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Gao SH, Wang GZ, Wang LP, Feng L, Zhou YC, Yu XJ, Liang F, Yang FY, Wang Z, Sun BB, Wang D, Liang LJ, Xie DW, Zhao S, Feng HP, Li X, Li KK, Tang TS, Huang YC, Wang SQ, Zhou GB. Corrigendum to "Mutations and clinical significance of calcium voltage-gated channel subunit alpha 1E (CACNA1E) in non-small cell lung cancer" [Cell Calcium 102 (2022) 102527]. Cell Calcium 2024; 119:102866. [PMID: 38428281 DOI: 10.1016/j.ceca.2024.102866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Affiliation(s)
- S H Gao
- State Key Laboratory of Membrane Biology, Institute of Zoology, Chinese Academy of Sciences & University of Chinese Academy of Sciences, Beijing, 100101, China; State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - G Z Wang
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - L P Wang
- State Key Laboratory of Membrane Biology, College of Life Sciences, Peking University, Beijing, 100091, China
| | - L Feng
- Department of Pathology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Y C Zhou
- Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University (Yunnan Tumor Hospital), Kunming, 650106, China
| | - X J Yu
- State Key Laboratory of Membrane Biology, Institute of Zoology, Chinese Academy of Sciences & University of Chinese Academy of Sciences, Beijing, 100101, China
| | - F Liang
- State Key Laboratory of Membrane Biology, Institute of Zoology, Chinese Academy of Sciences & University of Chinese Academy of Sciences, Beijing, 100101, China; State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - F Y Yang
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Z Wang
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - B B Sun
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - D Wang
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - L J Liang
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - D W Xie
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - S Zhao
- State Key Laboratory of Membrane Biology, Institute of Zoology, Chinese Academy of Sciences & University of Chinese Academy of Sciences, Beijing, 100101, China
| | - H P Feng
- State Key Laboratory of Membrane Biology, Institute of Zoology, Chinese Academy of Sciences & University of Chinese Academy of Sciences, Beijing, 100101, China
| | - X Li
- Computer Science Department, University of North Georgia, Dahlonega, GA, 30597, United States
| | - K K Li
- Computer Science Department, University of North Georgia, Dahlonega, GA, 30597, United States
| | - T S Tang
- State Key Laboratory of Membrane Biology, Institute of Zoology, Chinese Academy of Sciences & University of Chinese Academy of Sciences, Beijing, 100101, China
| | - Y C Huang
- Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University (Yunnan Tumor Hospital), Kunming, 650106, China
| | - S Q Wang
- State Key Laboratory of Membrane Biology, College of Life Sciences, Peking University, Beijing, 100091, China
| | - G B Zhou
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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Tang TS. Calling all clinicians: A brief 5-step model for exploring diabetes distress in a routine medical visit. Can J Diabetes 2024:S1499-2671(24)00063-7. [PMID: 38580205 DOI: 10.1016/j.jcjd.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 02/27/2024] [Accepted: 03/22/2024] [Indexed: 04/07/2024]
Affiliation(s)
- Tricia S Tang
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Tang TS, Yip AKW, Klein G, Moore L, Hessler D, Polonsky WH, Fisher L. Training peers to deliver mental health support to adults with type 1 diabetes using the REACHOUT mobile app. Diabet Med 2024; 41:e15210. [PMID: 37634222 DOI: 10.1111/dme.15210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/19/2023] [Accepted: 08/22/2023] [Indexed: 08/29/2023]
Abstract
AIMS While peer support research is growing in the Type 1 diabetes (T1D) community, the peer supporter training (PST) process is rarely documented in detail. This study provides a comprehensive description of PST and evaluation for the REACHOUT mental health support intervention, and examines the feasibility and perceived utility of PST. METHODS Fifty-three adults with T1D were recruited to participate in a 6-hour, zoom-based PST program for mental health support. The program was structured in three parts: (1) internal motivation, resilience and empathy; (2) mindfulness, emotions and diabetes distress; and (3) active listening and deferring clinical questions to professionals. Candidates were evaluated based on eight pre-established competency criteria during a 5-day support trial with an assigned standardized T1D participant. Perceived usefulness of training skills was also assessed 3 months into the REACHOUT mental health support intervention. RESULTS Fifty-one of the fifty-three candidates who completed training achieved the criteria to graduate. Mean scores for the eight competency domains were: listens actively (4.55); asks open-ended questions (4.12); expresses empathy (4.42); avoids passing judgment (4.67); sits with strong emotions (4.44); refrains from giving advice (4.38); makes reflections (4.5); and defers medical questions (4.58). Of the skills learned during the PST, 95% rated interpreting and discussing diabetes distress profile and expressing empathy as moderately to extremely useful. CONCLUSIONS Findings demonstrate that it is feasible to recruit and graduate the number of trainees needed using a rigorous process. Only by making training protocols available can the PST be replicated and translated to other T1D populations (e.g. adolescents, parents of children with T1D).
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Affiliation(s)
- Tricia S Tang
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Annie K W Yip
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gerri Klein
- BCDiabetes, Vancouver, British Columbia, Canada
| | - Lauren Moore
- Lauren Moore Counseling, British Columbia, Canada
| | - Danielle Hessler
- Department of Family Medicine, University of California, San Francisco, USA
| | - William H Polonsky
- Behavioral Diabetes Institute, San Diego, California, USA
- University of California, San Diego, California, USA
| | - Lawrence Fisher
- Department of Family Medicine, University of California, San Francisco, USA
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Tang TS, Seddigh S, Halbe E, Vesco AT. Testing 3 Digital Health Platforms to Improve Mental Health Outcomes in Adults With Type 1 Diabetes: A Pilot Trial. Can J Diabetes 2024; 48:18-25.e2. [PMID: 37625504 DOI: 10.1016/j.jcjd.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 07/23/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023]
Abstract
OBJECTIVE Our aim in this study was to examine the potential impact of a 3-pronged digital health pilot intervention (TRIFECTA) on diabetes distress and depressive symptoms among adults with type 1 diabetes (T1D) in British Columbia. METHODS We recruited 60 adults with T1D (mean age 38.9±15.1 years, 75% female, 77% Caucasian) who participated in the 6-month pilot intervention involving 3 digital health platforms: monthly, provider-led, group-based sessions over Zoom (virtual huddles); a WhatsApp peer texting group; and a web-based "Ask-the-expert" portal. Assessments were conducted at baseline and 6 months and measured diabetes distress (T1D Diabetes Distress Scale), depressive symptoms (9-item Personal Health Questionnaire), and TRIFECTA engagement metrics. RESULTS Participation in TRIFECTA was associated with significant reductions in Overall Distress (p=0.011) and 4 distress subscales: Powerlessness (p=0.006), Management Distress (p=0.001), Hypoglycemia Distress (p=0.029), and Eating Distress (p<0.001). A higher number of virtual huddles attended predicted lower Overall Distress (p=0.019) and Family/Friends Distress (p=0.023). A higher number of "Ask-the-expert" posts viewed predicted lower Overall Distress (p=0.046), whereas a higher number of WhatsApp messages posted predicted lower Management Distress (p=0.006). Furthermore, engagement in all 3 metrics was a predictor for lower Negative Social Perceptions Distress (p<0.05). No associations were seen in other distress subscales or for depressive symptoms. CONCLUSIONS Participation in TRIFECTA was linked to reduced diabetes distress levels, but not depressive symptoms, in a platform-dependent manner. This study provides promising pilot data for a subsequent large-scale and fully powered randomized controlled trial.
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Affiliation(s)
- Tricia S Tang
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Sorayya Seddigh
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eashan Halbe
- APEL, Division of Respiratory Medicine, Department of Medicine, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada; Experimental Medicine Program, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anthony T Vesco
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, United States; Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
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Titoria R, Fung A, Tang TS, Amed S. Systematic review of technology-mediated peer support interventions in paediatric type 1 diabetes care. Diabet Med 2023; 40:e15172. [PMID: 37428650 DOI: 10.1111/dme.15172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/12/2023]
Abstract
AIMS There is increasing interest in the role of peer support in diabetes care. However, technology-mediated peer support in paediatric type 1 diabetes remains understudied.We aimed todescribe technology-mediated peer support interventions for children living with type 1 diabetes, their caregivers and healthcare providers. METHODS CINAHL, Embase and MEDLINE (Ovid) were searched from Jan 2007 to June 2022. We included randomised and non-randomised trials with peer support interventions for children living with diabetes, their caregivers and/or healthcare providers. Studies examining clinical, behavioural or psychosocial outcomes were included. Quality was assessed with the Cochrane risk of bias tool. RESULTS Twelve of 308 retrieved studies were included, with a study duration range of 3 weeks to 24 months and most were randomised trials (n = 8, 66.67%). Four technology-based interventions were identified: phone-based text messages, video, web portal and social media, or a hybrid peer support model. Most (58.6%, n = 7) studies exclusively targeted children with diabetes. No significant improvement was observed in psychosocial outcomes (quality of life, n = 4; stress and coping, n = 4; social support, n = 2). Mixed findings were observed in HbA1c (n = 7) and 28.5% studies (n = 2/7) reported reduced incidence of hypoglycaemia. CONCLUSIONS Technology-mediated peer support interventions may have the potential to improve diabetes care and outcomes. However, further well-designed studies are necessary that address the needs of diverse populations and settings, and the sustainability of intervention effects.
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Affiliation(s)
- Reena Titoria
- Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Andrea Fung
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Tricia S Tang
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shazhan Amed
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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Seddigh S, Tang TS. Social support and diabetes distress: Does the messenger matter as much as the message? Chronic Illn 2023; 19:681-685. [PMID: 35619542 DOI: 10.1177/17423953221102622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We explored the relationship between social support (family/friends and health care team) and four diabetes distress subscales in 196 adults with type 2 diabetes in a specialty care setting. Health care support was associated with lower physician- and regimen-related distress, while friends/family support was related to lower interpersonal distress. The study was registered on clinicaltrials.gov (NCT02804620).
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Affiliation(s)
- Sorayya Seddigh
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Tricia S Tang
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Tang TS, Vesco AT, Fraser EG. Disruptions in Lifestyle Habits and Access to Social Support in the Time of COVID-19: Associations With Diabetes Distress and Depression Among Adults With Type 1 Diabetes Living in British Columbia. Can J Diabetes 2023; 47:497-502. [PMID: 37116655 PMCID: PMC10132832 DOI: 10.1016/j.jcjd.2023.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/30/2023] [Accepted: 04/21/2023] [Indexed: 04/30/2023]
Abstract
OBJECTIVES In this study, we examined rates of diabetes distress and depressive symptoms in adults with type 1 diabetes (T1D) during the COVID-19 lockdown and its association with disruptions in lifestyle habits and access to social support. METHODS This cross-sectional investigation included a convenience sample of 60 adults with T1D who completed a survey assessing diabetes distress (Type 1 Diabetes Distress Scale), depressive symptoms (Personal Health Questionnaire-9), and disruptions in lifestyle habits (sleep patterns, dietary patterns, exercise routine) and access to support from family/friends. Linear regression analyses examined COVID-19 disruption variables as predictors of diabetes distress and depressive severity. RESULTS Seventy-three percent and 38% of participants reported elevated diabetes distress and depressive symptoms, respectively. Greater eating disruption predicted higher depressive symptom severity (β=1.33, p=0.045) and eating distress (β=0.28, p=0.045). Greater social support disruption predicted higher eating distress (β=0.36, p=0.019). CONCLUSIONS Findings revealed high rates of diabetes distress and depressive symptoms in this T1D sample during the COVID-19 lockdown. Moreover, disruptions in some lifestyle habits and access to social support were associated with worse mental health outcomes.
