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Andersen JA, Rowland B, Gloster E, Felix HC, Riklon S, Jenkins D, Bing WI, Mendoza Kabua P, Hudson JS, Edem D, Niedenthal J, McElfish PA. Assessment of diabetes self-care behaviors and knowledge among Marshallese adults with type 2 diabetes in the Republic of the Marshall Islands. Prim Care Diabetes 2024; 18:74-78. [PMID: 38040537 PMCID: PMC10922376 DOI: 10.1016/j.pcd.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 10/09/2023] [Accepted: 11/19/2023] [Indexed: 12/03/2023]
Abstract
AIMS The aim of this study is to assess and document engagement in type 2 diabetes mellitus (T2DM) self-care behaviors and self-reported diabetes knowledge among Marshallese adults living in the Republic of the Marshall Islands (RMI). METHODS The study uses data from a T2DM health screening study completed in the RMI; survey and biometric data were captured as part of the health screenings. Study objectives were examined using descriptive statistics to describe the characteristics of the participants, their diabetes self-care behaviors, and their levels of self-reported diabetes knowledge. RESULTS Results indicate many Marshallese diagnosed with T2DM did not engage in adequate self-care behaviors, including blood sugar checks and foot examinations. Participants reported having forgone needed medical care and medication due to issues with cost and/or access, and participants reported low levels of diabetes knowledge. CONCLUSIONS The results demonstrate the need for further work in improving engagement in diabetes self-care by Marshallese living in the RMI. Increased engagement in self-care and diabetes education programs may help Marshallese with T2DM to improve control of their glucose and avoid long-term health complications, as well as reduce costs to the healthcare system.
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Affiliation(s)
- Jennifer A Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA
| | - Erin Gloster
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA
| | - Holly C Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA
| | - Desiree Jenkins
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA
| | - Williamina Ioanna Bing
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA
| | - Philmar Mendoza Kabua
- College of Nursing, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Jonell S Hudson
- College of Pharmacy, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave., Fayetteville, AR 72703, USA
| | - Dinesh Edem
- College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA
| | - Jack Niedenthal
- Republic of the Marshall Islands Ministry of Health & Human Services, PO Box 16, Majuro, MH 96960, MH
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St., Springdale, AR 72762, USA.
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Guerra KMP, Corrêa ÁCDP, Oliveira JCAXD, Alvarenga EC, Rosa ITM. Self-care of informal male workers during the COVID-19 pandemic in the light of Orem's theory. Rev Gaucha Enferm 2023; 44:e20220351. [PMID: 37909518 DOI: 10.1590/1983-1447.2023.20220351.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/10/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVE To understand the self-care requirements of informal male workers in carrying out their activities during the COVID-19 pandemic, in the light of Orem's theory. METHOD Qualitative approach, with an exploratory descriptive nature. Data collection was conducted through a closed questionnaire, with questions that refer to the self-care requirements and semi-structured interviews, both conducted in a virtual environment. Ten men working as delivery workers and app drivers participated. Data analysis was performed using thematic content analysis. RESULTS The diagnosis of the self-care requirements performed by each of the interviewees was presented. FINAL CONSIDERATIONS The work performed by the participants influences the self-care requirements of the population studied, and it is possible to infer that as specializations of these requirements occur, they are no longer performed or are practiced superficially.
