Revision and Psychometric Evaluation of the Diabetes Knowledge Questionnaire for People With Type 2 Diabetes.

Objective: Diabetes knowledge is associated with health, including lower A1C levels. The Diabetes Knowledge Questionnaire (DKQ-24), developed 30 years ago for Mexican Americans with type 2 diabetes and since used with diverse samples in many countries, contains outdated items that no longer accurately assess current knowledge needed for diabetes self-management. We revised the DKQ-24 and tested psychometric properties of the DKQ-Revised (DKQ-R) with a diverse sample. Methods: We conducted a five-phase instrumentation study as follows: 1) DKQ-24 items were revised to reflect current diabetes care standards; 2) the Delphi method was used to evaluate the DKQ-R's content validity (n = 5 experts); 3) cognitive interviews were conducted with people with type 2 diabetes (n = 5) to assess their interpretations of DKQ-R items; 4) cross-sectional administration of the DKQ-R to adults with type 2 diabetes was carried out to assess internal consistency reliability and convergent validity; and 5) an item analysis was conducted using discrimination index and point biserial analysis. Results: After receiving the experts' feedback and conducting the cognitive interviews, 39 items were administered to 258 participants with type 2 diabetes (42.2% women; 29.1% Latino, 42.6% Asian, mean age 55.7 years). To select the final items, we considered the item discrimination index, as well as item-to-total correlations, content area, and participant feedback. The final 22-item DKQ-R uses the same yes/no/I don't know response format as the DKQ-24. The DKQ-R is strongly correlated with the DKQ-24 (r = 0.71, P <0.01) and is weakly correlated with diabetes numeracy (r = 0.23, P <0.01), indicating adequate convergent validity; a Kuder-Richardson-20 coefficient of 0.77 indicated good reliability. Conclusion: The DKQ-R is a reliable and valid updated measure of diabetes knowledge for diverse populations with type 2 diabetes.

Impact of Fatigue and Its Influencing Factors on Diabetes Self-Management in Adults With Type 2 Diabetes: A Structural Equation Modeling Analysis.

PURPOSE: The purposes of this study were to (1) examine the relationships between fatigue, its influencing factors, and diabetes self-management and (2) test the mediation effects of fatigue on the link between the influencing factors and diabetes self-management in adults with type 2 diabetes. METHODS: This cross-sectional, correlational study was guided by the theory of unpleasant symptoms. Data were collected using structured questionnaires. Fatigue was measured by the Fatigue Symptom Inventory and the Multidimensional Fatigue Inventory. Diabetes self-management was measured by the Summary of Diabetes Self-Care Activities. From March to July 2021, a convenience sample of 150 participants was recruited from 2 diabetes outpatient clinics of a regional hospital in Taiwan. Data were analyzed using structural equation modeling. RESULTS: A more recent diagnosis of diabetes, more depressive symptoms, and lower sleep quality were related to higher fatigue. Higher fatigue correlated with less performance in diabetes self-management. Fatigue mediated the relationship between depressive symptoms, sleep quality, and diabetes self-management. CONCLUSIONS: Fatigue had a mediating effect on the link between psychological influencing factors and diabetes self-management. Future development of fatigue interventions integrating depressive symptoms and sleep management will likely increase the performance of diabetes self-management and improve the health outcomes in adults with type 2 diabetes. The study tested the theory of unpleasant symptoms using empirical data and will assist in building theory-guided fatigue interventions to improve diabetes self-management in people with type 2 diabetes.

Health status and Healthcare Access of Southeast Asian refugees in the United States: An integrative review.

OBJECTIVE: Since 2010, more than 527,000 refugees have resettled in the United States (US), most from Asia, fleeing war, violence, and persecution. However, there is little research that integrates findings about health among Southeast Asian refugees (SEAR). DESIGN: We conducted an integrative review of studies that examined health status, risk factors, and barriers to healthcare access among SEAR in the US. We synthesized findings of studies published from 1980, when the Refugee Act was enacted, to 2022 using five databases. We reviewed 20 articles and data were extracted into a table for synthesis. RESULTS: Participants were from Cambodia, Vietnam, Laos, Burma and the Thailand-Myanmar border. Hypertension (12%-64%), hypercholesterolemia (37%-39%), diabetes (0.6%-27%), heart disease (7%), bone and muscle problems (23%-50%), and chronic pain (8%-51%) were most common physical health problems; and PTSD (45%-86%) and depression (20%-80%) were the most common mental health problems. Trauma, resettlement stress, lack of community or religious engagement were associated with mental health problems. Language differences, transportation, and lack of health insurance were the most significant obstacles to receiving healthcare. CONCLUSION: SEAR experienced worse physical and mental health than the general US population. Different patterns of disease were identified depending on gender, time settled in the US, and ethnic group. Qualitative and longitudinal studies will elucidate refugees' experience and should guide interventions.

