scholarly journals The Design, Usability, and Feasibility of a Family-Focused Diabetes Self-Care Support mHealth Intervention for Diverse, Low-Income Adults with Type 2 Diabetes

2016 ◽  
Vol 2016 ◽  
pp. 1-13 ◽  
Author(s):  
Lindsay Satterwhite Mayberry ◽  
Cynthia A. Berg ◽  
Kryseana J. Harper ◽  
Chandra Y. Osborn
Keyword(s):  
Type 2 Diabetes ◽  
Low Socioeconomic Status ◽  
Low Income ◽  
Family Members ◽  
Self Care ◽  
Text Messages ◽  
User Engagement ◽  
Mhealth Intervention ◽  
Care Support

Family members’ helpful and harmful actions affect adherence to self-care and glycemic control among adults with type 2 diabetes (T2D) and low socioeconomic status. Few family interventions for adults with T2D address harmful actions or use text messages to reach family members. Through user-centered design and iterative usability/feasibility testing, we developed a mHealth intervention for disadvantaged adults with T2D called FAMS. FAMS delivers phone coaching to set self-care goals and improve patient participant’s (PP) ability to identify and address family actions that support/impede self-care. PPs receive text message support and can choose to invite a support person (SP) to receive text messages. We recruited 19 adults with T2D from three Federally Qualified Health Centers to use FAMS for two weeks and complete a feedback interview. Coach-reported data captured coaching success, technical data captured user engagement, and PP/SP interviews captured the FAMS experience. PPs were predominantly African American, 83% had incomes <$35,000, and 26% were married. Most SPs (n=7) were spouses/partners or adult children. PPs reported FAMS increased self-care and both PPs and SPs reported FAMS improved support for and communication about diabetes. FAMS is usable and feasible and appears to help patients manage self-care support, although some PPs may not have a SP.

scholarly journals Disparities in the use of a mHealth medication adherence promotion intervention for low-income adults with type 2 diabetes

2015 ◽  
Vol 23 (1) ◽  
pp. 12-18 ◽  
Author(s):  
Lyndsay A Nelson ◽  
Shelagh A Mulvaney ◽  
Tebeb Gebretsadik ◽  
Yun-Xian Ho ◽  
Kevin B Johnson ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Depressive Symptoms ◽  
Medication Adherence ◽  
Health Literacy ◽  
Low Income ◽  
Mhealth Intervention ◽  
Lower Health ◽  
The Relationship ◽  
Lower Health Literacy

Abstract Objective Mobile health (mHealth) interventions may improve diabetes outcomes, but require engagement. Little is known about what factors impede engagement, so the authors examined the relationship between patient factors and engagement in an mHealth medication adherence promotion intervention for low-income adults with type 2 diabetes (T2DM). Materials and Methods Eighty patients with T2DM participated in a 3-month mHealth intervention called MEssaging for Diabetes that leveraged a mobile communications platform. Participants received daily text messages addressing and assessing medication adherence, and weekly interactive automated calls with adherence feedback and questions for problem solving. Longitudinal repeated measures analyses assessed the relationship between participants’ baseline characteristics and the probability of engaging with texts and calls. Results On average, participants responded to 84.0% of texts and participated in 57.1% of calls. Compared to Whites, non-Whites had a 63% decreased relative odds (adjusted odds ratio [AOR] = 0.37, 95% confidence interval [CI], 0.19-0.73) of participating in calls. In addition, lower health literacy was associated with a decreased odds of participating in calls (AOR = 0.67, 95% CI, 0.46-0.99, P = .04), whereas older age ( Pnonlinear = .01) and more depressive symptoms (AOR = 0.62, 95% CI, 0.38-1.02, P = .059) trended toward a decreased odds of responding to texts. Conclusions Racial/ethnic minorities, older adults, and persons with lower health literacy or more depressive symptoms appeared to be the least engaged in a mHealth intervention. To facilitate equitable intervention impact, future research should identify and address factors interfering with mHealth engagement.