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Affiliation(s)
| | | | | | - Eric Campos Alvarenga
- Universidade Federal do Pará (UFPA), Departamento de Psicologia. Belém, Pará, Brasil
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Luig T, Ofosu NN, Chiu Y, Wang N, Omar N, Yip L, Aleba S, Maragang K, Ali M, Dormitorio I, Lee KK, Yeung RO, Campbell-Scherer D. Role of cultural brokering in advancing holistic primary care for diabetes and obesity: a participatory qualitative study. BMJ Open 2023; 13:e073318. [PMID: 37709303 PMCID: PMC10921915 DOI: 10.1136/bmjopen-2023-073318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 08/18/2023] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVES Diabetes and obesity care for ethnocultural migrant communities is hampered by a lack of understanding of premigration and postmigration stressors and their impact on social and clinical determinants of health within unique cultural contexts. We sought to understand the role of cultural brokering in primary healthcare to enhance chronic disease care for ethnocultural migrant communities. DESIGN AND SETTING Participatory qualitative descriptive-interpretive study with the Multicultural Health Brokers Cooperative in a Canadian urban centre. Cultural brokers are linguistic and culturally diverse community health workers who bridge cultural distance, support relationships and understanding between providers and patients to improve care outcomes. From 2019 to 2021, we met 16 times to collaborate on research design, analysis and writing. PARTICIPANTS Purposive sampling of 10 cultural brokers representing eight different major local ethnocultural communities. Data include 10 in-depth interviews and two observation sessions analysed deductively and inductively to collaboratively construct themes. RESULTS Findings highlight six thematic domains illustrating how cultural brokering enhances holistic primary healthcare. Through family-based relational supports and a trauma-informed care, brokering supports provider-patient interactions. This is achieved through brokers' (1) embeddedness in community relationships with deep knowledge of culture and life realities of ethnocultural immigrant populations; (2) holistic, contextual knowledge; (3) navigation and support of access to care; (4) cultural interpretation to support health assessment and communication; (5) addressing psychosocial needs and social determinants of health and (6) dedication to follow-up and at-home management practices. CONCLUSIONS Cultural brokers can be key partners in the primary care team to support people living with diabetes and/or obesity from ethnocultural immigrant and refugee communities. They enhance and support provider-patient relationships and communication and respond to the complex psychosocial and economic barriers to improve health. Consideration of how to better enable and expand cultural brokering to support chronic disease management in primary care is warranted.
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Affiliation(s)
- Thea Luig
- Physician Learning Program, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Nicole N Ofosu
- Physician Learning Program, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Yvonne Chiu
- Multicultural Health Brokers Cooperative, Edmonton, Alberta, Canada
| | - Nancy Wang
- Multicultural Health Brokers Cooperative, Edmonton, Alberta, Canada
| | - Nasreen Omar
- Multicultural Health Brokers Cooperative, Edmonton, Alberta, Canada
| | - Lydia Yip
- Multicultural Health Brokers Cooperative, Edmonton, Alberta, Canada
| | - Sarah Aleba
- Multicultural Health Brokers Cooperative, Edmonton, Alberta, Canada
| | - Kiki Maragang
- Multicultural Health Brokers Cooperative, Edmonton, Alberta, Canada
| | - Mulki Ali
- Multicultural Health Brokers Cooperative, Edmonton, Alberta, Canada
| | - Irene Dormitorio
- Multicultural Health Brokers Cooperative, Edmonton, Alberta, Canada
| | - Karen K Lee
- Division of Preventive Medicine, Department of Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Roseanne O Yeung
- Division of Endocrinology and Metabolism, Department of Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Denise Campbell-Scherer
- Physician Learning Program, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
- Family Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
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Andersen JA, Rowland B, O'Connor G, Bing WI, Riklon S, Mendoza-Kabua P, McElfish PA. Faith-based health screenings for Marshallese adults living in the Republic of the Marshall Islands: Study design and results. Front Public Health 2023; 11:1075763. [PMID: 37056659 PMCID: PMC10089260 DOI: 10.3389/fpubh.2023.1075763] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
Introduction Striking health disparities exist in the Republic of the Marshall Islands (RMI). The RMI has one of the highest age-adjusted type 2 diabetes mellitus (T2DM) rates in the world (23.0%) compared to global (9.3%) and United States (US; 13.3%) rates. We conducted health screenings including clinical indicators of T2DM and hypertension among Marshallese in the RMI. Methods Screenings were conducted at 20 churches on Majuro Atoll. Participants completed questionnaires and biometric data collection assessing glycated hemoglobin (HbA1c), blood pressure, and body mass index. Results Screenings included 528 participants and showed a high prevalence of T2DM, obesity, and hypertension. One-third of participants were referred to the non-communicable disease clinic. The percent of adults in this study with T2DM-indicative HbA1c (48.5%) is higher than observed at the national level (23.0%). Discussion Results highlight the need for non-communicable disease-related programs in the RMI.
