Assessment of Chronic Disease Management Strategies Among Health Care Practices in Medically Underserved South Carolina Counties

Diabetes and heart disease are among the leading causes of death and disability in the United States, and these conditions are especially prevalent in the South. South Carolina’s persistent racial and socioeconomic disparities in chronic disease outcomes are well-documented, yet little is known about how health care practices in medically underserved areas are addressing these challenges. Data were collected through a cross-sectional survey as part of two complementary 5-year cooperative agreements between the Centers for Disease Control and Prevention and the Division of Diabetes and Heart Disease Management (the Division) at the South Carolina Department of Health and Environmental Control. The Division fielded a survey to (a) assist in determining which Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) were best poised to implement specific strategies as part of these cooperative agreements and (b) provide data to establish the baseline for performance measures. FQHCs and RHCs in the top 25% of counties with the highest diabetes and heart disease burden were surveyed about eight domains: staffing/services, electronic health records, team-based care policies, lifestyle change programs, medication therapy management, telehealth, quality improvement collaboratives, and patient demographics. Data representing 71 practices revealed contrasts between RHCs and FQHCs and opportunities for improvement. For example, while most practices reported they were not implementing evidence-based lifestyle change programs (e.g., the National Diabetes Prevention Program), most RHCs and FQHCs expressed interest in starting such programs. Findings are being used to guide efforts to improve diabetes and heart disease prevention and management in South Carolina.

Modelling the complexity of pandemic-related lifestyle quality change and mental health: an analysis of a nationally representative UK general population sample

Purpose The COVID-19 pandemic has affected the way many individuals go about their daily lives. This study attempted to model the complexity of change in lifestyle quality as a result of the COVID-19 pandemic and its context within the UK adult population. Methods Data from the COVID-19 Psychological Research Consortium Study (Wave 3, July 2020; N = 1166) were utilised. A measure of COVID-19-related lifestyle change captured how individuals’ lifestyle quality had been altered as a consequence of the pandemic. Exploratory factor analysis and latent profile analysis were used to identify distinct lifestyle quality change subgroups, while multinomial logistic regression analysis was employed to describe class membership. Results Five lifestyle dimensions, reflecting partner relationships, health, family and friend relations, personal and social activities, and work life, were identified by the EFA, and seven classes characterised by distinct patterns of change across these dimensions emerged from the LPA: (1) better overall (3.3%), (2) worse except partner relations (6.0%), (3) worse overall (2.5%), (4) better relationships (9.5%), (5) better except partner relations (4.3%), (6) no different (67.9%), and (7) worse partner relations only (6.5%). Predictor variables differentiated membership of classes. Notably, classes 3 and 7 were associated with poorer mental health (COVID-19 related PTSD and suicidal ideation). Conclusions Four months into the pandemic, most individuals’ lifestyle quality remained largely unaffected by the crisis. Concerningly however, a substantial minority (15%) experienced worsened lifestyles compared to before the pandemic. In particular, a pronounced deterioration in partner relations seemed to constitute the more severe pandemic-related lifestyle change.

Insight into the Feasibility and Acceptability of a Multi-lifestyle Dementia Risk Intervention

Lifestyle interventions based on behaviour change principles may provide a useful mechanism in reducing dementia risk amongst older adults, however intervention acceptability remains relatively unexplored. We assessed the feasibility and acceptability of BRAIN BOOTCAMP, an Australian initiative aiming to improve dementia literary and reduce dementia risk by delivering a brain health box addressing multiple lifestyle factors through education, physical prompts and an individualised brain health profile. Semi-structured phone interviews were conducted with participants (N=94) at completion of the program (3-months) using a theoretical sampling approach to select a range of participants with varying brain health scores, age, gender, education and locality. Interview topics included participants’ overall experience and suggestions for program improvement. Interviews were transcribed and analysed using thematic analysis. Participants were mostly female (79%), with a mean age of 72.6 years (SD=5.4), from an English-speaking background (89.4%) and resided in metropolitan areas (76.6%). Participants positively perceived the program, resulting in high usability and acceptability. Valuable aspects included building dementia awareness in an innovative way, and having re-assessments which identified areas for personal improvement. Participants further discussed how the program prompted lifestyle change, including setting goals (e.g., physical activity) and facilitated a general awareness of their brain health. Suggested improvements included shorter surveys, regular check-ins, and specific tailoring of the program to be more inclusive for older adults with varying levels of health. Our study demonstrated that a simple, innovative program could be a promising medium for delivering comprehensive educational resources and induce lifestyle change for older adults.

