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Mayberry LS, Osborn CY. Family involvement is helpful and harmful to patients' self-care and glycemic control. PATIENT EDUCATION AND COUNSELING 2014; 97:418-25. [PMID: 25282327 PMCID: PMC4254324 DOI: 10.1016/j.pec.2014.09.011] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 08/04/2014] [Accepted: 09/10/2014] [Indexed: 05/24/2023]
Abstract
OBJECTIVE We assessed the relationships between supportive and obstructive family behaviors and patients' diabetes self-care activities and HbA1C, and potential interaction effects and differences by demographic characteristics. METHODS In a cross-sectional study, 192 adults with type 2 diabetes completed the Diabetes Family Behavior Checklist-II, the Summary of Diabetes Self-Care Activities, and a glycemic control (HbA1C) test. RESULTS Participants reported similar rates of supportive and obstructive behaviors that were positively correlated (rho=0.61, p<0.001). In adjusted analyses, supportive family behaviors were associated with adherence to different self-care behaviors (β=0.20 to 0.50, p<0.05), whereas obstructive family behaviors were associated with less adherence to self-care behaviors (β=-0.28 to -0.39, p<0.01) and worse HbA1C (β=0.18, p<0.05). Supportive behaviors protected against the detrimental effect of obstructive behaviors on HbA1C (interaction β=-0.22, p<0.001). Non-Whites reported more supportive and obstructive behaviors than Whites, but race did not affect the relationships between family behaviors and self-care or HbA1C. CONCLUSION Involving family members in patients' diabetes management may impede patients' self-care and compromise their glycemic control unless family members are taught to avoid obstructive behaviors. PRACTICE IMPLICATIONS Our findings endorse interventions that help family members develop actionable plans to support patients' self-care and train them to communicate productively about diabetes management.
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Affiliation(s)
| | - Chandra Y Osborn
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Barner JC, Bohman TM, Brown CM, Richards KM. Use of complementary and alternative medicine for treatment among African-Americans: a multivariate analysis. Res Social Adm Pharm 2010; 6:196-208. [PMID: 20813333 PMCID: PMC2933406 DOI: 10.1016/j.sapharm.2009.08.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Revised: 08/14/2009] [Accepted: 08/15/2009] [Indexed: 11/27/2022]
Abstract
BACKGROUND The use of complementary and alternative medicine (CAM) is substantial among African-Americans; however, research on characteristics of African-Americans who use CAM to treat specific conditions is scarce. OBJECTIVE To determine what predisposing, enabling, need, and disease-state factors are related to CAM use for treatment among a nationally representative sample of African-Americans. METHODS A cross-sectional study design was employed using the 2002 National Health Interview Survey (NHIS). A nationwide representative sample of adult (> or =18 years) African-Americans who used CAM in the past 12 months (n=16,113,651 weighted; n=2,952 unweighted) was included. The Andersen Health Care Utilization Model served as the framework with CAM use for treatment as the main outcome measure. Independent variables included the following: predisposing (eg, age, gender, and education); enabling (eg, income, employment, and access to care); need (eg, health status, physician visits, and prescription medication use); and disease state (ie, most prevalent conditions among African-Americans) factors. Multivariate logistic regression was used to address the study objective. RESULTS Approximately 1 in 5 (20.2%) who used CAM in the past 12 months used CAM to treat a specific condition. Ten of the 15 CAM modalities were used primarily for treatment by African-Americans. CAM for treatment was significantly (P<.05) associated with the following factors: graduate education, smaller family size, higher income, region (northeast, midwest, west more likely than south), depression/anxiety, more physician visits, less likely to engage in preventive care, more frequent exercise behavior, more activities of daily living (ADL) limitations, and neck pain. CONCLUSIONS Twenty percent of African-Americans who used CAM in the past year were treating a specific condition. Alternative medical systems, manipulative and body-based therapies, and folk medicine, prayer, biofeedback, and energy/Reiki were used most often. Health care professionals should routinely ask patients about the use of CAM, but when encountering African-Americans, there may be a number of factors that may serve as cues for further inquiry.
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Affiliation(s)
- Jamie C Barner
- Pharmacy Administration Division, College of Pharmacy, The University of Texas at Austin, Austin, TX 78712-0124, USA.