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Affiliation(s)
- Jennifer A. Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, United States
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, United States
| | - Gail O'Connor
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, United States
| | - Williamina Ioanna Bing
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Springdale, AR, United States
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, United States
| | | | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, AR, United States
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Ewing LE, Pathak R, Landes RD, Skinner CM, Binz R, Young SG, Riklon S, Stahr S, Su J, Boerma M, McElfish PA, Hauer-Jensen M, Koturbash I. Cytogenetic and epigenetic aberrations in peripheral lymphocytes of northwest Arkansas Marshallese. Int J Radiat Biol 2022; 99:644-655. [PMID: 35939319 PMCID: PMC9929030 DOI: 10.1080/09553002.2022.2110319] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/28/2022] [Accepted: 07/22/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Nuclear weapons testing in the northern Marshall Islands between 1946 and 1958 resulted in ionizing radiation (IR) exposure of the thousands of Marshallese. Furthermore, numerous islands were contaminated by radioactive fallout. Significant increases in cancer and metabolic syndrome incidences have been reported among Marshallese, and potential for further increases looms due to the latency of radiation-induced health effects. The purpose of this study was to investigate the genetic and epigenetic effects of exposure to IR that could be associated with radiation-induced disease among the Northwest Arkansas (NWA) Marshallese. MATERIALS AND METHODS We performed analysis of chromosomal aberrations and DNA methylation based on residential and exposure history of NWA Marshallese. RESULTS Analysis of chromosomal aberrations demonstrated higher incidence of genetic rearrangements in women with self-reported history of radiation exposure (95% CI: 0.10, 1.22; p=.022). Further clustering of study participants based on their residential history demonstrated that participants who spent substantial amounts of time (≥6 months) in the northern atolls (thus, in the proximity of nuclear tests) before 1980 had more chromosomal aberrations than their peers who lived only in the southern atolls (95% CI: 0.08, -0.95; p=.021), and that this difference was driven by women. A relationship between the time spent in the northern atolls and increase in chromosomal aberrations was observed: 0.31 increase in chromosomal aberrations for every 10 years spent at northern atolls (95% CI: 0.06, 0.57; p=.020). Finally, significant inverse correlations between the chromosomal aberrations and the extent of DNA methylation of four LINE-1 elements L1PA2, L1PA16, L1PREC1, and L1P4B were identified. CONCLUSIONS The results of this study provide first evidence of the presence of stable genetic and epigenetic rearrangements in peripheral lymphocytes of NWA Marshallese and warrant further studies to analyze the role of radiation exposure in health disparities experienced by this Pacific Island nation.
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Affiliation(s)
- Laura E. Ewing
- Department of Environmental and Occupational Health, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W Markham Str, Little Rock, Arkansas, USA
- Department of Biochemistry and Molecular Biology, College of Medicine, University of Arkansas for Medical Sciences, 4301 W Markham Str, Little Rock, Arkansas, USA
| | - Rupak Pathak
- Division of Radiation Health, Department of Pharmaceutical Sciences, College of Pharmacy, University of Arkansas for Medical Sciences, 4301 W Markham Str, Little Rock, AR, USA
| | - Reid D. Landes
- Department of Biostatistics, College of Medicine, University of Arkansas for Medical Sciences, 4301 W Markham Str, Little Rock, Arkansas, USA
| | - Charles M. Skinner
- Department of Environmental and Occupational Health, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W Markham Str, Little Rock, Arkansas, USA
- Department of Biochemistry and Molecular Biology, College of Medicine, University of Arkansas for Medical Sciences, 4301 W Markham Str, Little Rock, Arkansas, USA
| | - Regina Binz
- Division of Radiation Health, Department of Pharmaceutical Sciences, College of Pharmacy, University of Arkansas for Medical Sciences, 4301 W Markham Str, Little Rock, AR, USA
| | - Sean G. Young
- Department of Environmental and Occupational Health, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W Markham Str, Little Rock, Arkansas, USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Shelbie Stahr
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W Markham Str, Little Rock, Arkansas, USA
| | - Joseph Su
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W Markham Str, Little Rock, Arkansas, USA
| | - Marjan Boerma
- Division of Radiation Health, Department of Pharmaceutical Sciences, College of Pharmacy, University of Arkansas for Medical Sciences, 4301 W Markham Str, Little Rock, AR, USA
