of Community Health
Nursing, Vol 14, No 4: pages 211-224 PDF
Abstract: The importance of demonstrating that nursing care adds value to
client outcomes is discussed broadly as well as within the dimensions of a
community health nursing outcomes study The study examined the effect of a
community health nursing intervention on the health behaviors and health
status of adults with
insulin-treated diabetes as measured by client
outcomes using a two-group repeated measures experimental design The
findings indicate that the community health nursing intervention
significantly enhanced the self-reported self-care behaviors of blood
glucose testing, complication management, nutrition regimen adherence, and
reporting foot change in the experimental group No differences were found
between the groups in outcomes for dietary adherence, foot care, blood
glucose levels and overall diabetes knowledge, metabolic control, or
functional health status Challenges for community health nurse researchers
engaging in client outcome studies are delineated and discussed

Quote, page 214:Seventeen women and 5 men participated in the study with
an equal
distribution of African American and White participants The age range was
49 to 83, and
the mean family income was 15,000 for 75 of both groups Participants in
both groups were similar in age, height, and educational level

Montague, Mamie C, Sheryl A Nichols, and Arjun P Dutta Self-management
in African American Women With Diabetes The Diabetes Educator, 31: 700-
711 PDF
Purpose
This study describes demographic and medical
characteristics, self-
efficacy, locus of control, self-management defined by functional status,
hemoglobin HbA1c outcomes, and the relationships among these variables
based on age group differences 25-44 years, 45-64 years, and 65-84 years
in African American women with type 2 diabetes
Methods
Subjects n 75 in community medical practices were interviewed to
complete a demographic and medical form, the Diabetes Self-efficacy
Outcomes Expectancy Questionnaire DSEQ, the Diabetes Locus of Control
Scale, and the Medical Outcomes-Short Form 36 SF-36 A venous blood
sample was taken following the interview Data were analyzed for the total
sample and separately for age groups
Results
Scores on the self efficacy DSEQ and the locus of control LOC were
above average for all 3 groups Significant correlations were found among
subscales of the LOC, SF-36, and HbA1c HbA1c scores were abnormally high
across groups Significant group differences were found in duration of
diabetes and number of medications used
Conclusions
Despite high levels of internal locus of control and self-efficacy and
scores indicating good mental, physical, emotional, and social health, self-
management amongthe women was
inadequate, as indicated by abnormally high
HbA1c levels

Rhee, Mary K Diabetes Therapy; Barriers to diabetes education in urban
patients presented Diabetes Week Atlanta: Jul 18, 2005 pg 35 PDF
According to a study from the United States, This study explored
patients perceptions of barriers to diabetes education among a mostly
African American Population of adults with diabetes A survey was conducted
among 605 new patients attending an urban outpatient diabetes clinic The
questionnaire gathered information on issues patients believed would
adversely affect their ability to learn about diabetes

Rimmer, James H, Katie Silverman, Carol Braunschweig, Laurie Quinn, and
Yang Liu Feasibility of a Health Promotion Intervention for a Group of
Predominantly African American Women With Type 2 Diabetes The Diabetes
Educator, 28: 571-580 PDF
PURPOSE
this feasibility study was undertaken to determine if a group of
predominantly low-income, low-education, African American women with type 2
diabetes could achieve good compliance and improved health outcomes with a
carefully structured health promotion intervention
METHODS
The sample consisted of 30 participants from an urban
setting who were
diagnosed with type 2 diabetes but also had multiple chronic conditions
eg, obesity, hypertension, joint pain, and depression Participants
attended a university-based health promotion program where they completed a
12-week intervention that addressed diet, nutrition, and health behavior
Transportation was provided at no cost to the participants
RESULTS
Compliance with the 12-week program was 725 Participants made
significant improvements in total cholesterol and LDL-cholesterol levels,
cardiovascular fitness, muscular strength and endurance, and nutrition
knowledge
CONCLUSIONS
African American women with type 2 diabetes residing in difficult living
environments ie, poverty, high crime, and lack of family support can
achieve good compliance and health outcomes with a structured health
promotion program provided that barriers to participation eg,
transportation, cost, and commitment are removed prior to and during the
intervention