The influences of depression and loneliness on A1C among middle-aged and older adults with diabetes.

Even before increased social isolation associated with the COVID-19 pandemic, 43% of adults aged 60 and older reported experiencing loneliness. Depression and loneliness often co-exist and are significant issues faced by middle-aged as well as older adults because each condition is likely to worsen health outcomes. This study of middle-aged and older adults examined how depression and loneliness affect diabetes (DM) control (A1C levels). This study is a secondary analysis of data from the Midlife in the United States Refresher (MIDUS-R) survey, a national survey of adults aged 25-74 years. Correlation analyses were conducted, and a hierarchical logistic regression was estimated to predict A1C levels ≤7% (recommended goal) or >7 using 1) demographics and physical health (ethnicity, gender, education, age, and comorbidities), 2) family and friend support, and 3) depression and loneliness. The sample of 92 participants with DM and A1C data from the MIDUS-R had mean age = 57.37, were 51% male, 68% non-Hispanic White; 39.1% had A1C >7. The average level of depression was low (CES-D mean 9.42) and loneliness was moderate (UCLA scale mean 12.43). Loneliness was correlated with A1C (r= .26, p< .05); depressive symptoms (r= .71, p< .001), family and friends support (r= -.36, r= -.38, respectively, both p< .001). Only loneliness significantly predicted higher A1C levels. People with higher levels of loneliness had increased odds of having A1C >7 (OR = 1.18, p < .05) after controlling for depression and all other variables. Loneliness had a greater impact than depression on A1C level among persons with DM. Healthcare providers should assess patients for loneliness as well as depression and reduce adverse health impacts by referring to psychosocial support as needed.

Blood Aluminum Levels in Patients with Hemodialysis and Peritoneal Dialysis.

Background. This retrospective observational study attempted to examine the prevalence of abnormal blood aluminum levels in dialysis patients, and to explore the association of pathogenic factors, such as demographic, clinical, laboratory as well as the use of phosphate binding drugs, drugs for secondary hyperparathyroidism and erythropoiesis-stimulating drugs with the blood aluminum levels. Methods. The study included 1175 patients (874 hemodialysis and 301 peritoneal dialysis), recruited from Chang Gung Memorial Hospital in November 2020. Patients were stratified into two groups by their blood aluminum levels, as normal (<2 µg/dL, n = 1150) or abnormal (≥2 µg/dL, n = 25). Results. The patients aged 60.4 ± 13.2 years and were dialyzed for 8.6 ± 8.1 years. The average blood aluminum level was 1.0 ± 0.4 µg/dL. Patients with abnormal blood aluminum levels received more sevelamer than patients with normal blood aluminum level (p = 0.014). Patients with abnormal blood aluminum levels had higher platelet count (p = 0.001), triglyceride (p < 0.001) and total iron binding capacity (p = 0.003) than patients with normal blood aluminum levels. Moreover, the cardiothoracic ratio was higher in patients with abnormal blood aluminum levels than patients with normal blood aluminum levels (p = 0.003). Conclusions. The prevalence of abnormal blood aluminum levels was low at 2.2%. Nevertheless, the linking of cardiothoracic ratio of more than 0.5 as well as elevated blood platelet count and triglyceride level with blood aluminum levels are interesting, and warranted more researches in this area.

Illness Perceptions Mediate the Impact of Depressive Symptoms on Quality of Life Among Latinos with Type 2 Diabetes.

Latinos' type 2 diabetes (T2DM) and concurrent depression significantly lower quality of life (QoL). Patients' beliefs about their diabetes, called illness perceptions (IP), may account for the impact of depression on QoL. Using secondary data, we explored predictive and mediation relationships among IP, depression, and QoL among Mexican American adults with T2DM using hierarchical multiple regression and mediation analyses. Participants (n = 75) were predominately middle-aged, female, most scoring low on depressive-symptoms, who believed that diabetes was a chronic disease with serious consequences, controllable by treatment and personal self-management. Participants with higher acculturation and weak perceptions about negative consequences of diabetes reported better QoL. Depressive symptoms' impact on QoL were mediated by overall IP and perceptions about diabetes consequences, in particular. By eliciting patients' perceptions about disease consequences and teaching realistic ways to avoid them, clinicians may alleviate the impact of depression on QoL.