Refining a primary care shared decision-making aid for lifestyle change: mixed methods study

BackgroundThe important role of primary care in promoting healthy lifestyle behaviours needs informed support.AimTo elicit views on a 39-item shared decision-making (SDM) aid (SHARE-D) for lifestyle change and refine it to improve implementation.Design & settingMixed methods study.MethodHealth professionals, patients, and support workers, with experience of managing, or a history of, cardio- or cerebrovascular disease, were purposively recruited based on age, gender, and urban/rural location (n = 34). Participants completed a survey, rating the importance of including each item in a decision-aid, designed for use by patients with health professionals, and suggesting modifications. Semi-structured interviews (n = 30/34) were conducted and analysed thematically.ResultsSubstantial agreement was observed on rating item inclusion. Based on survey and interview data, 9/39 items were removed; 13 were amended. Qualitative themes were: (i) core content of the decision-aid, (ii) barriers to use, (iii) motivation for lifestyle change, and (iv) primary care implementation. ‘Self-reflective’ questions and goal setting were viewed as essential components. The paper-based format, length, clarity, and time required were barriers to its use. Optional support considered within the aid was seen as important to motivate change. A digital version, integrated into patient record systems was regarded as critical to implementation. A revised 30-item aid was considered suitable for facilitating brief conversations and promoting patient autonomy.ConclusionThe SHARE-D decision aid for healthy lifestyle change appears to have good content validity and acceptability. Survey and interview data provided in-depth information to support implementation of a refined version. Further studies should examine its effectiveness.

Tikanga Hauora. The Hauora Homies: An evaluation of a Kaupapa Māori Weight Loss and Lifestyle Change Model

<p>Tikanga Hauora – The Hauora Homies: An evaluation of a Kaupapa Māori Weight Loss and Lifestyle Change Model provides an understanding about how tikanga was practised during the implementation of the Hauora Homies and Kick in the Butt programmes, specifically the cultural principles of whanaungatanga (relationship, kinship, sense of family connection) and manaakitanga (kindness, generosity, support, hospitality). The thesis looks at how participants understood tikanga and if they believed the programmes were kaupapa Māori in approach. The thesis then examines how these principles supported participants to achieve programme outcomes and the immediate impact of the programmes. Finally, this thesis explores the use of Facebook as the main mode of communication during the programmes to provide insight into how tikanga is transformed into an online space. The evaluation is positioned within a kaupapa Māori framework, since the Hauora Homies programmes was initiated by Māori, benefited Māori, and represented and legitimised Māori experiences and worldviews on the issue. Both the programmes and the evaluation are accountable to Māori participants. Continuous engagement with the participants of the programmes and the support of a whānau network were key aspects during the thesis process. In total there are 31 participants in this sample, 26 females and five males. Thirty participants identified themselves as Māori and one participant as Samoan. Interviews were conducted with 10 participants and one administrator. Facebook data representing 31 participants was utilised and personal observation notes provided further insight into the programmes. Interpretive analysis and descriptive statistics analysis, with an underlying ethnographic approach, were used to analyse the collected data. A kaupapa Māori approach facilitated an analysis from a Māori standpoint and Te Pae Mahutonga provided a Māori health framework to identify the health promotion outcomes of the Hauora Homies model. The evaluation found that tikanga played a significant role within the programmes and was a critical component which provided a whānau approach and platform for participants to express themselves as Māori where Māori culture and values were the social norm. Whanaungatanga and manaakitanga were found to be fundamental and were embedded and practised in the model and programmes by creating, maintaining and strengthening relationships by actively engaging with participants online and offline. The evaluation also found the programmes had a positive impact on participants’ knowledge, attitudes, behaviour and awareness, which supported them in reaching their weight loss and lifestyle change goals. The changes included increased nutritional knowledge, increased fitness, and confidence and leadership skills amongst others. This evaluation will contribute towards evidence-based research into what works and what does not for Māori in a tikanga Māori, kaupapa Māori setting. This can contribute towards the design and implementation of lifestyle programmes at a whānau (family), hapū (sub-tribe), iwi (tribe) and national level, as well as open a forum for indigenous people from other areas in the world.</p>