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Affiliation(s)
- Tricia S Tang
- Faculty of Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Anthony T Vesco
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, United States; Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Ellen G Fraser
- The Canadian Centre for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, Lethbridge, Alberta, Canada
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Yau KW, Tang TS, Görges M, Pinkney S, Amed S. Using Human-Centered Design and Cocreation to Create the Live 5-2-1-0 Mobile App to Promote Healthy Behaviors in Children: App Design and Development. JMIR Pediatr Parent 2023; 6:e44792. [PMID: 37195754 DOI: 10.2196/44792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 03/12/2023] [Accepted: 03/24/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND The prevalence of obesity among Canadian children is rising, partly because of increasingly obesogenic environments that limit opportunities for physical activity and healthy nutrition. Live 5-2-1-0 is a community-based multisectoral childhood obesity prevention initiative that engages stakeholders to promote and support the message of consuming ≥5 servings of vegetables and fruits, having <2 hours of recreational screen time, participating in ≥1 hour of active play, and consuming 0 sugary drinks every day. A Live 5-2-1-0 Toolkit for health care providers (HCPs) was previously developed and piloted in 2 pediatric clinics at British Columbia Children's Hospital. OBJECTIVE This study aimed to co-create, in partnership with children, parents, and HCPs, a Live 5-2-1-0 mobile app that supports healthy behavior change and could be used as part of the Live 5-2-1-0 Toolkit for HCPs. METHODS Three focus groups (FGs) were conducted using human-centered design and participatory approaches. In FG 1, children (separately) and parents and HCPs (together) participated in sessions on app conceptualization and design. Researchers and app developers analyzed and interpreted qualitative data from FG 1 in an ideation session, and key themes were subsequently presented separately to parents, children, and HCPs in FG-2 (co-creation) sessions to identify desired app features. Parents and children tested a prototype in FG 3, provided feedback on usability and content, and completed questionnaires. Thematic analysis and descriptive statistics were used for the qualitative and quantitative data, respectively. RESULTS In total, 14 children (mean age 10.2, SD 1.3 years; 5/14, 36% male; 5/14, 36% White), 12 parents (9/12, 75% aged 40-49 years; 2/12, 17% male; 7/12, 58% White), and 18 HCPs participated; most parents and children (20/26, 77%) participated in ≥2 FGs. Parents wanted an app that empowered children to adopt healthy behaviors using internal motivation and accountability, whereas children described challenge-oriented goals and family-based activities as motivating. Parents and children identified gamification, goal setting, daily steps, family-based rewards, and daily notifications as desired features; HCPs wanted baseline behavior assessments and to track users' behavior change progress. Following prototype testing, parents and children reported ease in completing tasks, with a median score of 7 (IQR 6-7) on a 7-point Likert scale (1=very difficult; 7=very easy). Children liked most suggested rewards (28/37, 76%) and found 79% (76/96) of suggested daily challenges (healthy behavior activities that users complete to achieve their goal) realistic to achieve. Participant suggestions included strategies to maintain users' interest and content that further motivates healthy behavior change. CONCLUSIONS Co-creating a mobile health app with children, parents, and HCPs was feasible. Stakeholders desired an app that facilitated shared decision-making with children as active agents in behavior change. Future research will involve clinical implementation and assessment of the usability and effectiveness of the Live 5-2-1-0 app.
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Affiliation(s)
- Kiana W Yau
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada
| | - Tricia S Tang
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada
| | - Matthias Görges
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada
- Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, BC, Canada
| | - Susan Pinkney
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada
- Department of Pediatrics, The University of British Columbia, Vancouver, BC, Canada
| | - Shazhan Amed
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada
- Department of Pediatrics, The University of British Columbia, Vancouver, BC, Canada
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Qian Y, Emmerling DA, Kowitt SD, Ayala GX, Cherrington AL, Heisler M, Safford MM, Tang TS, Thom DH, Fisher EB. Diabetes distress mediates the relationship between depressive symptoms and glycaemic control among adults with type 2 diabetes: Findings from a multi-site diabetes peer support intervention. Diabet Med 2023:e15065. [PMID: 36762953 DOI: 10.1111/dme.15065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023]
Abstract
AIMS Diabetes distress is positively associated with HbA1c and may mediate the relationship between depressive symptoms and HbA1c . This study examined these relationships in a geographically, socioeconomically, and ethnically diverse sample of adults with type 2 diabetes. METHODS Using data from five US sites evaluating peer support for diabetes management (n = 917), Structural Equation Modeling (SEM) examined whether diabetes distress (four items from Diabetes Distress Scale) mediated the relationship between depressive symptoms (PHQ-8) and HbA1c . Sites compared interventions of varying content and duration with control conditions. Time from Baseline Assessment to Final Assessment varied from six to 18 months. Site characteristics were controlled by entering site as a covariate along with age, sex, education, diabetes duration, insulin use, and intervention/control assignment. RESULTS Depressive symptoms, diabetes distress, and HbA1c were all intercorrelated cross-sectionally and from Baseline to Final Assessment (rs from 0.10 to 0.57; ps <0.05). In SEM analyses, diabetes distress at Final Assessment mediated the relationship between Baseline depressive symptoms and HbA1c at Final Assessment (indirect effect: b = 0.031, p < 0.001), controlling for Baseline HbA1c and covariates. Parallel analysis of whether depressive symptoms mediated the relationship between Baseline diabetes distress and HbA1c at Final Assessment was not significant. CONCLUSIONS In this diverse sample, diabetes distress mediated the influence of depressive symptoms on HbA1c but the reverse, depressive symptoms mediating the effect of distress, was not found. These findings add to the evidence that diabetes distress is a worthy intervention target to improve clinical status and quality of life among individuals with type 2 diabetes.
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Affiliation(s)
- Yiqing Qian
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Peers for Progress, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, Chapel Hill, USA
| | - Dane A Emmerling
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sarah D Kowitt
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Guadalupe X Ayala
- School of Public Health, San Diego State University, San Diego, California, USA
| | - Andrea L Cherrington
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Michele Heisler
- VA Center for Clinical Management Research, Department of Health Behavior and Health Education, University of Michigan School of Public Health, and Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Monika M Safford
- Department of Medicine, Weill Medical College of Cornell University, New York, New York, USA
| | - Tricia S Tang
- Division of Endocrinology, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - David H Thom
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Edwin B Fisher
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Peers for Progress, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, Chapel Hill, USA
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Tang TS, Afshar R, Elliott T, Kong J, Gill S. From clinic to community: A randomized controlled trial of a peer support model for adults with type 2 diabetes from specialty care settings in British Columbia. Diabet Med 2022; 39:e14931. [PMID: 36052812 DOI: 10.1111/dme.14931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/12/2022] [Accepted: 07/31/2022] [Indexed: 11/30/2022]
Abstract
AIMS To examine the impact of a 12-month peer-led diabetes self-management support intervention delivered via telephone amongst adults with type 2 diabetes (T2D) from specialty care settings in British Columbia (BC). METHODS One-hundred ninety-six adults with T2D were randomly assigned to either a 12-month Peer-Led, Empowerment-based, Approach, to Self-management Efforts in Diabetes (PLEASED) intervention or a usual care condition. PLEASED involved weekly telephone contacts from a peer leader (PL) in the first 3 months followed by bi-weekly telephone contacts in the last 9 months. Assessments were conducted at baseline, 3 and 12 months. The primary outcome was HbA1c ; secondary outcomes included diabetes distress (DD), ApoB, systolic and diastolic blood pressure (BP), body mass index, waist circumference and depressive symptoms. RESULTS No within or between group changes were observed for HbA1c at 3 or 12 months. However, amongst participants with HbA1c ≥ 69 mmol/mol (8.5%), the PLEASED group significantly lowered their HbA1c at 12 months [-11.7 mmol/mol (-1.07%); 95% CI: -20.7, -2.5 (-1.89, -0.23); p = 0.016] compared to usual care. Amongst secondary outcomes, within-group improvements in overall DD were found at 3 months (-0.21; 95% CI: -0.35, -0.08; p = 0.002) for the PLEASED group and at 12 months for both groups (PLEASED: -0.35; 95% CI: -0.49, -0.21; p < 0.001 and control: -0.33; 95% CI: -0.47, -0.19; p < 0.001), however, no between-group differences were observed. The PLEASED group improved systolic BP at 12 months (-5.4 mm Hg; 95% CI: -10.0, -0.8; p = 0.023) compared to usual care. CONCLUSIONS Participation in a peer support intervention in diabetes delivered via telephone leads to long-term improvements in HbA1c amongst high-risk adults with T2D living in BC. TRIAL REGISTRATION The study was registered on clinicaltrials.gov (NT02804620).
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Affiliation(s)
- Tricia S Tang
- Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rowshanak Afshar
- Department of Family Medicine, University of British Columbia, West Vancouver, British Columbia, Canada
| | - Thomas Elliott
- Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason Kong
- Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sabrina Gill
- Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Ashrafi S, Deo N, Yip AKW, Seddigh S, Moradi R, Waraich R, Tang TS. Autopsy of a telephone-based peer support intervention: Exploring participants' perspectives of and experiences with a self-management support model for adults with type 2 diabetes from speciality care settings. Diabet Med 2022; 39:e14924. [PMID: 36097326 DOI: 10.1111/dme.14924] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 07/08/2022] [Accepted: 07/27/2022] [Indexed: 11/27/2022]
Abstract
AIMS To explore participants' experiences with and perspective of a telephone-based, peer-led diabetes self-management intervention targeting adults with type 2 diabetes (T2D) from speciality care settings. We also sought to identify areas for improvement for future iterations of the intervention. METHODS This study recruited 25 adults with T2D from the intervention arm of a randomized controlled trial of a peer support intervention for diabetes. Individuals took part in semi-structured interviews that explored the following topics: perceived impact of the intervention, relationship with peer leader, desirable characteristics in a peer leader, and suggestions for improving the intervention. Focus groups were recorded, transcribed, quality checked, coded, and analysed to develop themes and subthemes. RESULTS Four core themes emerged: (1) importance of the 'participant-peer leader' match, (2) peer leader roles and responsibilities, (3) need for flexible support models, and (4) factors affecting intervention implementation and engagement. The quality of the participant-peer leader relationship appeared to be linked to intervention satisfaction. Beyond demographic features such as age and sex, key characteristics for forming a strong match included stage of life, lifestyle, diabetes-related factors, and communication style. CONCLUSIONS Participants have unique ideas about what support should look like and preferences for how support is best delivered. Future models of peer support need to be customizable to individuals' needs and responsive to changes in life circumstances. If participants are the decision makers in the matching process, they may experience greater satisfaction and derive maximal benefits.
