Being with a Person in Our Care: Person-Centered Social Work Practice that is Authentically Person-Centered.

Person-centered care (PCC) has emerged over the last several decades as the benchmark for providing quality care for diverse populations, including older adults with multiple chronic conditions that affect daily life. This article critiques current conceptualizations of PCC, including the social work competencies recently developed by the Council on Social Work Education, finding that they do not fully incorporate certain key elements that would make them authentically person-centered. In addition to integrating traditional social work values and practice, social work's PCC should be grounded in the principles of classical Rogerian person-centered counseling and an expanded conceptualization of personhood that incorporates Kitwood's concepts for working with persons with dementia. Critically important in such a model of care is the relationship between the caring professional and the care recipient. This article recommends new social work competencies that incorporate both the relationship-building attitudes and skills needed to provide PCC that is authentically person-centered.

The Live Well, Be Well study: a community-based, translational lifestyle program to lower diabetes risk factors in ethnic minority and lower-socioeconomic status adults.

OBJECTIVES: We evaluated a community-based, translational lifestyle program to reduce diabetes risk in lower-socioeconomic status (SES) and ethnic minority adults. METHODS: Through an academic-public health department partnership, community-dwelling adults at risk for diabetes were randomly assigned to individualized lifestyle counseling delivered primarily via telephone by health department counselors or a wait-list control group. Primary outcomes (6 and 12 months) were fasting glucose level, triglycerides, high- and low-density lipoprotein cholesterol, weight, waist circumference, and systolic blood pressure. Secondary outcomes included diet, physical activity, and health-related quality of life. RESULTS: Of the 230 participants, study retention was 92%. The 6-month group differences for weight and triglycerides were significant. The intervention group lost 2 pounds more than did the control group (P=.03) and had decreased triglyceride levels (difference in change, 23 mg/dL; P=.02). At 6 months, the intervention group consumed 7.7 fewer grams per day of fat (P=.05) and more fruits and vegetables (P=.02) than did control participants. CONCLUSIONS: Despite challenges designing effective translational interventions for lower-SES and minority communities, this program modestly improved some diabetes risk factors. Thus, individualized, telephone-based models may be a promising alternative to group-based interventions.

An innovative multiphased strategy to recruit underserved adults into a randomized trial of a community-based diabetes risk reduction program.

PURPOSE: To conduct and evaluate a two-phased community-based approach to recruit lower socioeconomic status, minority, or Spanish-speaking adults at risk of developing diabetes to a randomized trial of a lifestyle intervention program delivered by a public health department. DESIGN: Within geographic areas comprising our target population, 4 community organizations provided local space for conducting the study and program. Phase I-outreach in venues surrounding these organizations-included diabetes education, a short diabetes risk appraisal (DRA), and diabetes risk screening based on a fasting fingerstick glucose test. Phase II-trial recruitment-began concurrently for those found to be at risk of developing diabetes in Phase I by explaining the study, lifestyle program, and research process. Those interested and eligible enrolled in the 1-year study. RESULTS: Over 2 years, approximately 5,110 individuals received diabetes education, 1,917 completed a DRA, and 1,164 were screened of which 641 (55%) had an elevated fingerstick result of ≥ 106 mg/dl. Of the study sampling frame-persons over age 25 at risk of developing diabetes (N = 544)-238 (43%) enrolled in the trial; of those who were study eligible (n = 427), 56% enrolled. In the final sample, mean age was 56 years (SD = 17), 78% were ethnic minorities, 32% were Spanish-speaking, and 15% had a high school education or less. IMPLICATIONS: Providing diabetes health education and screening prior to study recruitment may help overcome barriers to research participation in underserved communities, thus helping address difficulties recruiting minority and older populations into research, particularly research pertaining to chronic disease risk factors.

Description of an academic community partnership lifestyle program for lower income minority adults at risk for diabetes.

PURPOSE: Translating strategies and approaches from the successful clinically based Diabetes Prevention Program's lifestyle intervention to community settings is a key next step. This article describes a lifestyle program developed in partnership by researchers at a major university and public health professionals at a local health department. METHODS: The Live Well, Be Well (LWBW) program was designed to meet the needs of lower income, minority, and low-literacy adults at risk for diabetes. It was adapted from interventions with demonstrated efficacy and delivered in Spanish and English by health department staff. The program consisted of a 6-month active phase and a 6-month maintenance phase and was primarily telephone based, with one in-person planning session and several group workshops. In-person and group sessions were held in convenient community-based settings. Counselors provided education and skills training to modify diet and increase physical activity. Self-selected and attainable goal-setting and action plans were emphasized to enhance self-efficacy. LWBW is the intervention component of a randomized trial with primary outcomes of fasting glucose, weight, and other clinical measures. CONCLUSIONS: The program provides a unique translational model for implementing diabetes risk reduction programs for underserved populations. Individually tailored and nonprescriptive, it utilized existing health department infrastructure, focused on telephone counseling, used culturally appropriate, low-literacy materials, and was delivered in local, community-based facilities.