Robbins, Jessica M, Viola Vaccarino, Heping Zhang, Stanislav V Kasl Jan
2001 Socioeconomic status and type 2 diabetes of African American and
non-Hispanic white women and men: Evidence from the Third National Healthy
and Nutrition
Examination Survey American Journal of Public Health
Washington: Vol 91, Iss 1; p 76 PDF
Abstract: This study examined the associations of poverty income ratio
PIR, education, and occupational status with type 2 diabetes prevalence
among African American and non-Hispanic White White women and men aged 40
to 74 years Among African American women, there was a strong, graded
association between PIR and diabetes, which remained significant after
other risk factors were adjusted for

Russell, Kathleen Nancy Jewell 1992 Cultural Impact of Health-Care
Access: Challenges for Improving the Health of African Americans Journal
of Community Health Nursing, Vol 9, No 3: pages 161-169
Abstract: Disparities in health status of African Americans continue to
exist These disparities of poor health, in part, are attributed to
decreased access to healthcare services However, culture plays a key role
in health-care utilization patterns among African Americans The purpose of
this article is to examine cultural factors that affect health-care
practices among African Americans and to identify specific community health
nursing interventions that integrate these factors into health-care plans
for
African-American families and communities p 161

Preventable conditions such as cancer and uncontrolled hypertension and
diabetes continue to escalate in the Black adult population at much more
alarming rates than in the nonminority population Blacks are approximately
13 times as likely to die from cancer than Whites, 15 times to die from
heart disease, 2 times from stroke, and 25 times from complications of
diabetes United States Department of Health and Human Services [USDHHS],
1990p 162

Research shows that when income and education are controlled, health
status indicators consistently are poorer for Blacks than for Whites
National Center for Health Statistics, 1991 In the African-American
population, culture appears to play a major role in health-care practices
and health beliefs These practices and beliefs can affect an individuals
utilization of wellness and illness health-care services USDHHS,
1985p 162

Healthcare regimes within the current health-care delivery system often
fail to
fully integrate cultural values of African Americans Studies have shown
that cultural
values of Blacks have influenced the degree of adherence they had with
healthcare
treatment regimes Berg
Berg, 1989; Gabriel McAnarney, 1983; Parraga,
Weber, Engel, Reeb, Lerner, 1988; Scupholme, Robertson, Karnons,
1991 p 165

Strategies for providing improved culturally sensitive care include: a
magnifying the involvement of the African-American community in the needs
assessment, program design, service implementation, and the process and
outcome evaluation of health services delivery; b tapping into already
established informal and formal community networks for health-care services
utilization; and c restructuring internal health-care delivery services
to be culturally
sensitivep 165

For example, Uzoma and Feldman 1989 found that adherence to diabetic
treatment regimes were more likely to occur in inner city Black women than
in men
when both groups were provided with satisfying support personsp 166

Samuel-Hodge, Carmen D, Sandra W Headen, Anne H Skelly, Alyson F Ingram, et
al Influences on day-to-day self-management of type 2 diabetes among
African-American women: Spirituality, the multi-caregiver role, and other
social context factors Diabetes Care Alexandria: Jul 2000 Vol 23, Iss
7; p 928 6 pages PDF
The study focused on African American women in order to identify
culturally
relevant psychological issues and social context variables
influencing lifestyle behaviors-specifically diet and physical activity
They conducted 10 focus group interviews with 70 southern African American
women with type 2 diabetes Group interviews were audiotaped and
transcripts were coded using qualitative data analysis software A panel of
reviewers analyzed the coded responses for emerging themes and trends

Results: The dominant and most consistent themes that emerged from these
focus groups were 1 spirituality as an important factor in general health,
disease adjustment, and coping; 2 general life stress and multi-care
giving responsibilities interfering with daily disease management; and 3
the impact of diabetes manifested in feelings of dietary deprivation,
physical and emotional tiredness, worry; and fear of diabetes
complications

Conclusions: Our findings suggest that influences on diabetes self-
management behaviors of African-American women may be best understood from
a sociocultural and family context Interventions to improve self-
management for this population should recognize the influences of
spirituality; general life stress, multi-care giving responsibilities,
and
the psychological impact of diabetes These findings suggest that family-
centered and church-based approaches to diabetes care interventions are
appropriate