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Martin Hauer-Jensen
- Division of Radiation Health, Department of Pharmaceutical Sciences, College of Pharmacy, University of Arkansas for Medical Sciences, 4301 W Markham Str, Little Rock, AR, USA
| | - Igor Koturbash
- Department of Environmental and Occupational Health, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 W Markham Str, Little Rock, Arkansas, USA
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Yaagoob E, Hunter S, Chan S. The effectiveness of social media intervention in people with diabetes: An integrative review. J Clin Nurs 2022; 32:2419-2432. [PMID: 35545822 DOI: 10.1111/jocn.16354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/21/2022] [Accepted: 04/25/2022] [Indexed: 12/29/2022]
Abstract
AIM This integrative review aimed to synthesise the available quantitative and qualitative studies on the effectiveness of diabetes self-management education (DSME) delivered through social media on glycaemic control (HbA1c), knowledge, health-related quality-of-life (HRQoL), anxiety, depression and self-efficacy in people with diabetes mellitus. BACKGROUND DSME is the main component of diabetes management which contributes to behavioural changes and the improvement of metabolic control and self-monitoring skills. Due to limited face-to-face access to healthcare services, social media has increasingly been used to deliver DSME for people with diabetes. However, there is a paucity of reviews addressing the effectiveness of using social media in delivering DSME. DESIGN An integrative review was conducted based on Whittemore and Knafl's (2005) methodology. METHODS The following databases were searched for relevant studies published between 2000 and 2020: Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, Cochrane Library, PsycINFO, EMBASE, EMCare and Google Scholar. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. The PRISMA checklist for systematic reviews was used. RESULTS A total of 13 studies met the inclusion criteria and were included in this review. Facebook and WhatsApp were the most common social media platforms used to deliver DSME intervention. Nurses were the most frequent DSME providers. The duration and content of DSME in the reviewed studies varied. Consistent positive outcomes were found on glycaemic control, diabetic knowledge and self-efficacy. No studies considered the effect of DSME on HRQoL, anxiety and depression. CONCLUSIONS Social media DSME can be effective in reducing HbA1c levels, increasing diabetic knowledge and self-efficacy. Further studies are needed to examine the effectiveness of using social media to deliver DSME intervention on HRQoL, anxiety and depression. RELEVANCE TO CLINICAL PRACTICE This review provides nurses and healthcare professionals with evidence to support the use of social media to deliver DSME for people with diabetes. DSME delivered via social media supported by nurses would overcome limitations of face-to-face delivery such as geographical distance, travelling time, or other limited resources by patients with diabetes.
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Affiliation(s)
- Esmaeel Yaagoob
- School of Nursing and Midwifery, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Sharyn Hunter
- School of Nursing and Midwifery, The University of Newcastle, Callaghan, New South Wales, Australia
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McElfish PA, Rowland B, Scott AJ, Boyers J, Long CR, Felix HC, Kaholokula JK, Sinclair K, Bursac Z, Riklon S. Examining the Relationship Between Physical Activity and Self-Efficacy for Exercise Among Overweight and Obese Marshallese Adults. J Immigr Minor Health 2022; 24:461-468. [PMID: 33837895 PMCID: PMC9540904 DOI: 10.1007/s10903-021-01194-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2021] [Indexed: 01/26/2023]
Abstract
This study examined associations between physical activity frequency and self-efficacy for exercise (SEE) among Marshallese adults in the United States. Data were collected from overweight and obese Marshallese participants (N = 378) enrolled in a Diabetes Prevention Program trial. Logistic and ordinal logistic regressions were employed to examine associations between physical activity and SEE, adjusting for covariates. SEE was significantly associated with engaging in sufficient total physical activity [odds ratio (OR) = 1.70], moderate physical activity (OR = 2.23), and vigorous physical activity (OR = 2.13). Unemployment was associated with less frequent moderate physical activity (OR = 0.59). Younger age (OR = 0.98), being male (OR = 2.67), and reporting excellent health (OR = 3.14) or good health (OR = 2.06) were associated with more frequent vigorous physical activity. Physical activity is a modifiable lifestyle behavior associated with many chronic disease disparities faced by the Marshallese community, and the study results will be useful for practitioners and researchers working to address these disparities.