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Affiliation(s)
- Shadan Ashrafi
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Health Sciences Mall, Vancouver, British Columbia, Canada
| | - Neha Deo
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA
| | - Annie K W Yip
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sorayya Seddigh
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Health Sciences Mall, Vancouver, British Columbia, Canada
| | - Romina Moradi
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Roop Waraich
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tricia S Tang
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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12
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Afshar R, Askari AS, Sidhu R, Cox S, Sherifali D, Camp PG, Tang TS. Out of the mouths of Peer Leaders: Perspectives on how to improve a telephone-based peer support intervention in type 2 diabetes. Diabet Med 2022; 39:e14853. [PMID: 35437815 DOI: 10.1111/dme.14853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 04/11/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To explore the experiences of peer leaders with respect to delivering core components of a 12-month, telephone-based peer support intervention in type 2 diabetes within a tertiary-care setting. METHODS Seventeen peer leaders were recruited and interviewed. Interviews lasted approximately 20 to 45 min, were audio-taped, and transcribed verbatim. The transcripts were analysed by two team members using the qualitative descriptive approach. FINDINGS Peer leaders reported mutually beneficial and reciprocal relationships with participants. They encountered challenges in maintaining regular contact with participants and in motivating them to make lifestyle changes. To improve the programme, peer leaders suggested having more frequent - but shorter - training sessions and reducing the diabetes education component of the training programme. To enhance the intervention fidelity and retention rate, they recommended matching peer leaders to participants on more meaningful variables (e.g. diabetes-related commonalities, personality, life experiences, etc.) beyond just gender, geographic proximity and availability. They also requested more frequent face-to-face contacts with participants (Modality of Contact), and additional ongoing support from the research team. CONCLUSION Peer leaders were satisfied with the intervention design. However, future studies may consider more comprehensive peer leader-matching algorithms and increased opportunities for in-person communication modalities. CLINICALTRIALS gov Identifier: NCT02804620.
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Affiliation(s)
- Rowshanak Afshar
- Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Amir S Askari
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Rawel Sidhu
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Susan Cox
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | | | - Pat G Camp
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - Tricia S Tang
- Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, Canada
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13
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Mahmood B, Cox S, Ashe MC, Nettlefold L, Deo N, Puyat JH, Tang TS. ‘We just don’t have this in us…’: Understanding factors behind low levels of physical activity in South Asian immigrants in Metro-Vancouver, Canada. PLoS One 2022; 17:e0273266. [PMID: 36007081 PMCID: PMC9410550 DOI: 10.1371/journal.pone.0273266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/05/2022] [Indexed: 11/19/2022] Open
Abstract
Background South Asian immigrants in western countries are at a high risk for metabolic syndrome and associated chronic disease. While a physically active lifestyle is crucial in decreasing this risk, physical activity (PA) levels among this group remain low. The objectives of this study were to explore social and cultural factors that influence PA behavior, investigate how immigration process intersects with PA behaviors to influence PA levels and to engage community in a discussion about what can be done to increase PA in the South Asian community. Methods For this qualitative study, we conducted four Focus Group Discussions (FGDs) among a subset of participants who were part of a larger study. FGD data was coded and analysed using directed content analysis to identify key categories. Results Participants expressed a range of opinions, attitudes and beliefs about PA. Most believed they were sufficiently active. Women talked about restrictive social and cultural norms that discouraged uptake of exercise. Post-immigration levels of PA were low due to change in type of work and added responsibilities. Conclusion Health promoters need to consider social, cultural, and structural contexts when exploring possible behavior change interventions for South Asian immigrants.
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Affiliation(s)
- Bushra Mahmood
- Faculty of Medicine University of British Columbia, Vancouver, British Columbia, Canada
- * E-mail:
| | - Susan Cox
- The W. Maurice Young Centre for Applied Ethics, University of British Columbia, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Maureen C. Ashe
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lindsay Nettlefold
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Neha Deo
- Mayo Clinic, Alix School of Medicine, Rochester, Minnesota, United States of America
| | - Joseph H. Puyat
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation & Outcome Sciences, Saint Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Tricia S. Tang
- Faculty of Medicine University of British Columbia, Vancouver, British Columbia, Canada
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14
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Tate DF, Lutes LD, Bryant M, Truesdale KP, Hatley KE, Griffiths Z, Tang TS, Padgett LD, Pinto AM, Stevens J, Foster GD. Efficacy of a Commercial Weight Management Program Compared With a Do-It-Yourself Approach: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2226561. [PMID: 35972742 PMCID: PMC9382439 DOI: 10.1001/jamanetworkopen.2022.26561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Given the prevalence of obesity, accessible and effective treatment options are needed to manage obesity and its comorbid conditions. Commercial weight management programs are a potential solution to the lack of available treatment, providing greater access at lower cost than clinic-based approaches, but few commercial programs have been rigorously evaluated. OBJECTIVE To compare the differences in weight change between individuals randomly assigned to a commercial weight management program and those randomly assigned to a do-it-yourself (DIY) approach. DESIGN, SETTING, AND PARTICIPANTS This 1-year, randomized clinical trial conducted in the United States, Canada, and United Kingdom between June 19, 2018, and November 30, 2019, enrolled 373 adults aged 18 to 75 years with a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 25 to 45. Assessors were blinded to treatment conditions. INTERVENTIONS A widely available commercial weight management program that included reduced requirements for dietary self-monitoring and recommendations for a variety of DIY approaches to weight loss. MAIN OUTCOMES AND MEASURES The primary outcomes were the difference in weight change between the 2 groups at 3 and 12 months. The a priori hypothesis was that the commercial program would result in greater weight loss than the DIY approach at 3 and 12 months. Analyses were performed on an intention-to-treat basis. RESULTS The study include 373 participants (272 women [72.9%]; mean [SD] BMI, 33.8 [5.2]; 77 [20.6%] aged 18-34 years, 74 [19.8%] aged 35-43 years, 82 [22.0%] aged 44-52 years, and 140 [37.5%] aged 53-75 years). At 12 months, retention rates were 88.8% (166 of 187) for the commercial weight management program group and 95.7% (178 of 186) for the DIY group. At 3 months, participants in the commercial program had a mean (SD) weight loss of -3.8 (4.1) kg vs -1.8 (3.7) kg among those in the DIY group. At 12 months, participants in the commercial program had a mean (SD) weight loss of -4.4 (7.3) kg vs -1.7 (7.3) kg among those in the DIY group. The mean difference between groups was -2.0 kg (97.5% CI, -2.9 to -1.1 kg) at 3 months (P < .001) and -2.6 kg (97.5% CI, -4.3 to -0.8 kg) at 12 months (P < .001). A greater percentage of participants in the commercial program group than participants in the DIY group achieved loss of 5% of body weight at both 3 months (40.7% [72 of 177] vs 18.6% [34 of 183]) and 12 months (42.8% [71 of 166] vs 24.7% [44 of 178]). CONCLUSIONS AND RELEVANCE Adults randomly assigned to a commercial weight management program with reduced requirements for dietary self-monitoring lost more weight and were more likely to achieve weight loss of 5% at 3 and 12 months than adults following a DIY approach. This study contributes data on the efficacy of commercial weight management programs and DIY weight management approaches. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03571893.
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Affiliation(s)
- Deborah F. Tate
- Department of Nutrition, University of North Carolina at Chapel Hill
- Department of Health Behavior, University of North Carolina at Chapel Hill
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Lesley D. Lutes
- Department of Psychology, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Maria Bryant
- Department of Health Sciences, University of York, York, United Kingdom
- The Hull York Medical School, University of York, York, United Kingdom
| | | | - Karen E. Hatley
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | | | - Tricia S. Tang
- Department of Medicine, University of British Columbia, Vancouver Campus, Vancouver, British Columbia, Canada
| | - Louise D. Padgett
- Department of Health Sciences, University of York, York, United Kingdom
| | - Angela M. Pinto
- Department of Psychology, Baruch College/City University of New York, New York
| | - June Stevens
- Department of Nutrition, University of North Carolina at Chapel Hill
- Department of Epidemiology, University of North Carolina at Chapel Hill
| | - Gary D. Foster
- Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- WW, Maidenhead, Berkshire, UK
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15
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Ayala GX, Chan JCN, Cherrington AL, Elder J, Fisher EB, Heisler M, Howard AG, Ibarra L, Parada H, Safford M, Simmons D, Tang TS. Predictors and Effects of Participation in Peer Support: A Prospective Structural Equation Modeling Analysis. Ann Behav Med 2022; 56:909-919. [PMID: 35830356 DOI: 10.1093/abm/kaab114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Peer support provides varied health benefits, but how it achieves these benefits is not well understood. PURPOSE Examine a) predictors of participation in peer support interventions for diabetes management, and b) relationship between participation and glycemic control. METHODS Seven peer support interventions funded through Peers for Progress provided pre/post data on 1,746 participants' glycemic control (hemoglobin A1c), contacts with peer supporters as an indicator of participation, health literacy, availability/satisfaction with support for diabetes management from family and clinical team, quality of life (EQ-Index), diabetes distress, depression (PHQ-8), BMI, gender, age, education, and years with diabetes. RESULTS Structural equation modeling indicated a) lower levels of available support for diabetes management, higher depression scores, and older age predicted more contacts with peer supporters, and b) more contacts predicted lower levels of final HbA1c as did lower baseline levels of BMI and diabetes distress and fewer years living with diabetes. Parallel effects of contacts on HbA1c, although not statistically significant, were observed among those with baseline HbA1c values > 7.5% or > 9%. Additionally, no, low, moderate, and high contacts showed a significant linear, dose-response relationship with final HbA1c. Baseline and covariate-adjusted, final HbA1c was 8.18% versus 7.86% for those with no versus high contacts. CONCLUSIONS Peer support reached/benefitted those at greater disadvantage. Less social support for dealing with diabetes and higher PHQ-8 scores predicted greater participation in peer support. Participation in turn predicted lower HbA1c across levels of baseline HbA1c, and in a dose-response relationship across levels of participation.
