Adaptation and psychometric validation of Diabetes Health Profile (DHP-18) in patients with type 2 diabetes in Quito, Ecuador: a cross-sectional study.

INTRODUCTION: The Diabetes Health Profile (DHP-18), structured in three dimensions (psychological distress (PD), barriers to activity (BA) and disinhibited eating (DE)), assesses the psychological and behavioural burden of living with type 2 diabetes. The objectives were to adapt the DHP-18 linguistically and culturally for use with patients with type 2 DM in Ecuador, and to evaluate its psychometric properties. METHODS: Participants were recruited using purposive sampling through patient clubs at primary health centres in Quito, Ecuador. The DHP-18 validation consisted in the linguistic validation made by two Ecuadorian doctors and eight patient interviews. And in the psychometric validation, where participants provided clinical and sociodemographic data and responded to the SF-12v2 health survey and the linguistically and culturally adapted version of the DHP-18. The original measurement model was evaluated with confirmatory factor analysis (CFA). Reliability was assessed through internal consistency using Cronbach's alpha and test-retest reproducibility by administering DHP-18 in a random subgroup of the participants two weeks after (n = 75) using intraclass correlation coefficient (ICC). Convergent validity was assessed by establishing previous hypotheses of the expected correlations with the SF12v2 using Spearman's coefficient. RESULTS: Firstly, the DHP-18 was linguistically and culturally adapted. Secondly, in the psychometric validation, we included 146 participants, 58.2% female, the mean age was 56.8 and 31% had diabetes complications. The CFA indicated a good fit to the original three factor model (χ2 (132) = 162.738, p < 0.001; CFI = 0.990; TLI = 0.989; SRMR = 0.086 and RMSEA = 0.040. The BA dimension showed the lowest standardized factorial loads (λ) (ranging from 0.21 to 0.77), while λ ranged from 0.57 to 0.89 and from 0.46 to 0.73, for the PD and DE dimensions respectively. Cronbach's alphas were 0.81, 0.63 and 0.74 and ICCs 0.70, 0.57 and 0.62 for PD, BA and DE, respectively. Regarding convergent validity, we observed weaker correlations than expected between DHP-18 dimensions and SF-12v2 dimensions (r > -0.40 in two of three hypotheses). CONCLUSIONS: The original three factor model showed good fit to the data. Although reliability parameters were adequate for PD and DE dimensions, the BA presented lower internal consistency and future analysis should verify the applicability and cultural equivalence of some of the items of this dimension to Ecuador.

Compliance with Dietary Recommendations and Sociodemographic Factors in a Cross-Sectional Study of Natives and Immigrants in Spain.

To analyze compliance with dietary recommendations (DR) based on the Mediterranean Diet among natives and immigrants in Spain. A cross-sectional study was carried out using the Platform of Longitudinal Studies of Immigrant Families comparing immigrant workers from Colombia, Ecuador and Morocco with Spanish workers. Adjusted odds ratios (ORa) of sufficient compliance with DR were obtained by sociodemographic variables. We also obtained the adjusted difference in means (DMa) for foods for which there was compliance with DR. Moroccans had greater compliance for meat (ORa = 7.22), eggs (ORa = 5.03) and cured-meats (ORa = 89.78). Ecuadorians for sweets (ORa = 4.03) and Spaniards for natural-juices and dairy-products. Moroccans had the greatest compliance in terms of the number of foods (DMa = 1.53), while Colombians had the least (DMa = - 0.95). Men (DMa = - 0.98), those with primary or incomplete primary education (DMa = - 0.83) and single-parent families (DMa = - 0.58) showed lower compliance. Compliance with DR was low among both Spaniards and immigrants, despite differences in levels of compliance, especially between Moroccans and Colombians.

[Factors that influence the diet and eating habits of Chinese immigrant population in Catalonia (Spain)]. / Factores que influyen en la dieta y los hábitos alimentarios de la población inmigrante china en Cataluña.

OBJECTIVE: To characterize the diet and eating habits of adult immigrants of Chinese origin residing in Santa Coloma de Gramenet (Barcelona, Spain), and to identify the factors that influence the changes in diet and eating habits. METHOD: Qualitative study conducted in 2017 through a discussion group with eight adults of Chinese origin (one man and seven women). The information was complemented by five interviews with key informants (three men and two women) and non-participant observation in health promotion workshops aimed at Chinese patients of a health center in Santa Coloma de Gramenet. RESULTS: Chinese adults made three meals a day and tended to snack between meals. Their diet was based on rice, soy and proteins of vegetable origin. Participants rarely consumed milk and milk derivatives but highlighted their consumption of snacks, sugary drinks and pastries, as well as the incorporation of foods, new dishes and cooking techniques from the host country. The Chinese immigrants tried to maintain their diet of origin, however there were various barriers to this, such as the preference of the local diet by the children, work schedules and lack of time. CONCLUSIONS: A tendency towards dietary acculturation is observed among the participants. Health promotion activities aimed at Chinese families are needed to improve aspects of their diet and eating habits, aiming to reduce the consumption of snacks and sugary products.