Illness perceptions as a mediator between emotional distress and management self-efficacy among Chinese Americans with type 2 diabetes.

Objectives: Emotional distress and illness perceptions have been linked to patients' self-efficacy for diabetes management. This study, guided by Leventhal's Self-Regulatory Model, explores the direct effects of emotional distress (diabetes distress and depressive symptoms) on diabetes management self-efficacy, and the indirect effects through illness perceptions among Chinese Americans with type 2 diabetes (T2DM).Design: Data were obtained from a cross-sectional study of Chinese Americans with T2DM recruited from health fairs and other community settings (N = 155, 47.1% male, mean age 69.07 years). Data analyses including descriptive statistics, correlation, and PROCESS mediation models were used to examine the mediation effects of illness perceptions.Results: Diabetes distress and depressive symptoms had direct negative effects on self-efficacy. Perceived treatment control mediated the association between diabetes distress and self-efficacy, while none of the illness perceptions dimensions impacted the relationship between depressive symptoms and self-efficacy.Conclusion: Improved perceptions of treatment control can ameliorate diabetes distress and improve diabetes management self-efficacy among Chinese Americans. Health providers should elicit patients' illness perceptions as a first step in evaluating their diabetes management self-efficacy and provide appropriate culturally-tailored interventions.

An integrative review of fatigue in adults with type 2 diabetes mellitus: Implications for self-management and quality of life.

AIMS AND OBJECTIVES: To synthesise empirical studies on factors related to fatigue and its impact on diabetes self-management (DSM) and quality of life (QOL) in adults with type 2 diabetes mellitus (T2DM). BACKGROUND: Fatigue is commonly reported in people with T2DM, a chronic condition that is highly prevalent worldwide. However, a holistic understanding of the consequences and factors related to fatigue in adults with T2DM is not well synthesised. DESIGN: This integrative review used Whittemore and Knafl's methodology and was reported according to the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklist. METHODS: The theory of unpleasant symptoms (TOUS) was used as a conceptual model to guide the review. The PubMed, PsychINFO and CINAHL databases were searched to identify studies that recruited adults with T2DM, were peer-reviewed, written in English and investigated fatigue as a primary or secondary outcome. Two investigators independently appraised the quality of the studies and extracted the data. RESULTS: Twenty-nine articles met the inclusion criteria: 23 observational studies, two randomised controlled trials, one quasi-experimental study and three qualitative studies. All articles were of high quality. Physiological (e.g. T2DM duration, complications and inflammatory biomarkers), psychological (e.g. diabetes distress, depression and sleep quality) and situational factors (e.g. race/ethnicity, education and social support) were related to fatigue. Studies reported fatigue as a barrier to physical activity, healthy eating behaviours and the physical aspect of QOL. CONCLUSIONS: Multiple factors are related to fatigue in adults with T2DM. Gaps in the literature include the multiple dimensions of fatigue, the effectiveness of interventions to alleviate fatigue and fatigue experiences in under-represented populations. RELEVANCE TO CLINICAL PRACTICE: This integrative review supports the complex origin of fatigue and its impact on adults with T2DM. Nurses should evaluate modifiable factors related to fatigue and provide support to help improve DSM and QOL in this population.

Chronic Conditions and Psychological Distress in Older Asian Americans: The Mediating Role of Subjective Health Perception.

Given the importance of understanding the connection between physical and mental health in old age, the study examined the mediating role of subjective health perception in the relationship between chronic conditions and psychological distress among older Asian Americans. Using data from 533 Asian Americans aged 60 and over in the 2016 Asian American Quality of Life Study, the direct and indirect effect models were tested with multivariate linear regressions and the PROCESS macro. Results show that chronic conditions pose significant risks to psychological distress and that subjective health perception mediates their association. The observed role of subjective health perception as an intervening step between physical and mental health offers implications for gerontological social work research and practice by highlighting the importance of positive self-appraisals for the health and well-being in later years of life.

Trend in blood lead levels in Taiwanese adults 2005-2017.