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Affiliation(s)
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity and Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Andrea L Cherrington
- School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - John Elder
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Edwin B Fisher
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Michele Heisler
- Schools of Medicine and Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Annie Green Howard
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Leticia Ibarra
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Humberto Parada
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Monika Safford
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - David Simmons
- Campbelltown Hospital Endocrinology Department, Western Sydney University Macarthur Clinical School, Campbelltown, New South Wales, Australia
| | - Tricia S Tang
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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16
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Tang TS, Mahmood B, Amed S, McKay H. Drawing on Cultural Traditions to Improve Cardiorespiratory Fitness with South Asian Children: A Feasibility Study. Child Obes 2022; 18:333-341. [PMID: 34967668 DOI: 10.1089/chi.2021.0187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: South Asian children have a higher prevalence of cardiovascular disease risk factors compared with children of other ethnic backgrounds. Our objective was to explore the feasibility, acceptability, and potential fitness-related impact of a 7-month afterschool Bhangra dance intervention for South Asian children. Methods: We recruited 172 children grades 3 through 6 across 4 elementary schools for an intervention involving twice weekly Bhangra sessions in the school setting. Feasibility and acceptability were defined by recruitment, attendance, and retention metrics. The primary fitness outcome was cardiorespiratory fitness (CRF), measured via shuttle run laps and VO2 max. Secondary fitness outcomes included musculoskeletal (vertical jump height) and morphological fitness (waist circumference and BMI). Results: Sample size ranged from 28 to 54 participants per school (n = 172); mean attendance rate was 74%; and retention rate was 87%. VO2 max and shuttle laps increased by 1.4 mL·kg/min [95% confidence interval (CI): 0.93 to 1.84] and by 7.6 (95% CI: 6.11 to 9.08), respectively. Both these improvements remained significant after controlling for sex and age (VO2 max) and sex and baseline weight (shuttle laps). Musculoskeletal and morphological fitness indices also improved. Conclusions: Findings suggest that an afterschool Bhangra dance intervention is feasible, acceptable, and associated with CRF improvements as well as other indices of physical fitness.
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Affiliation(s)
- Tricia S Tang
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bushra Mahmood
- Department of Experimental Medicine Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shazhan Amed
- Department of Pediatrics, and University of British Columbia, Vancouver, British Columbia, Canada
| | - Heather McKay
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
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17
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Sekhon SS, Jhajj AS, Gill HPS, Khan N, Tang TS. Undiagnosed Hypertension in Vancouver's Punjabi Sikh Community: A Cross-Sectional Study. J Immigr Minor Health 2022; 24:1371-1374. [PMID: 35384546 DOI: 10.1007/s10903-022-01355-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
Abstract
South Asians bear a greater burden of cardiovascular disease (CVD) compared to other ethnic groups and hypertension is a major modifiable risk factor. The purpose of this study was to examine rates and predictors of uncontrolled blood pressure among an immigrant Punjabi Sikh community in Vancouver. We recruited 350 adults (40% women; mean age 67.3 ± 11.9 years) across 5 Sikh temples and measured blood pressure, heart rate, height, weight, waist circumference, socio-demographic background, and health history. 42% of participants had uncontrolled blood pressure of which one-third reported no previous history of hypertension. Based on modified cut-offs for South Asians, the mean waist circumferences across groups were well above target and 50% classified as obese. A higher percentage in the uncontrolled group (vs. controlled group) were of an older age, had a diabetes history and reported a physically active lifestyle. Findings suggest more efforts are needed to reduce the rates of uncontrolled blood pressure in this community. Interventions such as blood pressure drives, community-based outreach programs, and physical activity and dietary interventions should be explored to lower this CVD risk factor in this community.
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Affiliation(s)
- Sarpreet S Sekhon
- Core Internal Medicine Program, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada. .,Division of Endocrinology, University of British Columbia, 4th floor, Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC, Canada.
| | - Amrit S Jhajj
- Internal Medicine Program, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Harinder Pal S Gill
- Internal Medicine Program, Faculty of Medicine, Memorial University, St. John's, NL, Canada
| | - Nadia Khan
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.,Center for Health Evaluation and Outcomes Sciences, Vancouver, BC, Canada
| | - Tricia S Tang
- Division of Endocrinology, University of British Columbia, 4th floor, Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC, Canada
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18
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Yau KW, Tang TS, Görges M, Pinkney S, Kim AD, Kalia A, Amed S. Effectiveness of Mobile Apps in Promoting Healthy Behavior Changes and Preventing Obesity in Children: Systematic Review. JMIR Pediatr Parent 2022; 5:e34967. [PMID: 35343908 PMCID: PMC9002598 DOI: 10.2196/34967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 02/08/2022] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mobile apps have been increasingly incorporated into healthy behavior promotion interventions targeting childhood obesity. However, their effectiveness remains unclear. OBJECTIVE This paper aims to conduct a systematic review examining the effectiveness of mobile apps aimed at preventing childhood obesity by promoting health behavior changes in diet, physical activity, or sedentary behavior in children aged 8 to 12 years. METHODS MEDLINE, Embase, PsycINFO, CINAHL, and ERIC were systematically searched for peer-reviewed primary studies from January 2008 to July 2021, which included children aged 8 to 12 years; involved mobile app use; and targeted at least one obesity-related factor, including diet, physical activity, or sedentary behavior. Data extraction and risk of bias assessments were conducted by 2 authors. RESULTS Of the 13 studies identified, most used a quasi-experimental design (n=8, 62%). Significant improvements in physical activity (4/8, 50% studies), dietary outcomes (5/6, 83% studies), and BMI (2/6, 33% studies) were reported. All 6 multicomponent interventions and 57% (4/7) of standalone interventions reported significant outcomes in ≥1 behavioral change outcome measured (anthropometric, physical activity, dietary, and screen time outcomes). Gamification, behavioral monitoring, and goal setting were common features of the mobile apps used in these studies. CONCLUSIONS Apps for health behavior promotion interventions have the potential to increase the adoption of healthy behaviors among children; however, their effectiveness in improving anthropometric measures remains unclear. Further investigation of studies that use more rigorous study designs, as well as mobile apps as a standalone intervention, is needed.
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Affiliation(s)
- Kiana W Yau
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada.,Research Institute, BC Children's Hospital, Vancouver, BC, Canada
| | - Tricia S Tang
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada.,Research Institute, BC Children's Hospital, Vancouver, BC, Canada
| | - Matthias Görges
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada.,Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, BC, Canada
| | - Susan Pinkney
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada.,Department of Pediatrics, The University of British Columbia, Vancouver, BC, Canada
| | - Annie D Kim
- Department of Pediatrics, The University of British Columbia, Vancouver, BC, Canada
| | - Angela Kalia
- Department of Pediatrics, The University of British Columbia, Vancouver, BC, Canada
| | - Shazhan Amed
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada.,Department of Pediatrics, The University of British Columbia, Vancouver, BC, Canada
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19
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Titoria R, Amed S, Tang TS. Peer Support Interventions on Digital Platforms for Children With Type 1 Diabetes and Their Caregivers. Diabetes Spectr 2022; 35:26-32. [PMID: 35308148 PMCID: PMC8914597 DOI: 10.2337/ds21-0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Peer support for children with type 1 diabetes and their caregivers has been recognized as a key component in diabetes management and mental health. In this era of digitization, support programs delivered via technology are growing rapidly, particularly with increased access to technology and social media. Although the development of different digital modalities for this purpose is in its early stages, five different types of digital platforms have been recognized: voice, text, website, video, and social media. This article discusses the significance of peer support and explores various digital peer support interventions in pediatric patients with type 1 diabetes (0-18 years of age) and their caregivers.
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Affiliation(s)
- Reena Titoria
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Corresponding author: Reena Titoria,
| | - Shazhan Amed
- BC Children’s Hospital Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tricia S. Tang
- Department of Medicine, Division of Endocrinology, University of British Columbia, Vancouver, British Columbia, Canada
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20
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Afshar R, Sidhu R, Askari AS, Sherifali D, Camp PG, Cox S, Tang TS. “Tis better to give than receive?” Health-related benefits of delivering peer support in type 2 diabetes: A mixed methods study. Can J Diabetes 2022; 46:518-525. [DOI: 10.1016/j.jcjd.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 01/26/2022] [Accepted: 02/10/2022] [Indexed: 11/30/2022]
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21
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Afshar R, Sidhu R, Afshari R, Askari AS, Sherifali D, Camp PG, Cox S, Tang TS. Profiling “Success”: Demographic and Personality Predictors of Effective Peer Leaders in a Diabetes Self-Management Randomized Controlled Trial. Can J Diabetes 2022; 46:553-560. [DOI: 10.1016/j.jcjd.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/06/2021] [Accepted: 01/04/2022] [Indexed: 10/19/2022]
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22
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Carreon SA, Duran B, Tang TS, Streisand R, Anderson BJ, Lyons SK, McKay S, Hilliard ME. Here for You: A Review of Social Support Research in Young Adults With Diabetes. Diabetes Spectr 2021; 34:363-370. [PMID: 34866869 PMCID: PMC8603130 DOI: 10.2337/dsi21-0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Living with and managing diabetes is challenging during young adulthood, and social support may help relieve or minimize the burdens young adults with diabetes experience. This article reviews the types and sources of support young adults with diabetes receive and their associations with behavioral, psychosocial, and glycemic outcomes. Intervention research integrating social support and future directions for care are discussed.
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Affiliation(s)
| | - Brenda Duran
- Baylor College of Medicine & Texas Children’s Hospital, Houston, TX
| | - Tricia S. Tang
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Randi Streisand
- Children’s National Hospital, Washington, DC
- George Washington University School of Medicine, Washington, DC
| | | | - Sarah K. Lyons
- Baylor College of Medicine & Texas Children’s Hospital, Houston, TX
| | - Siripoom McKay
- Baylor College of Medicine & Texas Children’s Hospital, Houston, TX
| | - Marisa E. Hilliard
- Baylor College of Medicine & Texas Children’s Hospital, Houston, TX
- Corresponding author: Marisa E. Hilliard,
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Leung JMWS, Tang TS, Lim CE, Laffel LM, Amed S. The four I's of adolescent transition in type 1 diabetes care: A qualitative study. Diabet Med 2021; 38:e14443. [PMID: 33107064 DOI: 10.1111/dme.14443] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/23/2020] [Indexed: 02/05/2023]
Abstract
AIMS To explore adolescent perspectives on programme design in the transition to adult care. METHODS We conducted five focus groups on adolescents with type 1 diabetes nearing the age of transition to adult care. Study participants also completed an embedded survey where they rated a wide range of potential transition interventions. Focus group transcripts were analysed with three iterations of line-by-line coding to triangulate themes and subthemes. RESULTS Four themes were identified: Individualization-how to personalize the transition experience (having choices in the transition experience, meeting adult provider before transition and specific transition preparation); Identity-how the world relates to my diabetes (stigma of type 1 diabetes, confusion with type 2 diabetes, diagnosis disclosure and resilience); Interconnection-how my support system can help me with my diabetes (peer support, near peer support, parental support, loss of bond with paediatric team and fear of not having a bond with adult team); and Impediment-how my diabetes limits me (self-care takes work and time, unpredictability and restrictiveness, and emotional burden). Highly rated interventions from the survey included: good communication between the paediatric and adult teams, medical summary of past diabetes care, and having paediatric and adult teams in the same building. CONCLUSIONS The design of future transition interventions for adolescents with type 1 diabetes should address the issues of Individualization, Identity, Interconnection and Impediment. Collaborative processes between paediatric and adult providers were also rated as important strategies to facilitate the transition to adult care.