An Adaptive, Algorithm-based Text Message Intervention to Promote Health Behavior Adherence in Type 2 Diabetes: Treatment Development and Proof-of-Concept Trial

2021 ◽  
pp. 193229682110650
Author(s):  
Christopher M. Celano ◽  
Christina Massey ◽  
Jessica Long ◽  
Sonia Kim ◽  
Olivia Velasquez ◽  
...  
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Adaptive Algorithm ◽  
Controlled Trial ◽  
Text Message ◽  
Self Care ◽  
Well Being ◽  
Psychological Outcomes ◽  
Text Messages

Background: Most individuals with type 2 diabetes (T2D) struggle to adhere to one or more health behaviors. Text message interventions (TMIs) have the potential to improve adherence but have had mixed effects on diet and activity in T2D. We developed an eight-week, adaptive, algorithm-driven TMI to promote physical activity, diet, self-care, and well-being. Then, in a single-arm trial, we assessed its feasibility, acceptability, and preliminary efficacy in 15 individuals with T2D and suboptimal adherence. Methods: Participants received daily text messages and were asked to rate the utility of each message (0=not helpful, 10=very helpful). These ratings were used by an algorithm to select subsequent messages based on each participant’s prior ratings. We assessed intervention feasibility by rates of message transmission/response and acceptability through ratings of message utility and burden. Finally, we examined pre-post changes in diabetes self-care, diet, physical activity, and psychological outcomes and calculated effect sizes (Cohen’s d). Results: All text messages were delivered, and participants provided ratings for 79% of messages, above our a priori thresholds for feasibility. Participants rated the individual messages and overall TMI as subjectively useful (utility: 8.1 [SD=2.1] and 7.8 [SD=2.0], respectively) and not burdensome (burden: 0.8 [SD=1.8]). The intervention led to significant, medium- to large-sized improvements in self-care ( d=0.77), diet ( d=0.99), and activity ( d=0.61) but minimal change in psychological outcomes. Conclusions: The TMI was feasible and well-accepted, and it led to promising improvements in adherence-related outcomes. These findings should be confirmed in a larger randomized controlled trial.

scholarly journals The MEssaging for Diabetes Intervention Reduced Barriers to Medication Adherence Among Low-Income, Diverse Adults With Type 2

2016 ◽  
Vol 11 (1) ◽  
pp. 92-99 ◽  
Author(s):  
Lindsay S. Mayberry ◽  
Shelagh A. Mulvaney ◽  
Kevin B. Johnson ◽  
Chandra Y. Osborn
Keyword(s):  
Medication Adherence ◽  
Low Income ◽  
Text Messages ◽  
Self Report ◽  
Mhealth Intervention ◽  
Adherence Assessment ◽  
Diabetes Intervention ◽  
The Cost ◽  
Nested Regression

Background: Nonadherence to diabetes medication is prevalent and costly. MEssaging for Diabetes (MED), a mobile health (mHealth) intervention, identified and addressed user-specific barriers to medication adherence. We assessed whether MED reduced users’ targeted barriers and if barrier reductions were associated with within-participant improvements in adherence or glycemic control (HbA1c). Methods: Adults (N = 80) with type 2 diabetes completed self-report measures identifying barriers to adherence at baseline and monthly for 3 months. At each assessment, 17 barriers were assessed and ranked for each user. Each subsequent month, users received daily text messages addressing their 3 highest ranked barriers. Targeted barriers were different for each participant and could change monthly. Paired t-tests assessed within-participant improvement in targeted barriers each month, and nested regression models assessed if changes in a participant’s barrier scores were associated with improvements in adherence and HbA1c. Results: Participants were 69% non-white and 82% had incomes <$25K. Average HbA1c was 8.2 ± 2.0%. Assessment completion rates were 100% at baseline, 59% at 1 month, 30% at 2 months, and 65% at 3 months. The most commonly reported barriers were the cost of medications (76%), believing medications are harmful (58%), and lacking information about medications (53%). Participants’ barrier scores improved each month and barrier improvement predicted adherence assessed via nightly adherence assessment text messages ( P < .001). Among participants who completed assessments each month, barrier improvement in months 2 and 3 ( P < .05) predicted HbA1c improvement. Conclusions: Iterative, individual tailoring may overcome users’ barriers to adherence. Attrition is a challenge for mHealth interventions among low-income patients.

