Identifying Local Facilitators and Barriers to Screening Mammography Within a Rural Acute Care Hospital Service Area.

INTRODUCTION: Women living in rural areas are more likely to be diagnosed with advanced-stage breast cancer than their urban counterparts. The advanced stage at diagnosis is potentially attributable to lower rates of mammogram screening. We aimed to elucidate factors affecting women in decision-making about mammogram screening in a rural area in Wisconsin served by a critical access hospital. METHODS: We conducted an observational cross-sectional mixed-methods study, collecting data from various sources using 3 methods. Virtual interviews with hospital staff, virtual focus groups with community members, and a survey of women 40 years and older occurred from September 2021 through February 2022. Qualitative data were organized into themes of facilitators and barriers to mammogram screening. Survey responses were reported descriptively. FINDINGS: Eleven hospital staff interviewed and 21 community members who joined 1 of 3 virtual focus groups voiced similar perceptions of facilitators and barriers to mammogram screening. Clinician recommendation was among facilitators, while insurance concerns were the primary barrier. Among survey respondents (N = 282), mean age was 58.7, 98% self-identified as White, and 91% saw a health care provider in the past year. Top reasons for having their first mammogram were doctor recommendation (70%), family history (19%), and personal decision (18%). Top reasons they did not have a mammogram screening at least every year were putting it off (23%), lack of problems (17%), and pandemic-related reasons (15%). CONCLUSIONS: Improving patient education and supporting clinicians to deliver screening recommendations may increase appropriate screening. Future studies should focus on reaching women not engaged with the health system.

African American women's experiences of menopause: A focus group study.

OBJECTIVES: This study aimed to characterize African American women's experiences of menopause and their interactions with the health care system related to menopausal symptoms. STUDY DESIGN: We conducted four focus groups with community-dwelling midlife African American women. MAIN OUTCOMES MEASURES: Women who consented to participate completed demographic surveys. Transcripts of the four focus groups (n = 26) were analyzed and themes were elucidated. RESULTS: In total, 26 midlife African American women participated in the four focus groups. Participants revealed unmet needs regarding obtaining menopause information from their clinicians. Clinician discussions about menopause tended to be initiated by patients based on their symptoms. Some women reported feeling ignored and/or dismissed by the clinician when they initiated discussions of menopause. Women wanted their clinicians to provide information on menopause, which included receiving information prior to the menopause transition to help them know what to expect. CONCLUSION: Women wanted their clinicians to initiate discussions of menopause rather than wait for women to mention symptoms. Prioritizing menopause training for clinicians taking care of midlife African American women may help to improve discussions of menopause.

Balancing risks and rewards: How hematologists discuss uncertainty in allogeneic hematopoietic cell transplantation outcomes.

OBJECTIVE: Allogeneic hematopoietic cell transplant (alloHCT) offers many patients with blood cancers a chance of cure but carries risks. We characterized how hematologists discuss the high-risk, high-reward concept of alloHCT. METHODS: Qualitative analysis of video-recorded virtual encounters of hematologists who routinely perform alloHCT with actors portraying an older man recently diagnosed with high-risk myelodysplastic syndrome. RESULTS: Hematologists (n = 37) were a median age of 44 years, 65% male, and 68% white. They frequently used "teeter-totter" language that juxtaposed alloHCT's risks and rewards in a dynamic, quickly alternating fashion and communicated uncertainty in transplant outcomes. This dialogue oscillated between encouragement about alloHCT's potential for cure and caution about its risks and occurred within single speech turns and in exchanges between hematologist and patient. Fewer hematologists outlined their big-picture stance on transplant's risks and benefits early in the conversation. Meanwhile, hematologists varied in how they counseled patients to manage transplant-related uncertainty and consider treatment decision making. CONCLUSION: Hematologists use "teeter-totter" language to express hope and concern, confidence and uncertainty, and encouragement and caution about the high-risk, high-reward nature of alloHCT. PRACTICE IMPLICATIONS: Teeter-totter language may help frame big-picture content about alloHCT's risks and benefits that is essential for patient education and decision making.

Communication Strategies of Transplant Hematologists in High-Risk Decision-Making Conversations.