Tikanga Hauora. The Hauora Homies: An evaluation of a Kaupapa Māori Weight Loss and Lifestyle Change Model

<p>Tikanga Hauora – The Hauora Homies: An evaluation of a Kaupapa Māori Weight Loss and Lifestyle Change Model provides an understanding about how tikanga was practised during the implementation of the Hauora Homies and Kick in the Butt programmes, specifically the cultural principles of whanaungatanga (relationship, kinship, sense of family connection) and manaakitanga (kindness, generosity, support, hospitality). The thesis looks at how participants understood tikanga and if they believed the programmes were kaupapa Māori in approach. The thesis then examines how these principles supported participants to achieve programme outcomes and the immediate impact of the programmes. Finally, this thesis explores the use of Facebook as the main mode of communication during the programmes to provide insight into how tikanga is transformed into an online space. The evaluation is positioned within a kaupapa Māori framework, since the Hauora Homies programmes was initiated by Māori, benefited Māori, and represented and legitimised Māori experiences and worldviews on the issue. Both the programmes and the evaluation are accountable to Māori participants. Continuous engagement with the participants of the programmes and the support of a whānau network were key aspects during the thesis process. In total there are 31 participants in this sample, 26 females and five males. Thirty participants identified themselves as Māori and one participant as Samoan. Interviews were conducted with 10 participants and one administrator. Facebook data representing 31 participants was utilised and personal observation notes provided further insight into the programmes. Interpretive analysis and descriptive statistics analysis, with an underlying ethnographic approach, were used to analyse the collected data. A kaupapa Māori approach facilitated an analysis from a Māori standpoint and Te Pae Mahutonga provided a Māori health framework to identify the health promotion outcomes of the Hauora Homies model. The evaluation found that tikanga played a significant role within the programmes and was a critical component which provided a whānau approach and platform for participants to express themselves as Māori where Māori culture and values were the social norm. Whanaungatanga and manaakitanga were found to be fundamental and were embedded and practised in the model and programmes by creating, maintaining and strengthening relationships by actively engaging with participants online and offline. The evaluation also found the programmes had a positive impact on participants’ knowledge, attitudes, behaviour and awareness, which supported them in reaching their weight loss and lifestyle change goals. The changes included increased nutritional knowledge, increased fitness, and confidence and leadership skills amongst others. This evaluation will contribute towards evidence-based research into what works and what does not for Māori in a tikanga Māori, kaupapa Māori setting. This can contribute towards the design and implementation of lifestyle programmes at a whānau (family), hapū (sub-tribe), iwi (tribe) and national level, as well as open a forum for indigenous people from other areas in the world.</p>

Rethinking sustainability during WFH: A survey on living environment quality and energy use

This study is trying to investigate the occupant’s lifestyle change during the ‘Work from Home’ (WFH) in face of the COVID-19 pandemic in Indonesia. It is predicted that energy use, especially electricity use in the housing sector is increasing due to longer in-home period during activities restriction. In addition, the household’s way of using their thermal appliances such as air conditioner (AC), electric fan, and the ventilation ways by windows are also predicted to increase in hot and humid climate cities. For that reason, the survey was conducted during the mid of April to the end of April 2021 through the web-based questionnaires which are targeting the individual and families. First, the data collected are summarized includes the building characteristics, family structures, home appliances, lifestyle, and the ownership of thermal air conditioning system appliances. Secondly, to grasp the change in electricity use, we summarized the results about the lifestyle change related to home energy use during the period of WFH. Finally, from the results of this survey, people’s concerns and awareness regarding the health and quality of the surrounding environment are increasing. This could be good momentum for authority to establish a modern society with awareness and a good quality environment. A strategy for energy distribution and increasing the use of renewable energy in household buildings is needed to meet demand and build a sustainable society.