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Affiliation(s)
- Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA.
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Aaron J Scott
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Janine Boyers
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Christopher R Long
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Holly C Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Joseph Keawe'aimoku Kaholokula
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawaii At Manoa, Honolulu, HI, 96813, USA
| | - Ka'imi Sinclair
- Institute for Research and Education To Advance Community Health, College of Nursing, Washington State University, Seattle, WA, 98101, USA
| | - Zoran Bursac
- Department of Biostatistics, Robert Stempel College of Public Health, Florida International University, Miami, FL, 33199, USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
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McElfish PA, Andersen JA, Rowland B, Niedenthal J, Otuafi H, Riklon S, George A, Anzures E, Selig J, Bing W, Felix H. Assessment of Diabetes-Related Health Disparities among the Marshallese Living in the Republic of the Marshall Islands. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2021; 80:235-241. [PMID: 34661118 PMCID: PMC8504294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
There is a high prevalence of type 2 diabetes mellitus (T2DM) among the Marshallese in the Republic of the Marshall Islands (RMI). However, no prior literature has examined self-reported health indicators, self-management activities, barriers to care, diabetes knowledge, and family support for diabetes management. This study examined health indicators among participants with T2DM (n=41). Clinical measures included glycated hemoglobin (HbA1c) and fasting glucose level, blood pressure, pulse pressure, and cholesterol levels. Survey items included participants' self-reported health indicators, self-management activities, barriers to care, diabetes knowledge, and family support for diabetes management. Clinical health indicators demonstrate the poor health status of the participants, including uncontrolled fasting glucose levels and HbA1c levels (61.9% had an HbA1c ≥9.0%), high blood pressure, elevated pulse pressure (65.9% had pulse pressure >40 mmHg), and high total cholesterol. Participants report limited knowledge and participation in diabetes self-management behaviors, limited family support, and faced numerous barriers to medical care, medications, and supplies. This study provides insight into the T2DM disparities experienced by Marshallese in the RMI. This study is the first to document the self-reported health indicators, self-management activities, barriers to care, diabetes knowledge, and family support for diabetes management. The results highlight the need for T2DM management interventions and will be used to refine a culturally adapted intervention for delivery in the RMI.