PURPOSE: Shared decision making (SDM) is essential to empower patients with blood cancers to make goal-concordant decisions about allogeneic hematopoietic cell transplantation. This study characterizes communication strategies used by hematologists to discuss treatment options and facilitate SDM with patients in this high-risk, high-reward setting. METHODS AND MATERIALS: We recruited US hematologists who routinely perform allogeneic hematopoietic cell transplant through email. Participants conducted up to an hour-long video-recorded encounter with an actor portraying a 67-year-old man with recently diagnosed high-risk myelodysplastic syndrome. We transcribed and qualitatively analyzed video-recorded data. RESULTS: The mean age of participants (N = 37) was 44 years, 65% male, and 68% White. Many hematologists included similar key points in this initial consultation, although varied in how much detail they provided. Their discussion of treatment options included transplant and chemotherapy and less commonly supportive care or clinical trials. They often emphasized transplant's potential for cure, discussed transplant chronologically from pretransplant considerations through the post-transplant course, and outlined risks, complications, and major outcomes. Hematologists referred to several elements that formed the basis of treatment decision making. The strength of their treatment recommendations ranged from strong recommendations for transplant or chemotherapy to deferrals pending more information. Hematologists also varied in the extent to which they indicated the decision was physician-driven, patient-led, or shared. CONCLUSION: The transplant decision-making discussion is complex. Identification of similar content areas used by hematologists can be used as the basis for a communication tool to help hematologists discuss allogeneic hematopoietic cell transplant with patients.

Use and Engagement With Low-Intensity Cognitive Behavioral Therapy Techniques Used Within an App to Support Worry Management: Content Analysis of Log Data.

BACKGROUND: Low-intensity cognitive behavioral therapy (LICBT) has been implemented by the Improving Access to Psychological Therapies services across England to manage excessive worry associated with generalized anxiety disorder and support emotional well-being. However, barriers to access limit scalability. A solution has been to incorporate LICBT techniques derived from an evidence-based protocol within the Iona Mind Well-being app for Worry management (IMWW) with support provided through an algorithmically driven conversational agent. OBJECTIVE: This study aims to examine engagement with a mobile phone app to support worry management with specific attention directed toward interaction with specific LICBT techniques and examine the potential to reduce symptoms of anxiety. METHODS: Log data were examined with respect to a sample of "engaged" users who had completed at least 1 lesson related to the Worry Time and Problem Solving in-app modules that represented the "minimum dose." Paired sample 2-tailed t tests were undertaken to examine the potential for IMWW to reduce worry and anxiety, with multivariate linear regressions examining the extent to which completion of each of the techniques led to reductions in worry and anxiety. RESULTS: There was good engagement with the range of specific LICBT techniques included within IMWW. The vast majority of engaged users were able to interact with the cognitive behavioral therapy model and successfully record types of worry. When working through Problem Solving, the conversational agent was successfully used to support the user with lower levels of engagement. Several users engaged with Worry Time outside of the app. Forgetting to use the app was the most common reason for lack of engagement, with features of the app such as completion of routine outcome measures and weekly reflections having lower levels of engagement. Despite difficulties in the collection of end point data, there was a significant reduction in severity for both anxiety (t53=5.5; P<.001; 95% CI 2.4-5.2) and low mood (t53=2.3; P=.03; 95% CI 0.2-3.3). A statistically significant linear model was also fitted to the Generalized Anxiety Disorder-7 (F2,51=6.73; P<.001), while the model predicting changes in the Patient Health Questionnaire-8 did not reach significance (F2,51=2.33; P=.11). This indicates that the reduction in these measures was affected by in-app engagement with Worry Time and Problem Solving. CONCLUSIONS: Engaged users were able to successfully interact with the LICBT-specific techniques informed by an evidence-based protocol although there were lower completion rates of routine outcome measures and weekly reflections. Successful interaction with the specific techniques potentially contributes to promising data, indicating that IMWW may be effective in the management of excessive worry. A relationship between dose and improvement justifies the use of log data to inform future developments. However, attention needs to be directed toward enhancing interaction with wider features of the app given that larger improvements were associated with greater engagement.

Community-based Participatory Research: A Practical Guide for Radiologists.