Street Jr, Richard L Department of Speech Communication, Texas AM
University Bradford Millay, Department of Speech Communication, Texas
AM University Analyzing Patient Participation in Medical Encounters
Health Communication 2001, Vol 13, No 1, Pages 61-73 PDF
The piece contains a general discussion of some of the issues in patient
communication practices
Quote from Intro: An essential component of the delivery of health care is
the consultation between the patient and health care provider
Participation in the medical consultation is fundamentally a communicative
event in which clinicians and patients use talk to exchange information, to
share their expertise and points of view, to build a trusting relationship,
and to make health-related decisions A growing body of evidence
indicates that patients who more actively participate in these encounters
are more
satisfied with their health care, receive more patient-centered care eg,
information,
support from providers, are more committed to treatment regimens, have
a
stronger
sense of control over health, and even experience better health following
the visit
than do more passive patients for reviews, see Kaplan, Greenfield Ware,
1989;
Roter Hall, 1993; Street, 2001 Because patient involvement is an
important part
of the health care process, it is imperative that investigators analyze the
phenomenon
using reliable and valid measures that have a solid conceptual foundation

In this article, we have three objectives First, we describe the
conceptual
foundation and measurement strategies used in our approach to analyzing the
communicative acts that constitute patient participation in medical
encounters
Second, we apply our method to an analysis of nine videotaped recordings of
physician-patient interactions Two research questions RQs will be
examined:
a To what extent do patients ask questions, express concerns, and engage
in assertive
behavior in their interactions with physicians? and b Are patients more
active communicators when their physicians use partnership building eg,
soliciting
the patients opinion and supportive talk eg, reassurance,
encouragement?
Finally, we conclude with a discussion of challenges and prospects for
developing more
ecologically valid and efficient procedures for assessing
patient
participation in care p 61

Wagner, Julie, Kimberly Lacey, Gina Abbott, Mary de Groot, Deborah Chyun
2006 Knowledge of Heart Disease Risk in a Multicultural Community Sample
of People With Diabetes Annals of Behavioral Medicine, Vol 31, No 3:
pages 224-230 PDF
Abstract: Background: Prevention of coronary heart disease CHD is a
primary goal of diabetes management Unfortunately, CHD risk knowledge is
poor among people with diabetes Purpose: The objective is to determine
predictors of CHD risk knowledge in a community sample of people with
diabetes Methods: A total of 678 people with diabetes completed the Heart
Disease Facts Questionnaire HDFQ, a valid and reliable measure of
knowledge about the relationship between diabetes and heart disease
Results: In regression analysis with demographics predicting HDFQ scores,
sex, annual income, education, and health insurance status predicted HDFQ
scores In a separate regression analysis, having CHD risk factors did not
predict HDFQ scores, however, taking medication for CHD risk factors did
predict higher HDFQ scores An analysis of variance showed significant
differences
between ethnic groups for HDFQ scores; Whites M 209 showed
more CHD risk knowledge than African Americans M 196, who in turn
showed more than Latinos M 182 Asians scored near Whites M 204
but did not differ significantly from any other group Controlling for
numerous demographic, socioeconomic, health care, diabetes, and
cardiovascular health variables, the magnitude of ethnic differences was
attenuated, but persisted Conclusion: Education regarding modifiable risk
factors must be delivered in a timely fashion so that lifestyle
modification can be implemented and evaluated before pharmacotherapy is
deemed necessary African Americans and Latinos with diabetes are in the
greatest need of education regarding CHD risk

Whaley, Bryan S Explaining Illness: Research, Theory, and Strategies New
Jersey: Lawrence Erlbaum, 2000 Available as an electronic book through net
librarycom
Chapter: 13: Explaining Illness to African Americans: Employing Cultural
Concerns with Strategies Carolyn A Stroman, Department of Human
Communication Studies
Howard University
Prayer and repentance, not penicillin, cure sin
-Snow 1978, p 73
QUOTE page 299: This quotation cogently illustrates the central theme
of
this chapter; indeed, of this book: Culture is a key variable in the health
care arena and specifically in the explanation and understanding of
illness As used here, culture refers to the world views, values, beliefs,
attitudes, and behaviors that one acquires as a member of a given social
group Brown, 1963; Harwood, 1981 Culture has also been defined
expansively to include a broad range of social factors that lead people to
think and act in very unique ways Kreps Kunimoto, 1994, p 2