This study examined the trend of blood lead levels (BLLs) in Taiwanese adults and analyzed the variations in the BLL between Linkou (northern) and Kaohsiung (southern) hospital branches. Between 2005 and 2017, 3,804 adult participants received blood lead tests at the Linkou (n = 2,674) and Kaohsiung (n = 1,130) branches of Chang Gung Memorial Hospital. The geometric mean of BLL was 2.77 µg/dL. The adult participants from the Kaohsiung branch were not only age older (49.8±14.1 versus 39.4±14.2 years; P<0.001) and male predominant (65.8 versus 41.7%; P<0.001) but also showed a higher BLL (4.45±3.93 versus 2.82±2.42 µg/dL; P<0.001) and lower estimated glomerular filtration rate (87.62±25.94 versus 93.67±23.88; P<0.001) than those from the Linkou branch. Multivariable logistic regression analysis revealed that the Kaohsiung branch [odds ratio (OR): 7.143; 95% confident interval (CI): 5.682-8.929; P<0.001], older age (OR: 1.008; 95% CI: 1.000-1.015; P = 0.043) and reduced estimated glomerular filtration rate (OR: 1.009; 95% CI: 1.004-1.014; P = 0.001) were significant predictors for BLL > 5 µg/dL. Therefore, this study confirmed a continuous decreasing trend in the BLL in Taiwan after banning leaded petrol in 2000.

Resilience among nurses in long term care and rehabilitation settings.

BACKGROUND: Nurses practicing in long-term care or rehabilitation settings face unique challenges from prolonged or repeated exposure to stressors, given their extended time with patients. This puts them at risk for compassion fatigue, burnout, and secondary traumatic stress, which can lead to decreased resilience and sleep problems. AIM: The aim of this study was to examine relationships among resilience, professional quality of life, sleep, and demographics in nurses working in long-term care or rehabilitation settings, and to investigate whether demographics, professional quality of life, and sleep quality are significant predictors of nurses' resilience. METHODS: In this cross-sectional study, we used the following measures: demographics, the Connor-Davidson Resilience Questionnaire, the Pittsburgh Sleep Quality Index, and the Professional Quality of Life Scale (ProQOL). Data were analyzed with SPSS v25. Data analysis consisted of descriptive statistics, bivariate correlations, and multiple regression. RESULTS: Participants (N = 120) were mostly female (85%) and registered nurses (90%). Mean scores were 52.13 for resilience and 7.53 for sleep quality. Mean ProQOL subscale scores were 41.78 for compassion satisfaction, 22.28 for compassion fatigue, and 23.92 for secondary traumatic stress. Multiple regression models showed that compassion satisfaction, burnout, and secondary traumatic stress significantly predicted resilience (ß = 0.69, ß = -0.61, and ß = -0.34, respectively, all p < .05). CONCLUSIONS: Resilience is important in nurses' personal and professional lives because it helps to protect nurses from the negative consequences of stressors. Strategies, resources, and workplace support can promote self-care and resilience.

Predictors of Subjective Cognitive Decline Among People With Diabetes: Data From the Behavioral Risk Factor Surveillance System.

PURPOSE: The purpose of this study was to examine the prevalence of subjective cognitive decline (SCD) and SCD-related functional limitations among people with diabetes and to identify socioeconomic and comorbidity risk factors associated with SCD. METHODS: This study analyzed data from the 2017 Behavioral Risk Factor Surveillance System (BRFSS) with background variables (race, gender, education, and age), health-related factors (self-rated health, BMI, insurance, and comorbid conditions), and health behaviors (smoking, exercise, alcohol consumption) entered simultaneously to estimate logistic regression models of SCD. RESULTS: Within the sample (n = 5263 adults with diabetes), 48% were age ≥65 years; 50% were male; 55% were non-Hispanic White; and of the 15% who reported having SCD, 57% had functional limitations. Increased odds of reporting SCD were observed among individuals who were Hispanic (odds ratio [OR] = 2.21, P < .001), male (OR = 1.47, P < .01), depressed (OR = 3.85, P < .001), or had arthritis (OR = 1.43, P < .03). Participants with better self-rated health had a reduced likelihood of SCD (OR = 0.51, P < .001). CONCLUSIONS: Health care providers should assess high-risk patients for self-rated cognitive dysfunction and offer early interventions.

Environmental Cadmium Exposure and Dental Indices in Orthodontic Patients.