Community-based participatory research (CBPR) is defined by the Kellogg Community Health Scholars Program as a collaborative process that equitably involves all partners in the research process and recognizes the unique strengths that each community member brings. The CBPR process begins with a research topic of importance to the community, with the goal of combining knowledge and action with social change to improve community health and eliminate health disparities. CBPR engages and empowers affected communities to collaborate in defining the research question; sharing the study design process; collecting, analyzing, and disseminating the data; and implementing solutions. A CBPR approach in radiology has several potential applications, including removing limitations to high-quality imaging, improving secondary prevention, identifying barriers to technology access, and increasing diversity in the research participation for clinical trials. The authors provide an overview with the definitions of CBPR, explain how to conduct CBPR, and illustrate its applications in radiology. Finally, the challenges of CBPR and useful resources are discussed in detail. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.

A feasibility pilot trial of a peer-support educational behavioral intervention to improve diabetes medication adherence in African Americans.

BACKGROUND: African Americans are twice as likely to die from diabetes, compared to other racial and ethnic groups in the USA. Poor adherence to diabetes medications is common among African Americans and contributes to these disproportionally worse outcomes. A pilot study was conducted to determine the feasibility and acceptability of a peer-supported intervention targeting diabetes and medication beliefs, communication, and self-efficacy skills to enhance medication adherence among African Americans with type 2 diabetes. METHODS: Based on the extended self-regulatory model and information-motivation-behavioral skills model, this intervention was piloted using a single group pre/post-intervention study design at two sites. Seventeen African Americans who self-reported as adherent to diabetes medicines (ambassadors) were paired with 22 African Americans with self-reported poor medication adherence (buddies). Feasibility outcomes evaluated recruitment, retention, and intervention adherence. Measures assessed at baseline and 1-month post-intervention included glycemic control (hemoglobin A1c), self-reported medication adherence, diabetes beliefs, concerns about diabetes medicines, and diabetes self-efficacy. Wilcoxon signed-rank tests assessed for differences in mean scores of outcome variables at baseline compared with a 3-month follow-up. Semi-structured 60-min interviews were conducted with each buddy to explore their acceptability of the intervention. To ensure the rigor of the qualitative data, we focused on analytic criteria such as credibility, confirmability, and transferability. RESULTS: Most buddies and ambassadors were female and about 56 years old. Feasibility outcomes included recruitment success rates of 73% for buddies and 85% for ambassadors relative to our goals. Retention rate for hemoglobin A1c and medication adherence outcome assessment was 95% for buddies. Both buddies and ambassadors had excellent intervention adherence, with buddies having a mean attendance of 7.76 out of 8 sessions/phone calls and ambassadors completing > 99% of the 105 intervention calls with Buddies. Results showed a signal of change in hemoglobin A1c (effect size = 0.14) and medication adherence (effect size = 0.35) among buddies, reduction in buddies' negative beliefs about diabetes and an increase in necessity beliefs of diabetes medicines. Summative interviews with buddies showed they valued ambassador's encouragement of self-management behaviors. CONCLUSIONS: Results support conduct of an efficacy trial to address medication adherence for African Americans with type 2 diabetes using a peer-supported tailored intervention. TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT04028076 .

A review of African American women's experiences in menopause.

IMPORTANCE AND OBJECTIVE: Little is known and reported about the experiences of African American women as they transition to and experience menopause. Accepted norms are based on the experience of a predominantly White population. The aim of this study is to review available data about the distinct experiences of African American women during the menopause transition and menopause. METHODS: A literature search was developed and executed by the review team in collaboration with a health sciences librarian. The search combined controlled vocabulary and title/abstract terms related to the health status disparities of African Americans in the menopause transition and menopause. The following databases were searched from inception through April 28, 2022: PubMed, Scopus (Elsevier), and Web of Science Core Collection (Clarivate). DISCUSSION AND CONCLUSION: African American women experience distinct differences in physical, psychological, social, and quality of life measures during menopause. Increasing awareness about the unique menopause experiences of African American women is critically important to improve the health of this underserved population.

Psychometric evaluation of a culturally adapted illness perception questionnaire for African Americans with type 2 diabetes.