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Gallant MP, Spitze G, Grove JG. Chronic illness self-care and the family lives of older adults: a synthetic review across four ethnic groups. J Cross Cult Gerontol 2010; 25:21-43. [PMID: 20177963 DOI: 10.1007/s10823-010-9112-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The purpose of this paper is to integrate the literature on family and social ties among older ethnic minority men and women with the literature on chronic illness self-care among elders in these groups, in order to increase understanding of social influences on self-care behavior, raise questions for future research, and inform culturally appropriate interventions to maximize the health-promoting potential of social relationships. The paper presents demographic and chronic illness prevalence information, and then summarizes literature about patterns of chronic illness self-care behaviors for older African-Americans, Latinos, Asian-Americans, and American Indians in the U.S. For each group, the sociological literature about residential, cultural, and socioeconomic patterns, family lives, and other social ties is then reviewed, and the self-care literature that has accounted for these patterns is discussed. Finally, six themes are outlined and related questions are identified to further illuminate the social context of older adults' chronic illness self-care.
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Affiliation(s)
- Mary P Gallant
- Department of Health Policy, Management, & Behavior, University at Albany, State University of New York, Albany, NY, USA.
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Warren-Findlow J, Issel LM. Stress and coping in African American Women with chronic heart disease: a cultural cognitive coping model. J Transcult Nurs 2009; 21:45-54. [PMID: 19826059 DOI: 10.1177/1043659609348622] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This article examines the role of stress in relation to heart disease self-care among African American women. Women described a unique stress-coping model: Stress was a cause and contributor to "bad heart" and associated with "not worrying." Family history of heart disease was used as an experiential reference scale to evaluate the severity of women's heart health. Stress attributions were associated with coping practices to manage the effect of illness through emotion-focused coping and with the physiological worsening of their condition. This model highlights opportunities to reframe stress-coping activities into culturally based heart-healthy practices for African American women.
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Affiliation(s)
- Jan Warren-Findlow
- University of North Carolina at Charlotte, Charlotte, NC 28223-0001, USA.
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Daily temporal self-care responses to osteoarthritis symptoms by older African Americans and whites. J Cross Cult Gerontol 2009; 23:319-37. [PMID: 18841454 DOI: 10.1007/s10823-008-9082-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Osteoarthritis (OA) is the most prevalent form of arthritis and is among the most prevalent chronic conditions in the USA. Because there is no known cure for OA, treatment is directed towards the alleviation of pain, improving function, and limiting disability. The major burden of care falls on the individual, who tailors personal systems of care to alleviate troublesome symptoms. To date, little has been known about the temporal variations in self-care that older patients with OA develop, nor has it been known to what extent self-care patterns vary with ethnicity and disease severity. This patient-centered descriptive study was designed to demonstrate the self-care strategies used by older African Americans and whites to alleviate the symptoms of OA on a typical day and during specific segments of a typical day over the past 30 days. A sample of 551 older adults participated in in-depth interviews, and the authors clustered their responses into six categories. Findings showed that the frequency of particular behaviors varied by time of day, disease severity, and race. Overall, patterns of self-care behaviors were similar between African Americans and whites, but African Americans used them in different proportions than whites. This study contributes to our knowledge of the dynamic and changing nature of self-care actions even within a single day. By defining how self-care is used in one illness by two different ethnic groups, we may be able to design appropriate educational programs that are more culturally specific to better meet the needs of patients with OA.
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Striving for control: cognitive, self-care, and faith strategies employed by vulnerable black and white older adults with multiple chronic conditions. J Cross Cult Gerontol 2008; 23:377-99. [PMID: 18987966 DOI: 10.1007/s10823-008-9086-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2007] [Accepted: 10/10/2008] [Indexed: 10/21/2022]
Abstract
The average older adult reaches age 65 with at least two chronic, co-occurring illnesses, or multiple morbidities (MM). We currently lack critical information about the specific strategies older adults use to attempt to control these MM. To increase our understanding of how older adults attempt to manage these MM and retain control of their health, in-depth interviews were conducted with 41 Black and White middle aged and older men and women with MM. We were particularly interested in representing the experience of those groups more vulnerable to adverse health outcomes due to greater disease prevalence and low income. During in-depth interviews, we asked open-ended questions on life and health history and open-ended and semi-structured questions about self-care for multiple morbidities. Participants expressed a strong desire to remain in control of their health; to do so they employed a wide range of strategies including cognitive structuring techniques (being health vigilant, normalizing, resignation/relinquishing control, and social comparison), self-care activities (emphasizing diet, exercise, medication taking, modifying existing activities, going to the doctor), and faith orientations (prayer as a constructive support strategy, gaining strength from God, church as a central part of life). With the exception of faith orientations, there were no race/ethnicity differences in the strategies participants use. Future studies should expand on this knowledge by exploring the contextual, cultural, and psychological backdrop and characteristics that shape the use of these coping strategies.