BACKGROUND: Previous studies have shown that environmental cadmium exposure could disrupt salivary gland function and is associated with dental caries and reduced bone density. Therefore, this cross-sectional study attempted to determine whether tooth decay with tooth loss following cadmium exposure is associated with some dental or skeletal traits such as malocclusions, sagittal skeletal pattern, and tooth decay. METHODS: Between August 2019 and June 2020, 60 orthodontic patients with no history of previous orthodontics, functional appliances, or surgical treatment were examined. The patients were stratified into two groups according to their urine cadmium concentrations: high (>1.06 µg/g creatinine, n = 28) or low (<1.06 µg/g creatinine, n = 32). RESULTS: The patients were 25.07 ± 4.33 years old, and most were female (female/male: 51/9 or 85%). The skeletal relationship was mainly Class I (48.3%), followed by Class II (35.0%) and Class III (16.7%). Class I molar relationships were found in 46.7% of these patients, Class II molar relationships were found in 15%, and Class III molar relationships were found in 38.3%. The mean decayed, missing, and filled surface (DMFS) score was 8.05 ± 5.54, including 2.03 ± 3.11 for the decayed index, 0.58 ± 1.17 for the missing index, and 5.52 ± 3.92 for the filled index. The mean index of complexity outcome and need (ICON) score was 53.35 ± 9.01. The facial patterns of these patients were within the average low margin (26.65 ± 5.53 for Frankfort-mandibular plane angle (FMA)). There were no significant differences in the above-mentioned dental indices between patients with high urine cadmium concentrations and those with low urine cadmium concentrations. Patients were further stratified into low (<27, n = 34), average (27-34, n = 23), and high (>34, n = 3) FMA groups. There were no statistically significant differences in the urine cadmium concentration among the three groups. Nevertheless, a marginally significant p-value of 0.05 for urine cadmium concentration was noted between patients with low FMA and patients with high FMA. CONCLUSION: This analysis found no association between environmental cadmium exposure and dental indices in our orthodontic patients.

A systematic review and meta-analysis of patient activation in people living with chronic conditions.

OBJECTIVE: The objectives of this review are to (1) describe the state of the science of patient activation interventions for the self-management of chronic conditions; (2) identify effective intervention elements for improving patient activation; and (3) compare intervention effectiveness across chronic conditions. METHODS: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA). PubMed, CINAHL, and Web of Science databases were searched. RESULTS: Thirty-two articles published between 2005 and 2019 were identified with intervention elements of self-management, disease management, and education. Meta-analysis of a subset of seven randomized controlled trials (n = 7) that used the 13-item version of the Patient Activation Measure with data collection points at 6 months demonstrated that patient activation did not change significantly in comparison with controls (MD = 0.25, 95 % CI = 0.02-0.47). CONCLUSION: Most interventions reported significant improvement in patient activation and were linked to tasks such as regular exercise and monitoring glucose. However, the meta-analysis of RCTs did not confirm these findings. PRACTICE IMPLICATIONS: Patient activation can be assessed and addressed uniformly across all chronic conditions to improve patient engagement in care.

Emotional Distress and Self-Rated Health Among Middle-Aged and Older Chinese Americans with Type 2 Diabetes.

BACKGROUND: Self-Rated Health (SRH) is a valid proxy for individuals' overall well-being and mortality risk. This study examined contributions of diabetes distress (stress from diabetes self-management) and depressive symptoms to SRH among Chinese Americans with type 2 diabetes (T2DM). METHODS: For this cross-sectional study, a survey measuring diabetes distress, depressive symptoms, physical health, and demographics was administered to a convenience sample of 151 foreign-born community-dwelling Chinese Americans with T2DM. RESULTS: Fifty-five percent of participants rated their health as good or very good. With demographic and physical health variables controlled, hierarchical logistic regression showed that people who reported more diabetes distress (OR = 2.88, p < 0.05) or depressive symptoms (OR = 3.54, p < 0.05) were more likely to have poor SRH. Acculturation (OR = 0.88, p < 0.001) was protective for SRH. CONCLUSIONS: Diabetes distress and depressive symptoms are significantly associated with poor SRH and should be managed in Chinese Americans with T2DM.

Tc-99m TRODAT-1 SPECT is a Potential Biomarker for Restless Leg Syndrome in Patients with End-Stage.