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Affiliation(s)
- Joseph M W S Leung
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Tricia S Tang
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Catherine E Lim
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | | | - Shazhan Amed
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
- Department of Pediatrics, The University of British Columbia, Vancouver, BC, Canada
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Ashrafi S, Taylor D, Tang TS. Moving beyond 'don't ask, don't tell': Mental health needs of adults with type 1 diabetes in rural and remote regions of British Columbia. Diabet Med 2021; 38:e14534. [PMID: 33524209 DOI: 10.1111/dme.14534] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 01/20/2021] [Accepted: 01/25/2021] [Indexed: 11/27/2022]
Abstract
AIMS To investigate the mental health needs of adults with type 1 diabetes living in rural and remote regions of Interior, British Columbia (BC) and identify factors associated with accessing support. We also explored perspectives around using peer support and digital health strategies for delivering mental health support. METHODS This study recruited 38 adults with type 1 diabetes to complete a self-report survey and participate in focus groups. We conducted six 90-min focus groups that addressed the following: current and past mental health needs, social media use for type 1 diabetes support, peer supporter recruitment and training, and support delivery features for virtual care platforms. Focus groups were recorded, transcribed, quality checked, coded and analysed to develop themes and subthemes. RESULTS Four core themes emerged: (1) emotional challenges linked to type 1 diabetes management, (2) unique type 1 diabetes-related concerns in rural and remote communities, (3) previous support experiences and future support needs and (4) diabetes-related mental health support interventions involving peer support and digital health strategies. Existing support services are inadequate in meeting the needs of type 1 diabetes adults in Interior BC. Some have turned towards social media as a way to connect with the type 1 diabetes community for support. CONCLUSIONS Though type 1 diabetes adults living in rural and remote settings experience distress associated with the ongoing burdens, frustrations and fears of managing a complex chronic condition, many have not been offered support and do not know how to seek services in the present/future. Peer support and digital health strategies are two potential solutions to address this care gap.
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Affiliation(s)
- Shadan Ashrafi
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Deanne Taylor
- Interior Health Authority, Kelowna, BC, Canada
- Faculty of Health and Social Development/Nursing, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Tricia S Tang
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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Mahmood B, Tang TS, Afshar R, Ashe MC. Objective measurement of physical activity and sedentary behavior among South Asian adults: A systematic review. PLoS One 2020; 15:e0236573. [PMID: 32756595 PMCID: PMC7406035 DOI: 10.1371/journal.pone.0236573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 07/09/2020] [Indexed: 12/22/2022] Open
Abstract
Background South Asians are one of the fastest growing ethnic groups in western countries with a high incidence of chronic diseases like metabolic syndrome and cardiovascular disease occurring at younger ages and lower body weight compared with white Europeans. Physically active lifestyle and reduced sedentary time are modifiable risk factors that can decrease burden of chronic diseases. Population-level surveys based on self-report show South Asians engage in low levels of physical activity. Because of known limitations with self-report data, we aimed to synthesize available evidence to generate a physical activity /sedentary time profile of South Asians from studies using accelerometry. Methods We systematically searched Medline, EMBASE, CINAHL, PsycINFO, and SportDiscus. We included studies applying accelerometry to measure physical activity /sedentary time under free-living. Studies with an exclusive focus on drugs or including participants with health conditions/physical disability, and special populations (athletes/pregnant women) were excluded. Two authors independently adjudicated inclusion of citations at title/abstract and full text. We applied a standardized data abstraction form to extract relevant data. We evaluated methodological quality using Newcastle Ottawa Quality Assessment Scale. Due to variability and inconsistencies in measurement and reporting of physical activity /sedentary time, we only provide a narrative synthesis. Findings We identified only 14 studies(n = 1,338). Despite using similar accelerometry assumptions, we noted variability in reported outcomes for physical activity and sedentary time. Sedentary time ranged from 482(98) to 587 min/day. Mean light physical activity ranged from 211.69(67. 38) to 574(227) min/day. Moderate to vigorous physical activity among South Asian women ranged from 17–41 min/day and among men, 32–43 min/day. Conclusion South Asians exhibited higher levels of physical activity when compared to the Canadian population level survey but not when compared to the American population level survey. Overall, fewer studies, and small sample sizes led to considerable variability limiting any effective comparisons. Results highlight the importance of conducting methodologically robust studies based on random sampling to advance the field, and to capture true levels of sedentary time and physical activity in the South Asian population.
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Affiliation(s)
- Bushra Mahmood
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- * E-mail:
| | - Tricia S. Tang
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rowshanak Afshar
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Maureen C. Ashe
- Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
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Kalra G, Gill S, Tang TS. Depression and Diabetes Distress in South Asian Adults Living in Low- and Middle-Income Countries: A Scoping Review. Can J Diabetes 2020; 44:521-529.e1. [PMID: 32792106 DOI: 10.1016/j.jcjd.2020.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES In this study, we conducted a scoping review to identify the prevalence of both depression and diabetes distress in patients with type 2 diabetes in low- and middle-income countries in South Asia. METHODS This scoping review was grounded in the methodology of Arksey and O'Malley by searching for relevant studies using Ovid MEDLINE, PsycINFO and Cumulative Index of Nursing and Allied Health Literature databases, as well as grey literature sources and hand searches. Two reviewers independently screened and extracted data from articles that met the inclusion criteria. RESULTS A total of 46 studies were included, with only 1 addressing both depression and diabetes distress. We present 42 total articles on depression and 5 on diabetes distress. The prevalence of type 2 diabetes and elevated depressive symptoms ranged from 11.6% to 67.5%, whereas the prevalence of diabetes distress ranged from 18.0% to 76.2%. CONCLUSIONS The prevalence of elevated depressive symptoms was found to be much higher than that reported in data from high-income countries and in data on South Asians living in high-income countries. Diabetes distress was found to be lower compared with other studies; however, the scarcity of data makes this observation inconclusive. Variations in depression inventories, lack of culturally tailored inventories and the focus on urban clinic-based populations are identified as limitations and areas requiring further research. Our review provides evidence for the need of increased mental health screening and treatment in diabetes care in South Asian countries.
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Affiliation(s)
- Gunisha Kalra
- Faculty of Health Sciences-Global Health, McMaster University, Hamilton, Ontario, Canada
| | - Simran Gill
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tricia S Tang
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
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Abstract
AIMS To use both quantitative and qualitative approaches to characterize the diabetes distress profile of Chinese-Canadians with Type 2 diabetes and to better understand their experience of living with diabetes. METHODS We recruited 40 Chinese-Canadian adults with Type 2 diabetes who completed a Mandarin- or Cantonese-language diabetes education programme in Richmond, British Columbia. Using a mixed-methods sequential explanatory research design, participants first completed a 15-item Chinese version of the Diabetes Distress Scale, which included three subscales: emotional burden, regimen-related distress, and physician distress. The self-report survey was followed by a semi-structured interview that addressed the following diabetes-related topics: perspectives towards the healthcare team, emotional health, diabetes-related concerns and stressors, diabetes diagnosis experience, and sources of social support and diabetes education. RESULTS The mean (sd) scores for total distress 1.5 (0.5), emotional burden 1.7 (0.7), regimen-related distress 1.4 (0.5), and physician distress 1.4 (0.9), fell within the 'low distress' range (< 2.0). Qualitative analysis of semi-structured interviews showed that some participants were dissatisfied with diabetes care providers and experienced emotional challenges, particularly early in their diagnosis. Other themes that emerged included eating distress, fear of complications, language barriers, and medication concerns. CONCLUSIONS Not only did the qualitative findings from semi-structured interviews capture aspects of diabetes distress that were not included in the quantitative survey, it also uncovered inconsistencies between the two datasets. To more accurately understand the diabetes distress experience of any ethnic community, both quantitative and qualitative approaches contribute unique value.
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Affiliation(s)
- A Xia
- School of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - K W Yau
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - T S Tang
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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Cunliffe A, Dobson J, Swallow G, Ravenscroft J, Tang TS. Taipan snake venom time for antiphospholipid syndrome solves a 20-year diagnostic challenge. Clin Exp Dermatol 2020; 45:805-808. [PMID: 32432361 DOI: 10.1111/ced.14229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2020] [Indexed: 01/06/2023]
Affiliation(s)
- A Cunliffe
- Department of Dermatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - J Dobson
- Department of Dermatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - G Swallow
- Department of, Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - J Ravenscroft
- Department of Dermatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - T S Tang
- Department of Dermatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Leung JMWS, Al-Yahyawi NY, Choi HS, Stewart LL, Tang TS, Amed S. MON-631 Quality of Life in a Pragmatic Trial of a Type 1 Diabetes Adolescent Transition Program. J Endocr Soc 2020. [PMCID: PMC7207986 DOI: 10.1210/jendso/bvaa046.1211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction: Adolescents with type 1 diabetes (T1D) experience ongoing deterioration in their glycemic control as they transition to young adulthood.1 Several trials have evaluated possible transition interventions to ameliorate the care gap between pediatric and adult services in T1D care, although it remains unclear which are the most appropriate.2,3 In this pragmatic study, we sought to determine whether the change in quality of life pre- and post-transition was different between adolescents with T1D accessing a transition program versus those who did not. Methods: Between 2016-2018, we recruited 68 adolescents with T1D at their last pediatric diabetes clinic visit from a tertiary diabetes center without a structured transition program (control group) and 33 from a community-based outreach clinic with a transition program (intervention group) consisting of a transition coordinator, joint transition clinics, and pediatric and adult clinics located in the same building. At the time of transition and at one-year post-transition, we conducted chart reviews and administered surveys, including the SF-8 quality of life questionnaire. Analysis included descriptive statistics and linear regression models. Results: The control and intervention groups had the following characteristics, respectively: age at transition 18.4 years vs. 20.5 years (p<0.001); female 47% vs. 55% (p=0.49); average A1C at the time of transition 8.2% vs. 9.1% (p=0.0053). There was no statistically significant difference in the change in SF-8 scores for each of the eight domains (general health, physical functioning, role physical, bodily pain, vitality, social functioning, mental health, and role emotional) between the two groups. However, older age at transition was associated with an improvement in SF-8 vitality domain scores between the pre- and post-transition timepoints (p=0.034). Female sex was associated with a worsening in SF-8 vitality domain (p=0.004) and social functioning domain (p=0.015) scores between the pre- and post-transition timepoints. Finally, higher average A1C in the year prior to transition was associated with a worsening in SF-8 role physical domain scores between the pre- and post-transition timepoints (p=0.002). Conclusions: Quality of life scores in the vitality domain improved in the first year post-transition amongst young adults with T1D who transitioned at an older age, suggesting that a later transition may benefit adolescents with T1D. Additionally, worsening quality of life scores amongst young women and in those with higher pre-transition A1Cs suggest that these populations may require more specialized care at the time of transition. References: 1. Foster et al. Diabetes Technol Ther. 2019;21(2):66-72. 2. White et al. Lancet Child Adolesc Health. 2017;1(4):274-83. 3. Spaic et al. Diabetes Care. 2019;42(6):1018-26.