Cultural differences abound in the health care system; such variance
manifests in the medical encounter on various levels Differences in world
views exist between health care practitioners who hold notions
characterized and expressed by medical terminology and patients who enter
the situ-

PAGE 300-QUOTE: When race and ethnicity are factors in the patient-health
care practitioner equation, cultural differences take on a different
intensity As evidence of this, a great deal of research points to the
existence of sociocultural and socioeconomic differences in behavior and
reactions to illness, both among and within racial and ethnic groups
Furthermore, racial and social class biases have been found
in the
diagnosis and treatment of illness Blendon, Aiken, Freeman, Corey,
1989

PAGE 300-301: This chapter provides a framework for highlighting the
pivotal role of culture in the explanation and understanding of illness by
focusing on African Americans Specifically, the chapter: a describes
several features of African-American culture that have particular relevance
for communicating about illness, with special attention focused on the role
of religion, spirituality, and social support; b examines extant research
on explaining illness to African Americans; and c offers communication
strategies for explaining illness and improving health outcomes The
chapter concludes with suggestions for future research pertaining to
illness explanation among African Americans

QUOTE PAGE 301: In recent years, scholars have identified a number of
protective factors that help foster resiliency for individuals in
responding to risk in African-American life and culture Hill, 1972;
Taylor, Jackson, Chatters, 1997 Two protective factors-strong religious
orientation and strong kinship ties-hold particular significance for
illness and illness explanation

QUOTE PAGE 303: African Americans utilize a
range of sources for advice
and illness explanation Bailey 1987 found the following pattern of
health care seeking among a sample of African Americans residing in the
Detroit metropolitan area-after an illness occurred, the respondents
initially waited for a certain period of time for the body to heal itself
If healing did not occur, they sought advice from a family member, friend,
or even church leaders and-or a traditional healer Finally, they would
seek help from a physician

QUOTE PAGE 305: Research on Illness Explanation and African Americans

Every day in various health care settings eg, a hospital, clinic, or
doctors office, a health care provider explains a given illness to a
patient This patient-provider interaction, which typically involves a
doctor but increasingly involves a nurse practitioner, physician assistant,
or other such practitioner, varies from situation to situation Generally,
however, within this interaction, one of the following aspects of illness
is explained: a the etiology or cause of the illness; b the timing and
mode of onset of symptoms associated with the illness; c the severity of
the illness; and d the appropriate treatments for the illness
Harwood,
1981; Helman, 1994

Explaining illness is a complex, multifaceted activity In this cross-
cultural exchange, patients are expected to convey their symptoms in a
manner understandable to the health care provider and in return, health
care providers must provide clear, nontechnical information about the
illness Patients concerns about aspects of the illness may serve to
complicate the illness explanation process and prevent them from
participating in the medical encounter

QUOTE PAGE 306: The literature on health care provider-patient
communication, especially doctor-patient, is voluminous However, little of
this research is theory-driven and the available literature has failed to
provide a body of knowledge regarding illness explanation As Cegala,
McGee, and McNeilis 1996 noted, relatively little is actually known
about the dynamics of how doctors and patients seek and provide information
during the medical interview p 4 Thus, it is clear why the information
on illness explanation to African Americans is scant

Even when health care providers disseminate health information
specifically targeted toward African Americans, illness is explained
ineffectively Guidry, Fagan, and
Walker 1998 evaluated the Cancer
Prevention Material and African Americans Project and found that in
addition to being culturally insensitive, much of the information was
written at inappropriate reading levels see chap 5, this volume

Quote PAGE 310-11:

Moreover, it is recommended that whether health care professionals explain
illness orally, in writing, or both, they should be certain that they: a
simplify instructions, b use nontechnical language, and c provide
explicit directions and consistent advice Harwood, 1981; Svarstad, 1986;
Sylvester, 1998 As Jackson 1981 observed: physicians who provide
adequate explanations of their diagnoses will find that many of their urban
black patients understand them and have some awareness of the restrictions
or consequences that may be involved p 100; an adequate explanation
would, for example, detail the etiology, severity, and possible progression
of an illness in nontechnical terminology

Washington, A Eugene, Anna Nápoles-Springer , Deirdra A Forté , Mark
Alexander , Eliseo J Pérez-Stable Establishing Centers to Address
Treatment Effectiveness in Diverse Ethnic Groups: The MEDTEP Experience
Ethnicity and Health Routledge, part of the
Taylor Francis Group,
Volume 7, Number 4 / 2002, Pages: 231 - 242 No PDF
Objective To investigate racial ethnic and socioeconomic disparities in
health outcomes amenable to improvement through more effective delivery of
health care services

Design The Medical Treatment Effectiveness Program MEDTEP Research
Centers on Minority Populations were a group of centers in the USA funded
to improve the effectiveness of medical diagnosis and treatment to provide
technical assistance to ethnic minority health researchers to train new
researchers and to disseminate information to help ethnic minority patients
and their health care providers

Results Centers often provided many specific findings related to
assessment of the magnitude of disparities in health outcomes and to
approaches for eliminating these outcomes The Centers were able to build
community partnerships using an approach now defined as community-based
participatory research Centers changed the culture of their institutions
by making them more aware of the need to train diverse investigators and do
more to eliminate health disparities

Conclusions A key to the success of the Centers has been the unification
of a cadre of
committed investigators dedicated to the mentoring of
minority health researchers and to the elimination of ethnic and
socioeconomic disparities in health The MEDTEP Centers provide a model but
there remains a need for continued work

Whittemore Robin, Gail DEramo Melkus, Margaret Grey 2004 Applying the
Social Ecological Theory to Type 2 Diabetes Prevention and Management
Journal of Community Health Nursing Vol 21, No 2, Pages 87-99 PDF
Abstract: Obesity and Type 2 diabetes have become major public health
problems in the United States Community health nurses, with expertise in
preventive health care, have the potential to play a vital role in
addressing these significant health issues The purposes of this article1
are to identify current challenges related to obesity and Type 2 diabetes
and to present the social ecological theory as a framework for the
expansion of the reach of diabetes prevention and management that is
relevant to community health nurses

Quote page 88: However, research has documented that the typical consumer
of
diabetes education programs is highly motivated, educated, and White and
that there is
limited reach of these programs to ethnic minorities Eakin, Bull,
Glasgow,
Mason
2002; Glasgow, Eakin, Toobert, 1996 However, diabetes prevalence rates
are two to
six times higher in African American, Native American, and Hispanic
populations Centers for Disease Control [CDC], 2003 Culturally specific
programs have been developed with promising findings, and culturally
specific educational materials are becoming increasingly available
American Diabetes Association, 2003; Brown, Upchurch, Garcia,
Barton,Hanis, 1998; CDC, 2003; RaymondDEramo-Melkus, 1993 However,
these programs have had varying degrees of success in reaching the targeted
population Eakin et al, 2002, and the actual translation into clinical
practice is unknown

Specific Diabetes Electronic Journals Available at MSU highlighted in
green were searched in addition to others-recommend Diabetes Educator for
additional sources:

1 Clinical Diabetes,
2 Diabetes, not searchable but volumes listed, might be searchable in
another database
3 Diabetes / Metabolism Reviews,
4 Diabetes Care,
5 Diabetes Educator,
6 Diabetes Forecast,
7 Diabetes Week,
8 Diabetes, Obesity and Metabolism,
9 International Journal of Experimental Diabetes Research,
10 Journal of
Diabetes Nursing, searchable within health info trac
11 Pediatric Diabetes,
12 Practical Diabetes International
———————–

Quinn, Michael T, Sandy Cook, Kyle Nash, and Marshall H Chin 2001
Addressing Religion and Spirituality in African Americans With DiabetesPDF
The Diabetes Educator, September/October 2001; 27: 643 - 655 PDF

Source:idf.org