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Albert SM, Musa D, Kwoh CK, Hanlon JT, Silverman M. Self-care and professionally guided care in osteoarthritis: racial differences in a population-based sample. J Aging Health 2008; 20:198-216. [PMID: 18287328 DOI: 10.1177/0898264307310464] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study was to examine the prevalence of self-management practices among older White and African American persons with osteoarthritis. Self-management was defined broadly to include all behaviors adopted to reduce morbidity, whether recommended by physicians or not. METHODS A population-based sample of Medicare beneficiaries (N = 551) was recruited. An expanded set of self-management behaviors using structured and open-ended inquiry, along with use of arthritis-specific medications was elicited. RESULTS Few differences in self-care behaviors between race groups were found. However, older African American persons were significantly less likely to have prescriptions for nonsteroidal anti-inflammatory agents (NSAIDs) and more likely to use over-the-counter nonprescription analgesics. DISCUSSION Older White and African American persons made similar use of self-care strategies to reduce disease morbidity. African Americans without access to prescription pain relievers substituted nonprescription analgesics. A broader view of self-management is valuable for assessing the ways people may move between professionally guided care and self-care.
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Affiliation(s)
- Steven M Albert
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, A211 Crabtree, 130 DeSoto St., Pittsburgh, PA 15261, USA.
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Stoller EP, Hund AJ, Webster NJ, Blixen CE, Perzynski AT, McCormick RA, Kanuch SW, Dawson NV. Alcohol consumption within the context of hepatitis C: a qualitative study of non-problematic drinkers. Alcohol Alcohol 2006; 41:546-52. [PMID: 16855001 PMCID: PMC1939937 DOI: 10.1093/alcalc/agl055] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
AIMS Little is known about how non-problematic drinkers respond to advice to reduce alcohol consumption as part of disease management. In this article, we examine patient reports of drinking behaviour after being diagnosed with chronic hepatitis C, a condition for which alcohol consumption is contraindicated. METHODS In this qualitative study, we analyzed transcripts of semi-structured interviews with hepatitis C virus+ (HCV+) patients whose level of alcohol consumption would not be considered problematic in the absence of their diagnosis. RESULTS Most respondents reported some instances of adherence, but only half adhered to the advice to limit drinking consistently over time. Respondents who did not stop drinking often modified their behaviour by changing the type of alcohol consumed or limiting drinking to particular occasions. CONCLUSION Most informants understood the risks of drinking after HCV infection, particularly in the presence of symptoms, with the onset of complications, or when undergoing treatment. But some believed they could monitor their bodies for evidence of disease progression or that drinking was acceptable during early, asymptomatic stages of infection. Our results also identified situations in which patients need support in adhering to intentions not to drink, including social pressures, stressful situations, or environmental triggers.
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Rodríguez del Pozo P, Fins JJ. Death, dying and informatics: misrepresenting religion on MedLine. BMC Med Ethics 2005; 6:E6. [PMID: 15992401 PMCID: PMC1185543 DOI: 10.1186/1472-6939-6-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2005] [Accepted: 07/01/2005] [Indexed: 11/23/2022] Open
Abstract
Background The globalization of medical science carries for doctors worldwide a correlative duty to deepen their understanding of patients' cultural contexts and religious backgrounds, in order to satisfy each as a unique individual. To become better informed, practitioners may turn to MedLine, but it is unclear whether the information found there is an accurate representation of culture and religion. To test MedLine's representation of this field, we chose the topic of death and dying in the three major monotheistic religions. Methods We searched MedLine using PubMed in order to retrieve and thematically analyze full-length scholarly journal papers or case reports dealing with religious traditions and end-of-life care. Our search consisted of a string of words that included the most common denominations of the three religions, the standard heading terms used by the National Reference Center for Bioethics Literature (NRCBL), and the Medical Subject Headings (MeSH) used by the National Library of Medicine. Eligible articles were limited to English-language papers with an abstract. Results We found that while a bibliographic search in MedLine on this topic produced instant results and some valuable literature, the aggregate reflected a selection bias. American writers were over-represented given the global prevalence of these religious traditions. Denominationally affiliated authors predominated in representing the Christian traditions. The Islamic tradition was under-represented. Conclusion MedLine's capability to identify the most current, reliable and accurate information about purely scientific topics should not be assumed to be the same case when considering the interface of religion, culture and end-of-life care.