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Affiliation(s)
| | | | | | | | - Tricia S Tang
- The University of British Columbia, Vancouver, BC, Canada
| | - Shazhan Amed
- The University of British Columbia, Vancouver, BC, Canada
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Afshar R, Tang TS, Askari AS, Sidhu R, Brown H, Sherifali D. Peer support interventions in type 2 diabetes: Review of components and process outcomes. J Diabetes 2020; 12:315-338. [PMID: 31639255 DOI: 10.1111/1753-0407.12999] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/09/2019] [Accepted: 10/17/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND This review seeks to identify (a) the various components and process outcomes of type 2 diabetes peer support (PS) interventions and (b) the measures implemented to monitor intervention fidelity and evaluate outcomes in these studies. METHODS The MEDLINE, PubMed, EMBASE (Excerpta Medica Database), CENTRAL (Cochrane Central Register of Controlled Trials), CINAHL (Cumulative Index to Nursing and Allied Health Literature), and PsycINFO databases were searched from inception to May 2019. Two reviewers independently screened and extracted data from eligible articles via the Template for Intervention Description and Replication (TIDieR) checklist (why, what, who provided, how, where, when and how much, tailoring, modifications, and how well). RESULTS Twenty-three trials were included. The total number of participants was 7178. Most interventions were in primary care. Although face-to-face was the most common modality of contact, rates of contact were highest for telephone. Potential peer leaders (PLs) were identified primarily through recommendations from health professionals, based on their communication skills, glycosylated hemoglobin (HbA1c), and coaching interest. PLs were mostly female, university educated, and had a long history of diabetes (≥ 10 years). PL training varied significantly in length and content; the two most frequent topics were communication skills and diabetes knowledge. Although several studies implemented methods to evaluate "intervention fidelity," only few rigorously assessed the two key components of fidelity, "adherence" and "competence," through audio- and video-taping or direct observations. CONCLUSIONS The impact of PS on participants' health outcomes is well investigated; however, the implementation and evaluation strategies vary significantly across these studies. In the present review, we define the various components of PS interventions and propose suggestions for enhancing the implementation and evaluation of future PS models.
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Affiliation(s)
- Rowshanak Afshar
- Division of Endocrinology, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Tricia S Tang
- Division of Endocrinology, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Amir S Askari
- Division of Endocrinology, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Rawel Sidhu
- Division of Endocrinology, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Helen Brown
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Diana Sherifali
- School of Nursing, McMaster University, Vancouver, British Columbia, Canada
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Tang TS, Halani K, Sohal P, Bains P, Khan N. Do Cultural and Psychosocial Factors Contribute to Type 2 Diabetes Risk? A Look Into Vancouver's South Asian Community. Can J Diabetes 2019; 44:14-21. [PMID: 31444060 DOI: 10.1016/j.jcjd.2019.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 04/04/2019] [Accepted: 04/30/2019] [Indexed: 01/27/2023]
Abstract
OBJECTIVES South Asian immigrants are generally healthy upon arrival, but precipitously develop diabetes after immigration. Whether cultural and psychosocial factors contribute to diabetes risk in this ethnic minority group remains unclear. Existing prediction models focus primarily on clinical and lifestyle factors. This study explored whether nontraditional risk factors are incrementally predictive beyond traditional risk factors in this South Asian community. METHODS In this cross-sectional study, we recruited 425 South Asian adults attending Sikh and Hindu temples in Metro Vancouver between July 2013 and June 2014. We measured traditional risk factors, including glycated hemoglobin (A1C), apolipoprotein B, systolic and diastolic blood pressure (BP), waist circumference, weight, body mass index (BMI), dietary patterns and physical activity level. Self-report questionnaires assessed cultural and psychosocial factors, including acculturation, dinnertime (timing of the evening meal), religion and depressive symptoms. We constructed a penalized multivariable linear model with A1C level using the least absolute shrinkage and selection operator (LASSO) approach to overcome issues of overfitting and reduce prediction error of previous diabetes prediction models. RESULTS The LASSO model selected 24 risk factors for the optimal model to predict glycemic control. Results revealed that higher degree of acculturation (p=0.007), later dinnertime (p=0.01) and greater depressive symptoms (p=0.038) are important factors in diabetes risk in addition to traditional risk factors (fruit/vegetable/fibre intake, BMI and systolic BP). CONCLUSIONS Nontraditional factors, such as cultural practices and emotional functioning, are also important predictors of diabetes risk and should be considered when culturally tailoring diabetes prevention programs.
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Affiliation(s)
- Tricia S Tang
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | | | - Parmjit Sohal
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Paul Bains
- Canada India Network Society, Surrey, British Columbia, Canada
| | - Nadia Khan
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Tang TS, Afshar R, Elliott T, Kong J, Gill S. Study protocol and baseline sample characteristics: From clinic to community: Using peer support as a transition model for improving long-term diabetes-related health outcomes. Contemp Clin Trials 2019; 79:104-110. [PMID: 30739001 DOI: 10.1016/j.cct.2019.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 02/01/2019] [Accepted: 02/06/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The objective of this randomized controlled trial is to examine the effects of a 12-month telephone-based peer-led diabetes self-management support (DSMS) intervention on long-term diabetes-related health outcomes. METHODS In total, 197 participants with type 2 diabetes were recruited from specialty care settings (diabetes and endocrinology clinics). They were randomly assigned to 1) a 12-month Peer-Led, Empowerment-based Approach to Self-management Efforts in Diabetes (PLEASED) program where they received 12 weekly contacts from their peer supporter (PS) in the first 3 months, followed by 18 biweekly telephone support contacts over the last 9 months, or 2) usual care. The primary clinical and psychosocial outcomes were HbA1c and diabetes distress (DD), respectively. Secondary outcomes were cardiovascular risk factors. Assessments were conducted at baseline, 3 months, and 12 months. RESULT Of 197 recruited participants, 49.7% were female. The majority of participants were married/partnered, well-educated, employed, and Caucasian, with a mean HbA1c of 8.09 ± 1.7. Forty-two percent of participants reported little or no distress. There was no significant difference between the two groups. DISCUSSION Despite evidence showing that individuals with poor glycemic control benefit the most from peer support interventions, the majority of such interventions have been designed for and implemented in community and primary care-based settings. The present study investigates a 12-month peer support model to help patients initiate and sustain effective self-management behaviors while transitioning from specialty care to a community setting. The study was completed in November 2018. The outcome data analyses are currently underway. TRIAL REGISTRATION The study was registered on clinicaltrials.gov (NT02804620). PROTOCOL VERSION The protocol version is 3.5.
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Affiliation(s)
- Tricia S Tang
- Department of Medicine, The University of British Columbia, Gordon and Leslie Diamond Center, 2775 Laurel Street, Room 102011, Vancouver, BC V5Z 1M, Canada.
| | - Rowshanak Afshar
- Division of Endocrinology, Department of Medicine, The University of British Columbia, Canada.
| | - Thomas Elliott
- Division of Endocrinology, Department of Medicine, The University of British Columbia, Canada.
| | - Jason Kong
- Division of Endocrinology, Department of Medicine, The University of British Columbia, Canada.
| | - Sabrina Gill
- Division of Endocrinology, Department of Medicine, The University of British Columbia, Canada.
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Stuckey H, Fisher L, Polonsky WH, Hessler D, Snoek FJ, Tang TS, Hermanns N, Mundet-Tuduri X, da Silva MER, Sturt J, Okazaki K, Cao D, Hadjiyianni I, Ivanova JI, Desai U, Perez-Nieves M. Key factors for overcoming psychological insulin resistance: an examination of patient perspectives through content analysis. BMJ Open Diabetes Res Care 2019; 7:e000723. [PMID: 31908792 PMCID: PMC6936574 DOI: 10.1136/bmjdrc-2019-000723] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/17/2019] [Accepted: 10/01/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To understand participant perceptions about insulin and identify key behaviors of healthcare professionals (HCPs) that motivated initially reluctant adults from seven countries (n=40) who had type 2 diabetes (T2D) to start insulin treatment. RESEARCH DESIGN AND METHODS Telephone interviews were conducted with a subset of participants from an international investigation of adults with T2D who were reluctant to start insulin (EMOTION). Questions related to: (a) participants' thoughts about insulin before and after initiation; (b) reasons behind responses on the survey that were either 'not helpful at all' or 'helped a lot'; (c) actions their HCP may have taken to help start insulin treatment; and (d) advice they would give to others in a similar situation of starting insulin. Responses were coded by two independent reviewers (kappa 0.992). RESULTS Starting insulin treatment was perceived as a negative experience that would be painful and would lead down a 'slippery slope' to complications. HCPs engaged in four primary behaviors that helped with insulin acceptance: (1) showed the insulin pen/needle and demonstrated the injection process; (2) explained how insulin could help with diabetes control and reduce risk of complications; (3) used collaborative communication style; and (4) offered support and willingness to answer questions so that participants would not be 'on their own'. Following initiation, most participants noted that insulin was not 'as bad as they thought' and recommended insulin to other adults with T2D. CONCLUSIONS Based on these themes, two actionable strategies are suggested for HCPs to help people with psychological insulin resistance: (1) demonstrate the injection process and discuss negative perceptions of insulin as well as potential benefits; (2) offer autonomy in a person-centred collaborative approach, but provide support and accessibility to address concerns. These findings help HCPs to better understand ways in which they can engage reluctant people with T2D with specific strategies.
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Affiliation(s)
| | - Lawrence Fisher
- University of California San Francisco, San Francisco, California, USA
| | - William H Polonsky
- Behavioral Diabetes Institute, University of California, San Diego, Del Mar, California, USA
| | - Danielle Hessler
- University of California San Francisco, San Francisco, California, USA
| | - Frank J Snoek
- Amsterdam University Medical Centre Vrije Universiteit, Amsterdam, The Netherlands
| | - Tricia S Tang
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | - Kentaro Okazaki
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Dachuang Cao
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | | | - Urvi Desai
- Analysis Group Inc Boston, Boston, Massachusetts, USA
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Sidhu R, Tang TS. Response to the Letter to the Editor From Dr. Kawada, “Depressive Symptoms, Diabetes Distress and Serum Hemoglobin A1C in South Asians With Type 2 Diabetes Mellitus Living in Canada”. Can J Diabetes 2018; 42:4. [DOI: 10.1016/j.jcjd.2017.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 06/09/2017] [Indexed: 10/19/2022]
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Li D, Elliott T, Klein G, Ur E, Tang TS. Diabetes Nurse Case Management in a Canadian Tertiary Care Setting: Results of a Randomized Controlled Trial. Can J Diabetes 2017; 41:297-304. [DOI: 10.1016/j.jcjd.2016.10.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 10/17/2016] [Accepted: 10/21/2016] [Indexed: 11/16/2022]
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Wong EM, Afshar R, Qian H, Zhang M, Elliott TG, Tang TS. Diabetes Distress, Depression and Glycemic Control in a Canadian-Based Specialty Care Setting. Can J Diabetes 2017; 41:362-365. [PMID: 28462795 DOI: 10.1016/j.jcjd.2016.11.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/16/2016] [Accepted: 11/17/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The objectives of this study were to determine rates of diabetes distress and depression in patients with type 2 diabetes in a tertiary care setting, to examine the relationship among glycemic control, diabetes distress and depression, and to identify predictors of diabetes distress and depression on the basis of demographic and clinical characteristics. METHODS We recruited 148 adults with type 2 diabetes who were presenting to a specialty diabetes clinic in Vancouver, British Columbia, Canada. Participants completed a questionnaire measuring diabetes distress, depressive symptoms and demographic backgrounds. The Diabetes Distress Scale was used to assess overall distress as well as 4 distinct distress dimensions, including emotional burden, physician-related, regimen-related and interpersonal distress. The Personal Health Questionnaire-9 was used to assess depressive symptoms. Glycated hemoglobin (A1C) data were also collected. RESULTS The prevalence of diabetes distress and depression was 39% and 12% in our population, respectively. A1C levels emerged as a significant predictor of emotional burden (p=0.03) and regimen-related distress (p=0.01); higher A1C levels were associated with increased distress regarding emotional functioning and regimen adherence. A1C levels (p=0.02) and education levels (p=0.03) emerged as predictors of physician-related distress, with higher A1C levels associated with decreased distress regarding confidence in physicians. CONCLUSIONS Our findings reveal that the rate of diabetes distress for patients in a tertiary care setting is high. Furthermore, diabetes distress, particularly emotion- and self-care-related distress, plays a significant role in glycemic control, whereas depression does not. Routine screening for diabetes distress as part of an initial specialty clinic evaluation should be explored.