BACKGROUND: Diabetes is burdensome to African Americans, who are twice as likely to be diagnosed, more likely to develop complications and are at a greater risk for death and disability than non-Hispanic whites. Medication adherence interventions are sometimes ineffective for African Americans because their unique illness perceptions are not adequately addressed. The Illness Perception Questionnaire-Revised (IPQ-R) that assesses illness perceptions has shown reliability and validity problems when used with African Americans. Thus, the study objective was to adapt the IPQ-R for African Americans and assess the validity and reliability of the culturally adapted questionnaire. METHODS: The parent study used an exploratory sequential mixed methods design, to explore African Americans' illness perceptions qualitatively, used the results to adapt the IPQ-R, and tested the culturally adapted IPQ-R items quantitatively. In this paper, a preliminary culturally adapted IPQ-R refined based on the qualitative study, was administered to 170 middle-aged United States-based African Americans with type 2 diabetes in a face-to-face survey. Content, construct, convergent, and predictive validity, including reliability was examined. Pearson and item-total correlations, item analysis, exploratory factor analysis, multiple linear regression analysis, and test-retest were conducted. RESULTS: A revised culturally adapted IPQ-R was identified with a 9-factor structure and was distinct from the old factor structure of the original IPQ-R. The 'consequences' domain from the IPQ-R occurred as two factors (external and internal consequences) while the 'emotional representations' domain in the IPQ-R emerged as separate 'present' and 'future' emotional representation factors. Illness coherence' was differently conceptualized as 'illness interpretations' to capture additional culturally adapted items within this domain. Most items had factor loadings greater than 0.4, with moderate factor score correlations. Necessity and concern beliefs in medicines significantly correlated with domains of the culturally adapted IPQ-R. Pearson's correlation values were not greater than 0.7, indicating good convergent validity. The culturally adapted IPQ-R significantly predicted medication adherence. None of the correlation values were higher than 0.7 for the test-retest, indicating moderate reliability. Most domains of the culturally adapted IPQ-R had Cronbach's alpha values higher than 0.7, indicating good internal consistency. CONCLUSIONS: The results provide preliminary support for the validity of the culturally adapted IPQ-R in African Americans with diabetes, showing good construct, convergent and predictive validity, as well as reliability.

Using an exploratory sequential mixed methods design to adapt an Illness Perception Questionnaire for African Americans with diabetes: the mixed data integration process.

BACKGROUND: Although qualitative methods have been used to develop quantitative behavioral health measurements, studies rarely report on the exact development process of these questionnaires. In this methodological paper, we highlight the procedure of a mixed data integration process in using qualitative data to create quantitative questionnaire items. METHODS: We used an exploratory sequential mixed methods study design to culturally adapt the Illness Perception Questionnaire-Revised (IPQ-R) and address the sociocultural contexts of African Americans with type 2 diabetes. Forty African Americans with type 2 diabetes taking oral diabetes medication completed the qualitative focus groups and 170 participants completed the quantitative phase (surveys). Using the 'building approach' to integration, qualitative themes from the focus groups were matched to survey domains based on the self-regulatory model. Qualitative themes assessing perceptions of diabetes among African Americans were used to develop new survey items for a culturally adapted IPQ-R, as well as adapt original survey items. RESULTS: Important themes included the effect on friend/family relationships, lifestyle changes, food experiences (consequences domain), importance of medications (treatment control), comparisons with family members (illness coherence), fear, future worries, and anger (emotional representations). A new domain, 'sociocultural influences' was added to the adapted questionnaire based on qualitative themes of race and racism on provider roles, personal control, and community influences. Merging and integration of the qualitative and quantitative phases, (reported via a joint display) showed evidence of congruence between the illness perceptions from the qualitative focus groups and scores on the survey items. CONCLUSION: The use of mixed methods allowed for the development of a robust and patient-centered questionnaire. Future research should consider psychometric testing of the adapted IPQ-R, so that it may be used in addressing illness perceptions among African Americans.

Biopsychosocial characteristics associated with engagement in art making among older adults.

In order to design patient-centered art making interventions for health and well-being, investigators need to understand the population of interest regarding their relationship to engagement in art making activities. This study, therefore, aimed to examine older adults' characteristics that were associated with engagement in art making activities, and to provide practical examples of how to use the identified characteristics. We conducted correlation analyses to evaluate such associations, using cross-sectional survey data from the 2014 Health and Retirement Study (n=731). Female sex, higher education, personality traits, positive attitude toward the arts, and a larger social network size were positively associated with engagement in art making activities (p<.05). Males and those with lower education could be targeted, while the type of art making activity could be tailored based on personality traits for patient-centered art making interventions. Future studies can use this information to empirically study art making interventions for older adults.