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Affiliation(s)
- Pablo Rodríguez del Pozo
- Division of Medical Ethics, Weill Medical College of Cornell University in Qatar (WCMC-Q). P.O. Box 24144, Education City, Doha, Qatar
| | - Joseph J Fins
- Division of Medical Ethics, Weill Medical College of Cornell University (WMCCU), New York, USA
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Becker G, Gates RJ, Newsom E. Self-care among chronically ill African Americans: culture, health disparities, and health insurance status. Am J Public Health 2005; 94:2066-73. [PMID: 15569953 PMCID: PMC1448591 DOI: 10.2105/ajph.94.12.2066] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Little is known about the self-care practices of chronically ill African Americans or how lack of access to health care affects self-care. Results from a qualitative interview study of 167 African Americans who had one or more chronic illnesses found that self-care practices were culturally based, and the insured reported more extensive programs of self-care. Those who had some form of health insurance much more frequently reported the influence of physicians and health education programs in self-care regimens than did those who were uninsured. It is concluded that the cultural components of self-care have been underemphasized, and further, that the potential to maximize chronic illness management through self-care strategies is not realized for those who lack access to health care.
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Affiliation(s)
- Gay Becker
- Institute for Health and Aging, University of California, San Francisco, Box 0646, San Francisco, CA 94143-0646, USA.
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Abstract
PURPOSE To describe Filipino Americans' cultural traditions surrounding bodily awareness, especially how the principle of balance informs their views, and the link to self-management of chronic illness. METHODS This qualitative study used semistructured interviews with 85 Filipino Americans between the ages of 46 and 97 years. Volunteers were recruited from numerous health care sites in 1 geographic location in the United States. Respondents had 1 or more chronic illnesses. Taped and transcribed interviews were coded and evaluated for themes. RESULTS The concept of balance was central to Filipino Americans' portrayal of bodily awareness of signs and symptoms related to chronic illnesses, as well as to actions they took to manage their chronic illnesses. Efforts were made to control chronic illnesses through a variety of self-care practices. Diet posed a particular challenge because of the symbolic importance of food in Filipino culture and its use in the maintenance of social relationships. CONCLUSIONS The ways in which Filipino Americans combine attention to the body, values of balance and harmony, and emphasis on social well-being result in heightened attention to bodily processes. Filipino Americans' emphasis on bodily awareness suggests that this particular cultural strength can be used to enhance chronic illness management. Awareness of the cultural traditions of Filipino Americans can facilitate patient education about how to manage chronic illnesses.
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Affiliation(s)
- Gay Becker
- Institute for Health and Aging, University of California, San Francisco, Calif 94143-0646, USA.
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Silverman M, Terry MA, Zimmerman RK, Nutini JF, Ricci EM. The role of qualitative methods for investigating barriers to adult immunization. QUALITATIVE HEALTH RESEARCH 2002; 12:1058-1075. [PMID: 12365588 DOI: 10.1177/104973202129120449] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
In 1999, the Agency for Healthcare Research and Quality funded a study of barriers to immunization, which included a short-term qualitative data collection to assess the organizational and cultural features of selected primary care practices and to explore their impact on adult immunization rates. The authors describe the short-term qualitative data collection system and the contributions made by the qualitative study to the parent project. They address previously held concerns about qualitative research and provide a system that can be replicated or modified for use for projects designed to assess complex attitudes and behaviors that affect health outcomes.
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Affiliation(s)
- Myrna Silverman
- Department of Health Services Administration, Graduate School of Public Health, University of Pittsburgh, USA
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Ibrahim SA, Siminoff LA, Burant CJ, Kwoh CK. Variation in perceptions of treatment and self-care practices in elderly with osteoarthritis: a comparison between African American and white patients. ARTHRITIS AND RHEUMATISM 2001; 45:340-5. [PMID: 11501721 DOI: 10.1002/1529-0131(200108)45:4<340::aid-art346>3.0.co;2-5] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To compare elderly African American and white patients with osteoarthritis of the knee or hip with respect to their perceptions of the efficacy of traditional and complementary treatments and their self-care practices. METHODS An observational, cross-sectional study design using structured questionnaires was employed. RESULTS The sample consisted of 593 patients (44% African American and 56% white). The 2 groups were comparable with respect to age, disease severity or functional status, and comorbidities. African Americans were more likely than whites to report lower educational level and household income. African Americans were also more likely than whites to perceive various traditional and complementary care modalities as efficacious. However, they were less likely than whites to perceive joint replacement therapy as efficacious (odds ratio 0.52, 95% confidence interval 0.28-0.98). African American patients were more likely than white patients to rely on self-care measures for their arthritis. CONCLUSION African American and white patients with osteoarthritis of the knee or hip differ with respect to their perceptions of traditional and complementary treatments for arthritis and their self-care practices.
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Affiliation(s)
- S A Ibrahim
- Department of Medicine, University Hospitals of Cleveland, Case Western Reserve University School of Medicine, Ohio 44106-6033, USA
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