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Affiliation(s)
- Evelyn M Wong
- Division of Endocrinology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Rowshanak Afshar
- Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hong Qian
- Centre for Health Evaluation & Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Mira Zhang
- BC Diabetes, Vancouver, British Columbia, Canada
| | | | - Tricia S Tang
- Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Kowitt SD, Ayala GX, Cherrington AL, Horton LA, Safford MM, Soto S, Tang TS, Fisher EB. Examining the Support Peer Supporters Provide Using Structural Equation Modeling: Nondirective and Directive Support in Diabetes Management. Ann Behav Med 2017; 51:810-821. [DOI: 10.1007/s12160-017-9904-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Tang TS, Yusuf FLA, Polonsky WH, Fisher L. Assessing quality of life in diabetes: II - Deconstructing measures into a simple framework. Diabetes Res Clin Pract 2017; 126:286-302. [PMID: 28190527 DOI: 10.1016/j.diabres.2016.10.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 10/13/2016] [Indexed: 12/19/2022]
Abstract
A growing number of instruments measuring diabetes-specific health-related quality of life (HRQOL) have been identified in previous systematic reviews, the most recent being published in 2008. The purpose of this paper is report on an updated systematic review of diabetes-specific HRQOL measures highlighting the time period 2006-2016; to deconstruct existing diabetes-specific HRQOL measures into a simple framework for evaluating the goodness-of-fit between specific research needs and instrument characteristics; and to present core characteristics of measures not yet reported in other reviews to further facilitate scale selection. Using the databases Medline, Pubmed, CINAHL, OVID Embase, and PsycINFO, we identified 20 diabetes-specific HRQOL measures that met our inclusion criteria. For each measure, we extracted eight core characteristics for our measurement selection framework. These characteristics include target population (type 1 vs. type 2), number and type of HRQOL dimensions measured and scored, type of score and calculation algorithm, sensitivity to change data reported in subsequent studies, number of survey items, approximate time length to complete, number of studies using the instrument in the past 10years, and specific languages instruments is translated. This report provides a way to compare and contrast existing diabetes-specific HRQOL measures to aid in appropriate scale selection and utilization.
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Affiliation(s)
| | | | - William H Polonsky
- Behavioral Diabetes Institute, San Diego, CA, USA; University of California, San Diego, CA, USA
| | - Lawrence Fisher
- University of California, San Francisco, San Francisco, CA, USA
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Abstract
PURPOSE OF REVIEW South Asian (SA) immigrants have a higher burden of type 2 diabetes, report poor self-management, and remain a hard-to-engage group in behavioral interventions. The purpose of this review was to characterize recruitment and retention of SAs in behavioral interventions. RECENT FINDINGS We identified 14 studies with limited information regarding recruitment and retention. Overall recruitment rates were low: 12 studies had a mean recruitment rate of 44% among those screened, and 9 studies with complete information on eligibility had a mean recruitment rate of 65.8% among those eligible. Mean retention rate was 79.4% across all 14 studies. Although unstandardized and inconsistent reporting limited our ability to draw any conclusions regarding the best strategies to maximize recruitment and retention, we were able to highlight some novel and effective strategies. There is a need for consistent and standardized reporting of recruitment and retention-related information to encourage meaningful research and guide researchers in efficient allocation of resources and a successful conclusion of future interventions.
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Affiliation(s)
- Bushra Mahmood
- Department of Medicine, Division of Endocrinology, University of British Columbia, DHCC #10211, 2775 Laurel Street, 10th Floor, Vancouver, BC, V5Z 1M9, Canada
| | - Rowshanak Afshar
- Department of Medicine, Division of Endocrinology, University of British Columbia, DHCC #10211, 2775 Laurel Street, 10th Floor, Vancouver, BC, V5Z 1M9, Canada
| | - Tricia S Tang
- Department of Medicine, Division of Endocrinology, University of British Columbia, DHCC #10211, 2775 Laurel Street, 10th Floor, Vancouver, BC, V5Z 1M9, Canada.
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Sandhu SK, Tang TS. When's dinner? Does timing of dinner affect the cardiometabolic risk profiles of South-Asian Canadians at risk for diabetes. Diabet Med 2017; 34:539-542. [PMID: 26802477 DOI: 10.1111/dme.13081] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 10/28/2015] [Accepted: 01/19/2016] [Indexed: 11/29/2022]
Abstract
AIM To explore the relationship between the time dinner is consumed (dinnertime or timing of dinner) and cardiometabolic risk factors among South-Asian Canadians at risk for diabetes. METHODS We recruited 432 South-Asian adults affiliated with Sikh and Hindu Temples in Metro Vancouver. Participants deemed to be at risk of diabetes underwent a clinical and behavioural assessment. Dinnertime was measured via self-report. Clinical endpoints included HbA1c , apolipoprotein, blood pressure, weight, BMI and waist circumference. RESULTS The mean age of participants was 65 years and 59% were male. Dinnertime was categorized into three groups: early (before 18:00 h); average (18:00 to 20:00 h); and late (later than 20:00 h). Among the participants, 19% (n = 79), 44% (n = 187) and 37% (n = 157) reported early, average and late dinnertimes, respectively. Significant differences were found for dinnertime groups and years of residence in Canada, gender and employment. Compared with the early dinnertime group, the late dinnertime group lived in Canada for a shorter duration, comprised a higher proportion of males (66 vs 48%; P = 0.01) and were currently employed (37 vs 22%; P = 0.02). With regard to clinical endpoints, compared with the early dinnertime group, the late dinnertime group had lower systolic blood pressure (135.9 vs 131.7 mmHg; P = 0.03). After controlling for demographic characteristics, this difference was diminished. No significant differences were found between dinnertime and HbA1c , apolipoprotein, diastolic blood pressure, weight, BMI and waist circumference. CONCLUSION Findings suggest that, among this sample of South-Asian Canadians at risk of Type 2 diabetes, there was no association between timing of the evening meal and cardiometabolic profiles.
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Affiliation(s)
- S K Sandhu
- Division of Endocrinology and Metabolism, University of British Columbia, Vancouver, Canada
| | - T S Tang
- Division of Endocrinology and Metabolism, University of British Columbia, Vancouver, Canada
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Wong E, Afshar R, Zhang M, Elliott TG, Tang TS. Diabetes Distress is Associated with Poor Glycemic Control Among Patients with Type 2 Diabetes Presenting to a Tertiary Care Setting in Vancouver. Can J Diabetes 2015. [DOI: 10.1016/j.jcjd.2015.09.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Afshar R, Gasevic D, Tang TS. The Impact of Social Support on Glycemic Control and Complications Among South Asian Canadians with Type 2 Diabetes. Can J Diabetes 2015. [DOI: 10.1016/j.jcjd.2015.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Tang TS, Funnell MM, Sinco B, Spencer MS, Heisler M. Peer-Led, Empowerment-Based Approach to Self-Management Efforts in Diabetes (PLEASED): A Randomized Controlled Trial in an African American Community. Ann Fam Med 2015; 13 Suppl 1:S27-35. [PMID: 26304969 PMCID: PMC4648139 DOI: 10.1370/afm.1819] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
PURPOSE We compared a 3-month diabetes self-management education (DSME) program followed by a 12-month peer support intervention with a 3-month DSME program alone in terms of initial and sustained improvements in glycated hemoglobin (HbA1c). Secondary outcomes were risk factors for cardiovascular disease (CVD), diabetes distress, and social support. METHODS We randomized 106 community-dwelling African American adults with type 2 diabetes to a 3-month DSME program followed by 12 months of weekly group sessions and supplementary telephone support delivered by peer leaders or to a 3-month DSME program with no follow-up peer support. Assessments were conducted at baseline, 3, 9, and 15 months. RESULTS No changes in HbA1c were observed at 3 months or at 15 months for either group. The peer support group either sustained improvement in key CVD risk factors or stayed the same while the control group worsened at 15 months. At 15 months, the peer-support group had significantly lower low-density lipoprotein cholesterol levels (-15 mg/dL, P = .03), systolic blood pressure (-10 mm Hg, P = .01), diastolic blood pressure (-8.3 mm Hg, P = .001), and body mass index (-0.8 kg/m(2), P = .032) than the DSME-alone group. CONCLUSIONS In this population of African American adults, an initial DSME program, whether or not followed by 12 months of peer support, had no effect on glycemic control. Participants in the peer-support arm of the trial did, however, experience significant improvements in some CVD risk factors or stay approximately the same while the control group declined.
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Affiliation(s)
- Tricia S Tang
- University of British Columbia Department of Medicine, Vancouver, British Columbia
| | - Martha M Funnell
- University of Michigan Department of Learning Health Sciences. Ann Arbor Michigan
| | - Brandy Sinco
- University of Michigan School of Social Work, Ann Arbor, Michigan
| | | | - Michele Heisler
- University of Michigan Department of Internal Medicine, Ann Arbor, Michigan Ann Arbor VA Center for Clinical Management Research (CCMR), Ann Arbor, Michigan
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Fisher EB, Ayala GX, Ibarra L, Cherrington AL, Elder JP, Tang TS, Heisler M, Safford MM, Simmons D. Contributions of Peer Support to Health, Health Care, and Prevention: Papers from Peers for Progress. Ann Fam Med 2015; 13 Suppl 1:S2-8. [PMID: 26304968 PMCID: PMC4648132 DOI: 10.1370/afm.1852] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
SUBSTANTIAL: evidence documents the benefits of peer support provided by community health workers, lay health advisors, promotores de salud, and others. The papers in this supplement, all supported by the Peers for Progress program of the American Academy of Family Physicians Foundation, contribute to the growing body of literature addressing the efficacy, effectiveness, feasibility, reach, sustainability, and adoption of peer support for diabetes self-management. They and additional papers supported by Peers for Progress contribute to understanding how peer support can be implemented in real world settings. Topics include examination of the peers who provide peer support, reaching the hardly reached, success factors in peer support interventions, proactive approaches, attention to emotions, peer support in behavioral health, dissemination models and their application in China, peer support in the patient-centered medical home, research challenges, and policy implications.