A Culturally Adapted Depression Intervention for African American Adults: An Efficacy Trial.

BACKGROUND: Major depressive disorder (MDD) is one of the most common, costly, and debilitating psychiatric disorders in the United States, and the World Health Organization has identified MDD as a leading cause of disability. Although the rates of MDD among African American and White populations in the US are comparable, African Americans in the US tend to experience higher rates of disability associated with MDD compared to White people. Despite the high burden of MDD among African Americans, their use of mental health services is low, in part due to suboptimal care. OBJECTIVES: This study evaluated the efficacy of a culturally adapted depression intervention (Oh Happy Day Class [OHDC]) compared to an active control, the Coping with Depression (CWD) course. METHODS: A clustered randomized controlled trial was conducted with a sample of 132 patients with mild to moderate depressive symptoms. They were randomly assigned in a 2-armed randomized controlled trial. They received 1 of 2 (OHDC or CWD) 12-week interventions in weekly in-person group sessions. The primary outcome was a change in depressive symptoms during and post-intervention, measured with the Center for Epidemiologic Studies Depression Scale (CES-D) and the Quick Inventory of Depression Symptoms (QIDS). Analyses included log-rank test and mixed effects linear regression models. RESULTS: Both interventions were efficacious in reducing symptoms of depression. However, a greater dose of the culturally adapted intervention, Oh Happy Day Class, showed a greater reduction in depression symptoms. CONCLUSION: This study represents the first randomized controlled trial evaluating the culturally adapted treatment depression intervention, Oh Happy Day Class. These findings provide evidence for and the need for culturally adapted treatments. Future research with larger samples of African Americans from different regions across the US could examine effectiveness and generalizability of the Oh Happy Day Class depression treatment.

Culturally adapted depression intervention to manage depression among women with infertility in Ghana.

This study tested the feasibility of a culturally adapted depression intervention among women with infertility. Women who were seeking medical treatment for infertility were randomized into treatment and control groups. Data were collected at baseline, 6 weeks, 12 weeks, and 3 months post intervention. General linear mixed model using empirical Bayesian estimates for repeated measures was used. The findings indicate an improvement in the women's psychosocial health in the treatment group as compared with the controls. These findings strongly suggest that the management of these psychosocial problems should be an integral part of the management of infertility.

Depressive role impairment and subthreshold depression in older black and white women: race differences in the clinical significance criterion.

OBJECTIVES: We examined race differences in the DSM-IV clinical significance criterion (CSC), an indicator of depressive role impairment, and its impact on assessment outcomes in older white and black women with diagnosed and subthreshold depression. DESIGN: We conducted a secondary analysis of a community-based interview study, using group comparisons and logistic regression. SETTING: Lower-income neighborhoods in a Midwestern city. PARTICIPANTS: 411 community-dwelling depressed and non-depressed women ≥ 65 years (45.3% Black; mean age = 75.2, SD = 7.2) recruited through census tract-based telephone screening. MEASUREMENTS: SCID interview for DSM-IV to assess major depression and dysthymia; Center for Epidemiologic Studies-Depression Scale to define subthreshold depression (≥16 points); Mini-Mental State Examination, count of medical conditions, activities of daily living, and mental health treatment to assess health factors. RESULTS: Black participants were less likely than Whites to endorse the CSC (11.8% vs. 24.1%; p = .002). There were few race differences in depressive symptom type, severity, or count. Blacks with subthreshold depression endorsed more symptoms, though this comparison was not significant after adjustments. Health factors did not account for race differences in CSC endorsement. Disregarding the CSC-eliminated differences in diagnosis rate, race was a significant predictor of CSC endorsement in a logistic regression. CONCLUSIONS: Race differences in CSC endorsement are not due to depressive symptom presentations or health factors. The use of the CSC may lead to underdiagnosis of depression among black older adults. Subthreshold depression among Blacks may be more severe compared to Whites, thus requiring tailored assessment and treatment approaches.

A content validity and cognitive interview process to evaluate an Illness Perception Questionnaire for African Americans with type 2 diabetes.