Self-Care Behaviors and Glycemic Control in Low-Income Adults in México With Type 2 Diabetes Mellitus May Have Implications for Patients of Mexican Heritage Living in the United States

2015 ◽  
Vol 25 (2) ◽  
pp. 120-138 ◽  
Author(s):  
Lidia G. Compeán Ortiz ◽  
Beatriz Del Ángel Pérez ◽  
Eunice Reséndiz González ◽  
Socorro Piñones Martínez ◽  
Nora H. González Quirarte ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
United States ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Glycemic Control ◽  
Low Income ◽  
Self Care ◽  
The United States ◽  
Mexican Heritage

scholarly journals Influence of social determinants, diabetes knowledge, health behaviors, and glycemic control in type 2 diabetes: An analysis from real-world evidence

2020 ◽  
Author(s):  
Rubén Silva-Tinoco ◽  
Teresa Cuatecontzi-Xochitiotzi ◽  
Viridiana De la Torre-Saldaña ◽  
Enrique León-García ◽  
Javier Serna-Alvarado ◽  
...  
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Primary Care ◽  
Glycemic Control ◽  
Mexico City ◽  
Low Income ◽  
Self Care ◽  
Diabetes Knowledge ◽  
Care Behavior

Abstract Background Although important achievements have been done in type 2 diabetes mellitus (T2D) treatment and glycemic control, new strategies may take advantage of non-pharmacological approaches and of other potential determinants of health (e.g., socioeconomic status, education, diabetes knowledge, physical activity, and self-care behavior). However, the relationships between these factors are not totally clear and have not been studied in the context of large urban settings. This study aimed to explore the relationship between these determinants of glycemic control (GC) in a low-income urban population from Mexico City, focused in exploring potential the mediation of self-care behaviors in the association between diabetes knowledge and GC.Methods A multicenter cross-sectional study was conducted in patients with type 2 diabetes (T2D) from 28 primary care outpatient centers located in Mexico City. Using multivariable-adjusted models, we determined the associations between diabetes knowledge, self-care behaviors, and GC. The mediation analyses to determine the pathways on glycemic control were done using linear regression models, where the significance of indirect effects was calculated with bootstrapping.Results The population (N=513) had a mean age of 53.8 years (standard deviation: 11.3 yrs.), and 65.9% were women. Both socioeconomic status and level of education were directly associated with diabetes knowledge. Using multivariable-adjusted linear models, we found that diabetes knowledge was associated with GC (β: -0.102, 95% Confidence Interval [95% CI] -0.189, -0.014). Diabetes knowledge was also independently associated with self-care behavior (for physical activity: β: 0.181, 95% CI 0.088, 0.273), and self-care behavior was associated with GC (for physical activity: β: -0.112, 95% CI -0.194, -0.029). The association between diabetes knowledge and GC was not observed after adjustment for self-care behaviors, especially physical activity (β: -0.084, 95% CI -0.182, 0.014, p-value: 0.062). Finally, the mediation models showed that the effect of diabetes knowledge on GC was 17% independently mediated by physical activity (p-value: 0.049). Conclusions Socioeconomic and educational gradients influence diabetes knowledge among primary care patients with type 2 diabetes. Self-care activities, particularly physical activity, mediated the effect of diabetes knowledge on GC. Our results indicate that diabetes knowledge should be reinforced in low-income T2D patients, with an emphasis on the benefits physical activity has on improving GC.