Delivery of healthcare provider’s lifestyle advice and lifestyle behavioural change in adults who were overweight or obese in pre-diabetes management in the USA: NHANES (2013–2018)

ObjectiveThe purpose of this study is to examine the association between delivery of healthcare provider’s advice about lifestyle management and lifestyle behavioural change in pre-diabetes management in adults who were overweight or obese.DesignThis cross-sectional study included adults with body mass index (BMI) ≥25 kg/m2 and reporting pre-diabetes in USA. Outcomes included the prevalence of receiving provider’s advice on lifestyle management and patterns of practicing lifestyle change. The association between delivery of provider’s advice and lifestyle-related behavioural change in pre-diabetes management was examined.SettingUS Continuous National Health and Nutrition Examination Survey (2013–2018).ParticipantsA total of 1039 adults with BMI ≥25 kg/m2 reported pre-diabetes.ResultsOf eligible adults with pre-diabetes, 76.8% received provider’s advice about lifestyle change. The advice group showed higher proportions of ongoing lifestyle change than no advice group, including weight reduction/control (80.1% vs 70.9%, p=0.018), exercise (70.9% vs 60.9%, p=0.013) and diet modifications (83.8% vs 61.8%, p<0.001). After adjustment, those receiving provider’s advice were more likely to increase exercise (OR 1.63, 95% CI 1.12 to 2.38) and modify diet (OR 3.0, 95% CI 1.82 to 4.96).ConclusionOver 75% of US adults who were overweight or obese and reported pre-diabetes received healthcare provider’s advice about reducing the risk of diabetes through lifestyle change. Provider’s advice increased the likelihood of lifestyle-related behavioural change to exercise and diet.

The impact of health literacy-sensitive design and heart age in a cardiovascular disease prevention decision aid: randomised controlled trial and end user testing (Preprint)

BACKGROUND Shared decision making is as an essential principle for cardiovascular disease (CVD) prevention, where asymptomatic people are considering lifelong medication and lifestyle changes. OBJECTIVE This project aimed to develop and evaluate the first literacy-sensitive CVD prevention decision aid (DA) developed for people with low health literacy, and investigate the impact of literacy-sensitive design and heart age. METHODS We developed the standard DA based on international standards. The standard DA was based on our existing GP decision aid; the literacy-sensitive DA included simple language, supporting images, white space and a lifestyle action plan; the control DA used Heart Foundation materials. A randomised trial included 859 people aged 45-74 using a 3 (DA: standard, literacy-sensitive, control) x 2 (heart age: heart age + percentage risk, percentage risk only) factorial design, with outcomes including prevention intentions/behaviours, gist/verbatim knowledge of risk, credibility, emotional response and decisional conflict. We iteratively improved the literacy-sensitive version based on end user testing interviews with 20 people with varying health literacy levels. RESULTS Immediately post-intervention (n=859), there were no differences between the DA groups on any outcome. The heart age group was less likely to have a positive emotional response, perceived the message as less credible, and had higher gist/verbatim knowledge of heart age risk but not percentage risk. After 4 weeks (n=596), the DA groups had better gist knowledge of percentage risk than control. The literacy-sensitive decision aid group had higher fruit consumption, and the standard decision aid group had better verbatim knowledge of percentage risk. Verbatim knowledge was higher for heart age than percentage risk amongst those who received both. CONCLUSIONS The literacy-sensitive DA resulted in increased knowledge and lifestyle change for participants with varying health literacy levels and CVD risk results. Adding heart age did not increase lifestyle change intentions or behaviour but did affect psychological outcomes, consistent with previous findings. CLINICALTRIAL The trial protocol was pre-registered at ANZCTR (Trial number ACTRN12620000806965).