Improving physical activity resource guides to bridge the divide between the clinic and the community.

INTRODUCTION: Primary care providers have limited time for physical activity counseling. They can optimize counseling time by referring patients to community resources for more comprehensive support. To facilitate referrals, resource guides (lists of community opportunities with descriptive information) are often created but seldom used. We elicited the detailed opinions of providers about how to make resource guides more useful for them. METHODS: We asked a convenience sample of health care providers open-ended questions about resource guide usefulness. Providers included 7 physicians, 6 physical/occupational therapists, 5 registered nurses, and 2 nurse practitioners practicing in diverse settings. We identified key themes using grounded theory methodology. RESULTS: All participants thought resource guides were potentially useful, particularly providers who worked in communities that were socioeconomically or culturally different from their own. Perceived benefits included providing easy access to information, facilitating specific activity recommendations, and reminding health care providers about the scope of available opportunities. Participants cautioned that resource guides were not a substitute for individual recommendations or provider counseling. They said resource guide usefulness was limited by inconvenience, frustration with outdated entries, and discomfort referring patients to programs without personal experience of program quality. Providers offered suggestions for useful information to include in the resource guides. CONCLUSION: Resource guides may offer a critical link between clinical services and community resources. Integrating guides with existing clinical systems, incorporating mechanisms for frequent updating, and providing multiple copies will help address provider concerns. Web-based resource guides may help achieve these goals.

Multilevel perspectives on diffusing a physical activity promotion program to reach diverse older adults.

Diffusing research-based physical activity programs in underserved communities could improve the health of ethnically diverse populations. We utilized a multilevel, community-based approach to determine attitudes, resources, needs, and barriers to physical activity and the potential diffusion of a physical activity promotion program to reach minority and lower-income older adults. Formative research using focus groups and individual interviews elicited feedback from multiple community sectors: community members, task force and coalition members, administrators, service implementers, health care providers, and physical activity instructors. Using qualitative data analysis, 47 transcripts (N = 197) were analyzed. Most sectors identified needs for culturally diverse resources, promotion of existing resources, demonstration of future cost savings, and culturally tailored, proactive outreach. The program was viewed favorably, especially if integrated into existing resources. Linking sectors to connect resources and expertise was considered essential. Complexities of such large-scale collaborations were identified. These results may guide communities interested in diffusing health promotion interventions.

Diffusing a research-based physical activity promotion program for seniors into diverse communities: CHAMPS III.

INTRODUCTION: Increasing the physical activity levels of older adults through diffusion of successful research-based programs into community settings is challenging because of differences between research and real-world settings. This project diffused the Community Healthy Activities Model Program for Seniors (CHAMPS) II, an individual-level research-based physical activity promotion program, through three community organizations to reach lower-income and minority (primarily Hispanic or Latino and African American) seniors. METHODS: Through an academic-community partnership, university staff worked with each organization to adapt the program to be appealing and effective, enable their staff and volunteers to provide the program, increase participants' physical activity, and leave sustainable programs in place. Evaluation was based on methods recommended by the Centers for Disease Control and Prevention. RESULTS: The adapted programs, referred to as CHAMPS III, differed from the original program and among organizations. Group-based components and resource guides were included and new features were added; however, individualized components were not offered because of limited resources. A total of 321 people enrolled among three organizations; there was a trend toward increased physical activity at two organizations (an estimated increase of 481 kcal/week [P = .08] and 437 kcal/week [P = .06] expended in physical activity). Evaluation revealed challenges and unexpected community-level benefits. All organizations are continuing efforts to promote physical activity for older adults. CONCLUSION: This project enabled community organizations to implement physical activity promotion programs. The overarching challenge was to retain original program features within each organization's resources yet be sustainable. Although the programs differed from the original research program, they were a catalyst for numerous community-level changes. Our findings can guide similar projects to reach underserved older adults.

"You aren't going to get better by just sitting around": physical activity perceptions, motivations, and barriers in adults 75 years of age or older.

Despite accumulating evidence of cardiovascular benefits associated with physical activity in older people, sedentary behavior increases with age. Few physical activity research studies focus on underactive adults 75 years and older. In-depth qualitative interviews using open-ended questions explored perceptions, motivations, and barriers to physical activity in 33 previously sedentary or underactive adults age > or =75. Data were analyzed using the NUD*IST (Non-numerical, Unstructured Data Indexing, Searching, and Theorizing) qualitative analysis program. Participants saw sedentary behavior as harmful, considered themselves relatively active, were unsure of amounts of physical activity to do, and welcomed more physical activity information from their doctors. Motivations included health, independence, family, and appearances. Barriers were poor health, lack of time, aging, and adverse environments. Results suggest that people continue to be interested in physical activity as they age, but some misperceptions about physical activity exist. Even with health problems and age, physical activity counseling by doctors is valued and considered helpful by this age group.