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Affiliation(s)
- Edwin B Fisher
- Peers for Progress, American Academy of Family Physicians Foundation, Leawood, Kansas Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Guadalupe X Ayala
- San Diego State University College of Health and Human Services and Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California
| | | | - Andrea L Cherrington
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - John P Elder
- San Diego State University College of Health and Human Services and Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California
| | - Tricia S Tang
- University of British Columbia Department of Medicine, Vancouver, British Columbia
| | - Michele Heisler
- University of Michigan Department of Internal Medicine, Ann Arbor, Michigan
| | - Monika M Safford
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - David Simmons
- School of Medicine, University of Western Sydney, Australia Institute of Metabolic Science, Cambridge University Hospitals, NHS Foundation Trust, Cambridge, England
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Abstract
AIM To examine the feasibility and potential health impact of a diabetes self-management education and support intervention involving peer support on glycaemic control and diabetes distress. METHODS A total of 41 South-Asian adults with Type 2 diabetes were recruited for a 24-week diabetes self-management education and support pilot intervention involving peer support. The intervention consisted of six weekly education sessions co-facilitated by a certified diabetes educator and two peer leaders, followed by 18 weekly support sessions facilitated by two peer leaders. Education sessions were guided entirely by participants' self-management questions and also emphasized goal setting and action planning. Support sessions were based on empowerment principles and participants discussed self-management challenges, shared emotions, asked self-management questions, problem-solved in a group, set goals, and developed and evaluated action plans. Feasibility outcomes included recruitment and retention. Primary health-related outcomes included HbA1c levels and diabetes distress (measured at baseline, 6 and 24 weeks). Programme satisfaction was also assessed. RESULTS Pre-established criteria for recruitment and retention were met. Paired t-tests showed no changes in HbA1c and diabetes distress at 6 weeks. At 24 weeks, HbA1c levels deteriorated [54 mmol/mol (7.1%) vs 61 mmol/mol (7.7%)] while diabetes distress scores improved (2.0 vs 1.7). CONCLUSIONS Although feasible, findings suggest this peer-support model may have a positive impact on diabetes distress, but not on HbA1c levels. Culturally responsive modifications (e.g. intervention location) to the pilot model are needed and could lead to more favourable health outcomes for this community. Such a re-designed peer-support model will require further investigation.
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Affiliation(s)
- T S Tang
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - P S Sohal
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - A K Garg
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Tang TS, Digby EM, Wright AM, Chan JHM, Mazanderani AB, Ross SA, Tildesley HG, Lee AM, White AS, Tildesley HD. Real-time continuous glucose monitoring versus internet-based blood glucose monitoring in adults with type 2 diabetes: a study of treatment satisfaction. Diabetes Res Clin Pract 2014; 106:481-6. [PMID: 25458333 DOI: 10.1016/j.diabres.2014.09.050] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 06/03/2014] [Accepted: 09/14/2014] [Indexed: 11/18/2022]
Abstract
AIMS To compare treatment satisfaction between real-time continuous glucose monitoring (RT-CGM) and internet-blood glucose monitoring (IBGM) in adults with type 2 diabetes treated with insulin. METHODS This study recruited 40 patients who completed a parallel randomized controlled trial comparing a RT-CGM to an IBGM. Patients in the RT-CGM group monitored their blood-glucose levels bi-weekly and emailed results to their endocrinologist. Patients in the IBGM group also monitored their blood-glucose levels bi-weekly, but entered their data into an IBGM. Both groups used a secure website to submit blood-glucose readings and to receive feedback from their endocrinologist. Feedback included changes in therapy, suggestions on testing frequency, lifestyle modifications and/or encouragement to continue with no changes. At the end of 6 months, treatment satisfaction was measured using the 8-item Diabetes Treatment Satisfaction Questionnaire. In this study, "treatment" refers to the blood glucose monitoring system to which patients were randomized. RESULTS Thirty-two of the 40 patients completed the treatment satisfaction questionnaire (80%). Compared to the RT-CGM group, the IBGM group reported a significantly higher level of overall treatment satisfaction (24.80 vs. 33.41, p<0.000). Ratings of individual satisfaction components including convenience, flexibility, likelihood of recommending treatment to others, and willingness to continue with treatment were also found to be significantly higher in the IBGM group. CONCLUSION Patients using IBGM are more satisfied with their blood glucose monitoring system compared to those using RT-CGM.
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Affiliation(s)
- Tricia S Tang
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | | | | | | | | | - Stuart A Ross
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | | | | | - Adam S White
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Hugh D Tildesley
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Tang TS, Funnell M, Sinco B, Piatt G, Palmisano G, Spencer MS, Kieffer EC, Heisler M. Comparative effectiveness of peer leaders and community health workers in diabetes self-management support: results of a randomized controlled trial. Diabetes Care 2014; 37:1525-34. [PMID: 24722495 PMCID: PMC4030090 DOI: 10.2337/dc13-2161] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare a peer leader (PL) versus a community health worker (CHW) telephone outreach intervention in sustaining improvements in HbA1c over 12 months after a 6-month diabetes self-management education (DSME) program. RESEARCH DESIGN AND METHODS One hundred and sixteen Latino adults with type 2 diabetes were recruited from a federally qualified health center and randomized to (1) a 6-month DSME program followed by 12 months of weekly group sessions delivered by PLs with telephone outreach to those unable to attend or (2) a 6-month DSME program followed by 12 months of monthly telephone outreach delivered by CHWs. The primary outcome was HbA1c. Secondary outcomes were cardiovascular disease risk factors, diabetes distress, and diabetes social support. Assessments were conducted at baseline, 6, 12, and 18 months. RESULTS After DSME, the PL group achieved a reduction in mean HbA1c (8.2-7.5% or 66-58 mmol/mol, P < 0.0001) that was maintained at 18 months (-0.6% or -6.6 mmol/mol from baseline [P = 0.009]). The CHW group also showed a reduction in HbA1c (7.8 vs. 7.3% or 62 vs. 56 mmol/mol, P = 0.0004) post-6 month DSME; however, it was attenuated at 18 months (-0.3% or -3.3 mmol/mol from baseline, within-group P = 0.234). Only the PL group maintained improvements achieved in blood pressure at 18 months. At the 18-month follow-up, both groups maintained improvements in waist circumference, diabetes support, and diabetes distress, with no significant differences between groups. CONCLUSIONS Both low-cost maintenance programs led by either a PL or a CHW maintained improvements in key patient-reported diabetes outcomes, but the PL intervention may have additional benefit in sustaining clinical improvements beyond 12 months.
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Affiliation(s)
- Tricia S Tang
- University of British Columbia Department of Medicine, Vancouver, British Columbia, Canada
| | - Martha Funnell
- University of Michigan Department of Medical Education, Ann Arbor, MI
| | - Brandy Sinco
- University of Michigan School of Social Work, Ann Arbor, MI
| | - Gretchen Piatt
- University of Michigan Department of Medical Education, Ann Arbor, MI
| | | | | | | | - Michele Heisler
- University of Michigan Department of Internal Medicine, Ann Arbor, MIAnn Arbor VA Center for Clinical Management Research, Ann Arbor, MI
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Yeung RO, Oh M, Tang TS. Does a 2.5-year self-management education and support intervention change patterns of healthcare use in African-American adults with type 2 diabetes? Diabet Med 2014; 31:472-6. [PMID: 24303850 DOI: 10.1111/dme.12374] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 10/24/2013] [Accepted: 11/17/2013] [Indexed: 12/28/2022]
Abstract
AIMS To investigate the impact of a 2.5-year diabetes self-management education and support intervention on healthcare use and to examine factors associated with patterns of healthcare use. METHODS We recruited 60 African-American adults with type 2 diabetes who completed a 2.5-year empowerment-based diabetes self-management education and support intervention. Primary healthcare use outcomes included acute care visits, non-acute care visits and days lost to disability. Acute care was a composite score calculated from the frequency of urgent care visits, emergency department visits and hospitalizations. Non-acute care measured the frequency of scheduled outpatient visits. To examine change in patterns of healthcare use, we compared the frequency of healthcare visits over the 6-month period preceding the intervention with that in the last 6 months of the intervention. RESULTS No significant changes in patterns of healthcare use were found for acute care, non-acute care or days lost to disability. Multiple regression models found higher levels of depression (P = 0.001) to be associated with a greater number of non-acute healthcare visits, and found longer duration of diabetes (P = 0.019) and lower levels of diastolic blood pressure (P = 0.025) to be associated with fewer days lost to disability. CONCLUSIONS Participation in a long-term diabetes self-management education and support intervention had no impact on healthcare use in our sample of African-American subjects.
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Affiliation(s)
- R O Yeung
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Tang TS, Nwankwo R, Whiten Y, Oney C. Outcomes of a church-based diabetes prevention program delivered by peers: a feasibility study. Diabetes Educ 2014; 40:223-30. [PMID: 24481174 DOI: 10.1177/0145721713520569] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE This purpose of this study was to investigate the feasibility and potential health impact of a church-based diabetes prevention program delivered by peers. METHODS Thirteen at-risk African American adults were recruited to a peer-led diabetes prevention program adapted from the National Diabetes Education Program's Power to Prevent curriculum. The program consisted of 6 core education sessions followed by 6 biweekly telephone support calls. Components of feasibility examined included recruitment, attendance, and retention. Baseline, 8-week, and 20-week assessments measured clinical outcomes (percentage body weight change, waist circumference, lipid panel, blood pressure) and lifestyle behaviors (eg, physical activity and diet). RESULTS Of the 13 participants enrolled at baseline, 11 completed the intervention. Mean attendance across 6 core sessions was 5.2 classes (87%). At 8 weeks, significant improvements were found for physical activity (P = .031), waist circumference (P = .049), serum cholesterol (P = .036), systolic blood pressure (P = .013), and fat intake (P = .006). At 20 weeks, not only did participants sustain the improvements made following the core intervention, but they also demonstrated additional improvements for HDL (P = .002) and diastolic blood pressure (P = .004). CONCLUSION Findings suggest that it is feasible to conduct a peer-led diabetes prevention program in a church-based setting that has a potentially positive impact on health-related outcomes.
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Affiliation(s)
- Tricia S Tang
- Department of Medicine, University of British Columbia School of Medicine, Vancouver, British Columbia, Canada (Dr Tang),Department of Medical Education, University of Michigan Medical School, Ann Arbor, Michigan (Dr Tang, Ms Nwankwo)
| | - Robin Nwankwo
- Department of Medical Education, University of Michigan Medical School, Ann Arbor, Michigan (Dr Tang, Ms Nwankwo)
| | - Yolanda Whiten
- Ann Arbor Community Center, Ann Arbor, Michigan (Ms Whiten)
| | - Christina Oney
- Department of Personality & Social Contexts Psychology, School of Psychology, University of Michigan, Ann Arbor, Michigan (Dr Oney)
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