scholarly journals Determinants of Glycemic Control among Urban Patients with Type 2 Diabetes: A mediation analysis from real-world evidence

2020 ◽  
Author(s):  
Rubén Silva-Tinoco ◽  
Teresa Cuatecontzi-Xochitiotzi ◽  
Viridiana De la Torre-Saldaña ◽  
Enrique León-García ◽  
Javier Serna-Alvarado ◽  
...  
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Low Income ◽  
Self Care ◽  
P Value ◽  
Diabetes Knowledge ◽  
Linear Regression Models ◽  
Care Behavior

Abstract Aims To explore the determinants of glycemic control (GC) among patients with type 2 diabetes (PwD) to provide insight into the pathways of the effect of diabetes knowledge on GC.Methods A multicenter cross-sectional study was conducted in PwD from 28 primary outpatient centers located in Mexico City. Using the multivariable-adjusted models, we determined the associations between diabetes knowledge, self-care behaviors, and glycemic control. The mediation analyses used linear regression models, where the significance of indirect effects was calculated with bootstrapping.Results The population (N=513) had a mean age of 53.8 years (standard deviation: 11.3 yrs.), and 65.9% were women. Using multivariable-adjusted linear models, we found that diabetes knowledge was associated with glycemic control (β: -0.102, 95% Confidence Interval [95% CI] -0.189, -0.014). Diabetes knowledge was also independently associated with self-care behavior (for physical activity: β: 0.181, 95% CI 0.088, 0.273), and self-care behavior was associated with glycemic control (for physical activity: β: -0.112, 95% CI -0.194, -0.029).The association between diabetes knowledge and glycemic control was lost after adjustment for self-care behaviors, especially physical activity (β: -0.084, 95% CI -0.182, 0.014, p -value: 0.062). Finally, the mediation models showed that the effect of diabetes knowledge on glycemic control was 17% independently mediated by physical activity ( p -value: 0.049).Conclusions Self-care activities, particularly physical activity, mediated the effect of diabetes knowledge on glycemic control. Our results indicate that diabetes knowledge should be reinforced in low-income PwD, with an emphasis on the benefits physical activity has on improving GC.

Self-Reported Physical Activity in Medically Underserved Adults With Type 2 Diabetes in Clinical and Community Settings

2015 ◽  
Vol 12 (7) ◽  
pp. 968-975 ◽  
Author(s):  
John Cooper ◽  
Barbara Stetson ◽  
Jason Bonner ◽  
Sean Spille ◽  
Sathya Krishnasamy ◽  
...  
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Low Income ◽  
Short Form ◽  
International Comparisons ◽  
Self Care ◽  
Community Dwelling ◽  
Self Report ◽  
Clinical Settings

Background:This study assessed physical activity (PA) in community dwelling adults with Type 2 diabetes, using multiple instruments reflecting internationally normed PA and diabetes-specific self-care behaviors.Methods:Two hundred and fifty-three Black (44.8%) and White (55.2%) Americans [mean age = 57.93; 39.5% male] recruited at low-income clinic and community health settings. Participants completed validated PA self-report measures developed for international comparisons (International Physical Activity Questionnaire Short Form), characterization of diabetes self-care (Summary of Diabetes Self-Care Activities Measure; SDSCA) and exercise-related domains including provider recommendations and PA behaviors and barriers (Personal Diabetes Questionnaire; PDQ).Results:Self-reported PA and PA correlates differed by instrument. BMI was negatively correlated with PA level assessed by the PDQ in both genders, and assessed with SDSCA activity items in females. PA levels were low, comparable to previous research with community and diabetes samples. Pain was the most frequently reported barrier; females reported more frequent PA barriers overall.Conclusions:When using self-report PA measures for PA evaluation of adults with diabetes in clinical settings, it is critical to consider population and setting in selecting appropriate tools. PA barriers may be an important consideration when interpreting PA levels and developing interventions. Recommendations for incorporating these measures in clinical and research settings are discussed.