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Affiliation(s)
- Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR (PAM, JAA, SR)
| | - Jennifer A. Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR (PAM, JAA, SR)
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR (BR, WB)
| | - Jack Niedenthal
- Republic of the Marshall Islands Ministry of Health & Human Services, Majuro, MH (JN, HO, AG, EA)
| | - Henry Otuafi
- Republic of the Marshall Islands Ministry of Health & Human Services, Majuro, MH (JN, HO, AG, EA)
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR (PAM, JAA, SR)
| | - Ainrik George
- Republic of the Marshall Islands Ministry of Health & Human Services, Majuro, MH (JN, HO, AG, EA)
| | - Edlen Anzures
- Republic of the Marshall Islands Ministry of Health & Human Services, Majuro, MH (JN, HO, AG, EA)
| | - James Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR (JS, HF)
| | - Wana Bing
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR (BR, WB)
| | - Holly Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR (JS, HF)
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Andersen JA, Felix H, Selig J, Rowland B, Bing W, Hudson J, Niedenthal J, Otuafi H, Riklon S, Azures E, George A, McElfish PA. Feasibility and efficacy of a pilot family model of diabetes self-management intervention in the Republic of the Marshall Islands. Contemp Clin Trials Commun 2021; 23:100824. [PMID: 34401596 PMCID: PMC8349743 DOI: 10.1016/j.conctc.2021.100824] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 07/06/2021] [Accepted: 07/24/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The Republic of the Marshall Islands (RMI) faces numerous health disparities, including one of the highest prevalence of type 2 diabetes mellitus (T2DM) in the world. Diabetes self-management education and support (DSMES) has shown efficacy in improving glycemic control and through increases in knowledge and self-management activities; however, there is limited research on DSMES in the RMI. This study evaluated the feasibility and efficacy of a culturally adapted family model of DSMES (F-DSMES) in the RMI. The F-DSME included 8 h of group educational classes delivered in churches by a community health worker. METHODS This pilot study assessed retention and dosage rates (e.g., class attendance) among the participants with T2DM (n = 41). Efficacy was evaluated by examining pre- and post-intervention differences in HbA1c, knowledge, family support, and self-management activities among those who completed the post-intervention data collection (n = 23). RESULTS The results indicate completion of post-intervention data collection and attendance were associated; 70% of participants who completed the post-intervention data collection received at least 6 h of intervention compared to 3 h for those who did not. Although the reduction in HbA1c was not statistically significant, participants demonstrated statically significant increases in knowledge, family support, and an increase in self-management including in checking of blood glucose and feet. CONCLUSIONS This study provides important information to help address T2DM disparities in the RMI, including the feasibility and efficacy of F-DSMES. Additional research will help in understanding how to translate improvements in knowledge, family support, and self-management activities into improvements in HbA1c. This may include addressing social ecological factors that affect glycemic control.
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Affiliation(s)
- Jennifer A. Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Holly Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - James Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Wana Bing
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Jonell Hudson
- College of Pharmacy, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Jack Niedenthal
- Republic of the Marshall Islands Ministry of Health & Human Services, Majuro, 96960, MH, USA
| | - Henry Otuafi
- Republic of the Marshall Islands Ministry of Health & Human Services, Majuro, 96960, MH, USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
| | - Edlen Azures
- Republic of the Marshall Islands Ministry of Health & Human Services, Majuro, 96960, MH, USA
| | - Ainrik George
- Republic of the Marshall Islands Ministry of Health & Human Services, Majuro, 96960, MH, USA
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, 72703, USA
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Brevidelli MM, Oliveira ABD, Rodrigues GVG, Gamba MA, De Domenico EBL. Factores sociodemográficos, clínicos y psicosociales relacionados con el autocuidado de la diabetes. REVISTA CUIDARTE 2021. [DOI: 10.15649/cuidarte.2057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introducción: Aunque la ciencia ha descubierto diversos factores que intervienen en el autocuidado de la diabetes, todavía quedan algunos vacíos sobre todo en lo que respecta a los comportamientos de autocuidado entre personas con diferentes características socioeconómicas. El objetivo del presente estudio fue identificar la adherencia al autocuidado de la diabetes y su correlación con factores sociodemográficos, clínicos y psicosociales entre los usuarios del sistema de salud suplementaria en Sao Paulo. Materiales y métodos: Se realizó un estudio transversal con 214 participantes que padecían diabetes tipo 2, en el que se utilizaron las versiones brasileñas del cuestionario de actividades de autocuidado en diabetes, el cuestionario de actitudes sobre diabetes y la escala de empoderamiento de la diabetes. Se empleó un modelo de regresión lineal múltiple (método regresión stepwise) para delinear las correlaciones entre las variables. Resultados: Los participantes mostraron una adherencia moderada al autocuidado global. Factores como ser mujer, estar casado/en unión libre estable, ser jubilado, tener más tiempo de diagnóstico y mostrar una actitud más positiva frente a la diabetes explicaron el 93.0% de la varianza en el autocuidado global. Discusión: El estudio es inédito en la caracterización del autocuidado de la diabetes entre los usuarios del sistema de salud complementaria en Brasil. Si bien los resultados son similares a los de estudios nacionales e internacionales, estos se sugieren que, dada la complejidad de la enfermedad, el autocuidado de la diabetes se descuida constantemente y se requiere una mayor formación entre los profesionales de la salud para tratar los aspectos psicosociales asociados. Conclusión: Los resultados sugieren que las intervenciones educativas para la promoción del autocuidado deben diseñarse teniendo en cuenta el perfil sociodemográfico y clínico de los participantes, así como la promoción de la autoeficacia para disminuir la actitud negativa hacia la diabetes.