Rationales: Restless leg syndrome (RLS) is a common complication in patients with end-stage renal disease (ESRD). However, there is a lack of biomarkers linking uremic RLS to dopaminergic neurons. Previous studies demonstrated that Tc-99m TRODAT-1 SPECT was a biomarker for RLS but the correlation between the physiologic parameter was lacking. METHODS: Overall, 32 patients were enrolled in the study and divided into the following 3 groups: (1) control (n = 13), (2) ESRD without RLS (n = 8) and (3) ESRD with RLS (n = 11). All patients had a clinical diagnosis of RLS and received Tc-99m TRODAT-1 SPECT. A subgroup analysis was performed to compare differences between the control and ESRD with RLS groups. Tc-99m TRODAT-1 SPECT was performed and activities in the striatum and occipital areas were measured using manually delineated regions of interest (ROIs) by an experienced nuclear medicine radiologist who was blinded to clinical data. RESULTS: The total ratio of Tc-99m TRODAT SPECT was lower in the ESRD with RLS group (p = 0.046). The uptake ratio of TRODAT negatively correlated with serum parathyroid hormone (r = -0.577, p = 0.015) and ferritin (r = -0.464, p = 0.039) concentrations. However, the uptake positively correlated with the hemoglobin concentration (r = 0.531, p = 0.011). The sensitivity and specificity of the total TRODAT ratio for predicting RLS in the overall population were 95.0% and 67.7%, respectively, at a cutoff value of 0.980 (area under the curve of receiver operating characteristic curve was 0.767, p = 0.024). CONCLUSION: In patients with ESRD and RLS, Tc-99m TRODAT might be a potential biomarker. Dysregulated hemoglobin, serum parathyroid hormone and serum ferritin concentrations might influence the uptake of the TRODAT ratio.

Fatigue, Pain, Sleep Difficulties, and Depressive Symptoms in Mexican Americans and Chinese Americans with Type 2 Diabetes.

Fatigue, pain, sleep difficulties, and depressive symptoms are common in people with type 2 diabetes (T2DM). However, most studies of diabetes symptoms are not conducted with Mexican- or Chinese Americans. We aim to compare the symptoms between the two ethnic groups and examine the predictors of fatigue. This is a secondary analysis of two datasets (72 Mexican Americans and 134 Chinese Americans with T2DM). The Theory of Unpleasant Symptoms guided variable selection. We used χ2 tests to compare symptoms (measured by the Illness Perception Questionnaire-Revised and CES-D) between the two ethnic groups, and logistic regression to predict fatigue. Compared to Chinese Americans, Mexican Americans reported more fatigue, sleep difficulties, and pain. Depressive symptoms (OR = 6.13, p < 0.001) and medium acculturation (OR = 2.45, p = 0.017) significantly predicted fatigue. The two ethnic groups demonstrated differences in symptoms. Fatigue and related symptoms should be further evaluated in Mexican- and Chinese Americans with T2DM.

An interdisciplinary approach using case management and clinical pharmacy improves results for people with diabetes.

BACKGROUND: People with diabetes face many challenges to following healthcare provider recommendations for self-management and few are able to achieve and maintain reductions in average blood glucose level. Interdisciplinary teams are a promising strategy to help patients with diabetes improve outcomes. METHODS: An observational analysis of electronic health record data to evaluate the impact of a clinical pharmacist, case manager, or a combination of both on clinical outcomes for patients with diabetes. FINDINGS: All patients (N = 970), regardless of visit type, had a statistically significant improvement in A1C, LDL, and total cholesterol over 1 year. Patients who saw both a case manager and clinical pharmacist had the greatest improvements with the steepest changes across all measures. CONCLUSION: Clinics should create interdisciplinary teams that include a clinical pharmacist and a case manager to have the best outcomes for their patients with diabetes.

Culturally-tailored interventions for chronic disease self-management among Chinese Americans: a systematic review.

Objectives: Literature review evaluating the effectiveness and cultural surface and deep structures of interventions designed to improve Chinese Americans' chronic disease self-management.Method: PubMed, PsycINFO, CINAHL, and Health Source databases were searched for research conducted from 1990 to 2016 on self-management interventions for Chinese Americans with chronic disease.Results: Ten articles comprised eight interventions, which each addressed a dimension of cultural surface structure, all providing linguistically appropriate messages delivered via bilingual staff. Five interventions also addressed cultural deep structure dimensions by providing culturally congruent counsellors or educators, or incorporating Chinese cultural values and social customs. Six interventions resulted in significant improvements in major outcome variables. Participants also reported high satisfaction and retention rates were high.Conclusion: Culturally-tailored interventions that incorporate surface and deep structural elements of culture are sensitive and generally effective for Chinese Americans to improve access to health care, disease awareness, social environment, and participants' ability to practice self-management skills.