scholarly journals Exploring the barriers and facilitators of dietary self-care for type 2 diabetes: a qualitative study in Ghana

2019 ◽  
Vol 9 (3) ◽  
pp. 223-232 ◽  
Author(s):  
Martin Hushie
Keyword(s):  
Type 2 Diabetes ◽  
Family Members ◽  
Self Care ◽  
Adult Patients ◽  
Barriers And Facilitators ◽  
Future Research ◽  
Health Providers ◽  
Diabetes Clinic ◽  
Management Interventions

Background: There is an increasing prevalence of type 2 diabetes (T2D) globally and countries in Sub Sahara Africa, such as Ghana are contending with the epidemic. The main objective of this study was to explore the barriers and facilitators of T2D self-care as perceived by patients and health providers (HPs) in Ghana. Methods: A maximum variation sample of 33 adult patients with a range of demographic features, diabetic conditions and self-care regimens and 3 providers were purposely selected from the specialist diabetes clinic of a private hospital in Accra, Ghana. Data were collected using indepth interviews, which were recorded and transcribed; and non-participant observational field notes-that were analyzed thematically through directed content analysis. Results: The findings reveal that T2D adult patients face many inter-related challenges to diabetes self-care, than enabling factors that fell into four major domains:1) the counselling process and context (patients missing follow-up appointments, unacceptance of diagnosis); 2) recommended food and diet regimens (changing habitual diets, dislike and confusion about recommended diets); 3) social aspects (social functions interfering with dietary regimens, family members diverting patient from dietary goals) and 4) fears (non-disclosure to family member/ pretense of being well). Conclusion: Integrated self-management interventions are needed to address these barriers, including tailoring dietary education to patients’ specific needs, guiding patients on how to manage diet during social occasions and among family members; and as well, providing mental health support. Future research should focus on T2D self-care behaviours and practices outside the clinic, including home, work and shopping environments.

scholarly journals Self-Care and Family Support among People with Type 2 Diabetes

2020 ◽  
Author(s):  
Shashi Kandel ◽  
Wit Wichaidit
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Factor Analysis ◽  
Family Support ◽  
Exploratory Factor Analysis ◽  
Family Members ◽  
Self Care ◽  
Daily Physical Activity ◽  
Care Practices

Objective: To assess the prevalence of self-care practices, and family support among people with type 2 diabetes. Material and Methods: We conducted a cross-sectional study among outpatients for people with type 2 diabetes, at a teaching hospital in Kathmandu, Nepal. We modified the Summary of Diabetes Self-Care Activities, and Diabetes Family Behavior Checklist scales; to measure self-care practices and perceived family support, respectively, so as to better suit the Nepali context. We performed an exploratory factor analysis to identify independent, latent dimensions of family support. Results: We recruited 411 patients (56.9% females), aged between 25 and 92. From these, we found high levels of adherence to daily intakes of the oral hypoglycemic agent (98.2%) and insulin (100.0%), daily physical activity (86.4%) and daily vegetable consumption (78.3%). Respondents commonly reported that they, and their family members ate meals together (98.1%). Family members also suggested things to help them take their medications on time (89.5%) and additionally helped them to decide on changes based on their glucose test results (84.2%). Exploratory factor analysis uncovered three behavior dimensions: nagging and arguing (“authoritarian”), praise and encouragement (“supportive”) and plan-making (“planning”). Conclusion: We presented data on self-care as well as family support among people with type 2 diabetes, tailored to the local context. From the data a high level of medication adherence and daily physical activity was observed. “Eating together” was the most reported family support behavior. We identified three dimensions of family support behaviors, which are potentially helpful for future health promotion programs, and provides a methodological basis for future studies in other low and middle-income countries.

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