OBJECTIVE: The Illness Perception Questionnaire (IPQ) is the only available and empirically validated tool used to gain insight into patient illness beliefs. However, the IPQ has reliability and validity problems when used with African Americans (AAs) and needs to be culturally-adapted and validated for use with this group. This study aimed to utilize findings from focus groups to culturally adapt the IPQ for use in AAs with diabetes. Ten cognitive interviews among AAs with type 2 diabetes explored patients' interpretation and understanding of the adapted IPQ. RESULTS: Forty-four new survey items were added to the IPQ. Twenty-nine of the forty-four items were determined as the appropriate number of questions to be tested because of time, and to reduce respondent burden. After the first round of interviews, an item-by-item review of the new items identified problems related to AA comprehension of certain items, their applicability, and wording/tone. Five items identified as problematic were related to AAs understanding of a cure for diabetes, their perception of how food influences their diabetes, how their identity as AAs influence diabetes control, and the dialogue about diabetes within their families and/or community. Findings support the newly developed illness perception questions as culturally specific to AAs with diabetes after being tested for content validity and participant understanding using cognitive interviews.

Utilizing the common sense model to explore African Americans' perception of type 2 diabetes: A qualitative study.

Illness perceptions, which are likely influenced by patients' cultural contexts, are associated with disease self-management and adherence. African American patients perceptions of type 2 diabetes is not well understood and no known studies has used a comprehensive evidence-based theoretical framework to explore what AAs with type 2 diabetes know, believe, and think about type 2 diabetes. Understanding perceptions of an illness shared by a group of people will be useful in developing culturally-appropriate interventions targeted to the needs of the community. The purpose of this study is to explore African Americans' perceptions of type 2 diabetes based on the common sense model of illness and self-regulation. Using a phenomenology qualitative approach and purposive sampling, 40 African American men and women, age 45-60 years old with diagnosed type 2 diabetes at least one year prior, and who took at least one prescription diabetes medication, participated in six semi-structured 90-minute focus groups conducted in a private space. Qualitative content analysis was conducted to explore African Americans beliefs about type 2 diabetes. Participants expressed that historical issues, e.g., slavery, healthcare providers, the government, and God influenced how they developed diabetes. Participants reported a loss of autonomy, a change of their identity as an employee, a social individual and sexual person, as well as anger and frustration due to having diabetes. Diabetes made the African American family bonding experience of eating difficult, and the disease diminished their cultural experiences. Concerns about diabetes ranged from fear of death and amputations to the inability to prevent the disease among their children/grandchildren. Participants perceived that medications, faith in God, and positive thinking about survival helped control diabetes. Conclusions: Improved diabetes self-management and medication adherence may depend on the meaning African Americans attach to diabetes, available psychosocial support for managing diabetes, and African Americans experience with diabetes.

"I did not want to take that medicine": African-Americans' reasons for diabetes medication nonadherence and perceived solutions for enhancing adherence.

BACKGROUND: Diabetes is disproportionally burdensome among African-Americans (AAs) and medication adherence is important for optimal outcomes. Limited studies have qualitatively examined reasons for nonadherence among AAs with type 2 diabetes, though AAs are less adherent to prescribed medications compared to whites. This study explored the reasons for medication nonadherence and adherence among AAs with type 2 diabetes and examined AAs' perceived solutions for enhancing adherence. METHODS: Forty AAs, age 45-60 years with type 2 diabetes for at least 1 year prior, taking at least one prescribed diabetes medication, participated in six semistructured 90-minute focus groups. Using a phenomenology qualitative approach, reasons for nonadherence and adherence, as well as participants' perceived solutions for increasing adherence were explored. Qualitative content analysis was conducted. RESULTS: AAs' reasons for intentional nonadherence were associated with 1) their perception of medicines including concerns about medication side effects, as well as fear and frustration associated with taking medicines; 2) their perception of illness (disbelief of diabetes diagnosis); and 3) access to medicines and information resources. Participants reported taking their medicines because they valued being alive to perform their social and family roles, and their belief in the doctor's recommendation and medication helpfulness. Participants provided solutions for enhancing adherence by focusing on the roles of health care providers, patients, and the church. AAs wanted provider counseling on the necessity of taking medicines and the consequences of not taking them, indicating the need for the AA community to support and teach self-advocacy in diabetes self-management, and the church to act as an advocate in ensuring medication use. CONCLUSION: Intentional reasons of AAs with type 2 diabetes for not taking their medicines were related to their perception of medicines and illness. Solutions for enhancing diabetes medication adherence among AAs should focus on the roles of providers, patients, and the church.