Como citar este artículo: Brevidelli, Maria Meimei; Oliveira, Adriana Bueno de; Rodrigues, Gilcelli Vascom Girotto; Gamba, Monica Antar; DeDomenico, Edvane Birello Lopes. Fatores sociodemográficos, clínicos e psicossociais correlacionados ao autocuidado em diabetes. Revista Cuidarte. 2021;12(2):e2057 http://dx.doi.org/10.15649/cuidarte.2057
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McElfish PA, Boyers J, Purvis RS, O'Connor B, Carleton A, Bing W, Rowland B, Molgaard C, George A, Tibon LR, Hoose D, Riklon S. Family model diabetes self-management education and support in faith-based organizations in the republic of the Marshall Islands study protocol. Contemp Clin Trials Commun 2021; 21:100710. [PMID: 33506140 PMCID: PMC7815654 DOI: 10.1016/j.conctc.2021.100710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 12/15/2020] [Accepted: 01/04/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Marshallese living in the Republic of the Marshall Islands (RMI) experience significant health disparities, with high rates of type 2 diabetes mellitus. In addition to health disparities, the RMI experienced nuclear testing that exposed inhabitants to nuclear fallout, unethical research practices, and contaminated natural food sources. OBJECTIVES This research uses a community-based participatory research (CBPR) approach to effectively engage community partners and honor their contributions in all stages of the research. A CBPR approach will leverage culturally situated knowledge and practices of the Marshallese community in the RMI to ensure the success of the research. METHODS This manuscript describes the methods used to test the feasibility of delivering a culturally adapted family model of diabetes self-management education and support in faith-based organizations in the RMI. CONCLUSIONS This manuscript describes the protocol for creating working with community partners and implementing a feasibility study in the RMI.
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Affiliation(s)
- Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 72703, USA
| | - Janine Boyers
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 7270, USA
| | - Rachel S. Purvis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 72703, USA
| | - Betsy O'Connor
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 7270, USA
| | - Ayoola Carleton
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 7270, USA
| | - Williamina Bing
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 7270, USA
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 7270, USA
| | - Craig Molgaard
- College of Public Health, University of Arkansas for Medical Sciences, 4301 W Markham Street, Little Rock, AR, 72205, USA
| | - Ainrik George
- Marshall Islands Postal Service Authority, Majuro, 96960, Marshall Islands
| | - Lydia R. Tibon
- Kora in Jiban Lorojake Ejmour, PO Box 372, G & L Building Ground Floor, Majuro, 96960, Marshall Islands
| | - Dalton Hoose
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 72703, USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Avenue, Fayetteville, AR, 72703, USA
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Felix HC, Narcisse MR, Long CR, McElfish PA. Effects of a family diabetes self-management education intervention on the patients' supporters. FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2020; 38:121-129. [PMID: 32281816 PMCID: PMC7292793 DOI: 10.1037/fsh0000470] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
INTRODUCTION Diabetes self-management education (DSME) programs that engage the families of patients with diabetes have shown to be effective in improving diabetes-related outcomes of the patients. The health effects of these "family models" of DSME on participating family members are rarely studied. Opportunity exists for the participating family members to benefit from the healthy lifestyle recommendations offered through such programs. METHOD Using data from a randomized controlled trial to assess the effect of family DSME compared to standard DSME among Marshallese adults with Type 2 diabetes, this study examined baseline to 12-month changes in A1c, body mass index (BMI), food consumption, and physical activity among participating family members, comparing outcomes of family members based on attended at least 1 (n = 98) versus attended no (n = 44) DSME sessions. RESULTS Overall, family member attendance was low. There were no differences in the level of change from baseline to 12 months for A1c, BMI, food consumption, and physical activity between groups. After controlling for attendance and sociodemographic measures, lowering of BMI was the only significant predictor of not having an A1c level indicative of diabetes at 12 months. DISCUSSION Future research on family DSME should consider ways to improve family member attendance; have them set their own health improvement goals; and integrate healthy lifestyle education, such as healthy eating and being physically active, along with the DSME core content to create an added benefit of diabetes prevention for participating family members. The limitations of this study and recommendations for future research are provided. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Dickey TA, Balli ML, Warmack TS, Rowland B, Hudson J, Seaton V, Riklon S, Purvis RS, McElfish PA. Perceptions and utilization of traditional healing among Marshallese adults residing in Arkansas. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2020; 17:/j/jcim.ahead-of-print/jcim-2018-0198/jcim-2018-0198.xml. [PMID: 32284443 DOI: 10.1515/jcim-2018-0198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 09/29/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Tiffany A Dickey
- College of Pharmacy, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, USA
| | - Michelle L Balli
- College of Pharmacy, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, USA
| | - T Scott Warmack
- College of Pharmacy, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, USA
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, USA
| | - Jonell Hudson
- College of Pharmacy, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, USA
| | - Victoria Seaton
- College of Pharmacy, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, USA
| | - Sheldon Riklon
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR 72703-5011, USA
| | - Rachel S Purvis
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR 72703-5011, USA
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McElfish PA, Purvis RS, Esquivel MK, Sinclair KA, Townsend C, Hawley NL, Haggard-Duff LK, Kaholokula JK. Diabetes Disparities and Promising Interventions to Address Diabetes in Native Hawaiian and Pacific Islander Populations. Curr Diab Rep 2019; 19:19. [PMID: 30887399 PMCID: PMC7171975 DOI: 10.1007/s11892-019-1138-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW The Native Hawaiian and Pacific Islander (NHPI) population is rapidly growing in the USA. NHPIs face significant health disparities and have a high prevalence of diabetes compared to the general US population. RECENT FINDINGS Recent culturally-adapted diabetes interventions have shown promise in addressing these disparities among NHPI communities. The interventions showed success by utilizing a community-based approach that honored NHPIs' collectivist culture, addressed social determinants of health that influence disease control and prevention, and utilized NHPI community health workers (CHWs) and peer educators for key roles in implementation of the intervention. To address health disparities in the NHPI community, much can be learned from existing, successful interventions. Promising interventions share several attributes. The interventions were: culturally adapted using a community-based participatory research approach; addressed specific social determinants of health (i.e., cost of healthy food, transportation, access to health care) that influence disease control and prevention; honored the collectivist culture of NHPI communities by integrating social networks and extended family members; and utilized NHPI community members, including peer educators and CHWs, for intervention implementation. Further investment to scale these interventions for regional and national implementation is needed to address the significant diabetes disparities that NHPIs face.
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Affiliation(s)
- Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA.
| | - Rachel S Purvis
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA
| | - Monica K Esquivel
- Department of Human Nutrition Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawaii at Manoa, 1955 East West Road Ag Sci 314 L, Honolulu, HI, 96822, USA
| | - Ka'imi A Sinclair
- College of Nursing, Washington State University, 1100 Olive Way, Suite 1200, Seattle, WA, 98101, USA
| | - Claire Townsend
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawaii at Manoa, 677 Ala Moana Blvd, Suite 1016, Honolulu, HI, 96813, USA
| | - Nicola L Hawley
- Yale School of Public Health, Yale University, 60 College St, New Haven, CT, 06510, USA
| | - Lauren K Haggard-Duff
- College of Nursing, University of Arkansas for Medical Sciences Northwest, 1125 N. College Ave, Fayetteville, AR, 72703, USA
| | - Joseph Keawe'aimoku Kaholokula
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawaii at Manoa, 677 Ala Moana Blvd, Suite 1016, Honolulu, HI, 96813, USA
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