Sociocultural Influences on African Americans' Representations of Type 2 Diabetes: A Qualitative Study.

Objective: Illness representations, known as patients' beliefs and expectations about an illness, may be influenced by cultural beliefs and personal experiences. This study explored African Americans' perceptions of the sociocultural factors that influence their representations of diabetes. Design: Six semi-structured focus groups. Setting: Private space at a convenient site. Participants: Forty African Americans, aged 45-60 years with type 2 diabetes for at least one year prior. Results: Participants perceived that there was a race-mediated effect of how they developed diabetes because of poverty due to past slavery, racial discrimination by health care providers, and the stigma associated with diabetes within the African American community. Participants perceived that poverty influenced African Americans' unhealthy eating habits, which led to diabetes diagnosis among their ancestors and their development of the disease since it was hereditary. Participants also perceived that there was provider ill intention, ie, providers were purposefully making people sick, and their lack of education on diabetes from providers was done on purpose, as information on diabetes was withheld and not shared due to racial discrimination. Perceived stigma by the community led to African Americans' avoidance and denial of the disease, and subsequently the development of diabetes. Conclusions: To enhance disease management for African Americans with diabetes, it is important to focus on the sociocultural context of how African Americans view their world that may be influenced by their knowledge of negative historical circumstances and their current provider relationship, which, in turn, may be reflected in their perceptions of diabetes.

The Health Equity Leadership Institute (HELI): Developing workforce capacity for health disparities research.

INTRODUCTION: Efforts to address health disparities and achieve health equity are critically dependent on the development of a diverse research workforce. However, many researchers from underrepresented backgrounds face challenges in advancing their careers, securing independent funding, and finding the mentorship needed to expand their research. METHODS: Faculty from the University of Maryland at College Park and the University of Wisconsin-Madison developed and evaluated an intensive week-long research and career-development institute-the Health Equity Leadership Institute (HELI)-with the goal of increasing the number of underrepresented scholars who can sustain their ongoing commitment to health equity research. RESULTS: In 2010-2016, HELI brought 145 diverse scholars (78% from an underrepresented background; 81% female) together to engage with each other and learn from supportive faculty. Overall, scholar feedback was highly positive on all survey items, with average agreement ratings of 4.45-4.84 based on a 5-point Likert scale. Eighty-five percent of scholars remain in academic positions. In the first three cohorts, 73% of HELI participants have been promoted and 23% have secured independent federal funding. CONCLUSIONS: HELI includes an evidence-based curriculum to develop a diverse workforce for health equity research. For those institutions interested in implementing such an institute to develop and support underrepresented early stage investigators, a resource toolbox is provided.

Perceived discrimination and health-related quality-of-life: gender differences among older African Americans.

PURPOSE: Emerging data suggest that African-American women may fare worse than African-American men in health-related quality-of-life (HRQOL). Perceived discrimination is an important contributor to poor health overall among African Americans, but few studies examined the intersecting effects of perceived discrimination and gender in explaining HRQOL disparities. We investigated gender differences in HRQOL and tested whether perceived discrimination accounted for these differences. METHODS: We examined data from the Chicago Health and Aging Project in which 5652 African-American adults aged 65 and older completed structured questionnaires about demographic and socioeconomic characteristics, HRQOL, perceived discrimination, and health-related variables. Logistic regression models were used to identify associations between perceived discrimination and gender differences in poor HRQOL outcomes (defined as 14+ unhealthy days in overall, physical, or mental health over the past 30 days) when controlling for the other variables. RESULTS: More women reported poor overall HRQOL than men (24 vs. 16% respectively). Higher perceived discrimination was significantly associated with worse overall HRQOL (OR 1.11; 95% CI 1.08, 1.15), with stronger effects for women in overall and mental HRQOL. These gender disparities remained significant until controlling for potentially confounding variables. Perceived discrimination did not account for gender differences in poor physical HRQOL. CONCLUSIONS: Perceived discrimination is associated with poor HRQOL in older African Americans, with this association appearing stronger in women than men for mental HRQOL. These findings warrant further investigation of effects of perceived discrimination in gender disparities in overall health, and such research can inform and guide efforts for reducing these disparities.