Contextualizing Evidence for Action on Diabetes in Low-Resource Settings-Project CEAD Part-II, Strengthening the Health System: A Mixed-Methods Study Protocol.

Diabetes is a major public health problem, increasingly affecting low- and middle-income countries. The project CEAD (Contextualizing Evidence for Action in Diabetes in low-resource settings) aims to evaluate the implementation of comprehensive diabetes care in two low-resource settings in Ecuador and to stimulate context-led health systems innovations to improve diabetes care and reduce inequity. The mixed-methods approach includes a 24-month retrospective study to assess the current level of implementation of comprehensive diabetes care and participants will be followed up prospectively for two years to assess changes in healthcare and clinical outcomes from the outset of the research. We will include individuals diagnosed with type-2 diabetes aged over 18 years, who are accessing diabetes care in health facilities in the study districts. Varied stakeholders (patients and family members, community members, healthcare workers and decision-makers) will interpret the underlying causes of the observed weaknesses and propose solutions to strengthen diabetes-related healthcare in focus group discussions (FG). A second set of FG will analyze perceived improvements in healthcare based on prospective cohort findings and consider the success/failure of any context-led innovations occurring throughout the research. Our study will demonstrate how evidence can be contextualized to stimulate local innovations and overcome weaknesses of diabetes-related healthcare in low resource settings.

Influence of Employment Conditions and Length of Residence on Adherence to Dietary Recommendations in Immigrant Workers in Spain.

The objective of this article is to analyze the influence of employment conditions on adherence to dietary recommendations among those born in Spain and immigrants by their time of residence. Data were used from the Platform of Longitudinal Studies of Immigrant Families (PELFI) cohort (n = 215) to compare Spaniards and immigrants with <14 and >14 years of residence. The questionnaire on frequency of food consumption (15 items) was used to measure adherence to dietary recommendations. Logistic regression models were used, adjusting for sociodemographic characteristics and employment conditions. Adherence to dietary recommendations was greater among Spaniards, followed by immigrants with >14 years of residence and <14 years of residence. The greatest adherence among Spaniards was for eggs (immigrants ≥ 14 years: 1/ORa = 2.89, <14 years: 1/ORa = 3.92), fish (immigrants ≥ 14 immigrants: 1/ORa = 2.33, <14 years: 1/ORa = 4.72), vegetables (immigrants ≥ 14 years: 1/ORa = 3.26, <14 years: 1/ORa = 4.87), dairy products (immigrants ≥ 14 years: 1/ORa = 14.34, <14 years: 1/ORa = 26.78), and sugary drinks (immigrants ≥14 years: 1/ORa = 2.12, <14 years: 1/ORa = 3.48), and the lowest adherence was for the consumption of sausages and cold cuts (immigrants ≥ 14 years: Ora = 7.62, <14 years: ORa = 24.65). Adjusting for sociodemographic and employment conditions variables did not result in variation in the observed differences between Spaniards, immigrants with <14 years of residence, and immigrants with >14 years of residence.

¿Cómo es la alimentación de la población inmigrante residente en España? Resultados a partir de una revisión sistemática / What is the diet of the immigrant population resident in Spain? Results based on a systematic review

La alimentación es uno de los determinantes fundamentales de la salud y se relaciona con factores socioeconómicos y aculturación en inmigrantes. El objetivo de este trabajo es describir la evidencia existente sobre alimentación, nutrición y dieta en población inmigrante en España, según procedencia, valorando la calidad metodológica de los estudios. Se realizó una revisión sistemática que incluyó diecisiete artículos de diseño transversal, el 71% de calidad media y solo uno de calidad excelente; siete sobre población adolescente y diez sobre adultos, con un total de 9.871 participantes. La alimentación de la población inmigrante es heterogénea porque procede de países con características culturales y geográficas diferentes. Los adolescentes tienen una dieta de menor calidad, positivamente asociada con el nivel socioeconómico; la aculturación y el tiempo de residencia se asociaron con aspectos tanto positivos (adquisición de patrones alimentarios más saludables, mejor cumplimiento de algunas recomendaciones de consumo) como negativos (mayor ingesta de carne o bollería, menor consumo de verduras o pescado, entre otros). Los adultos mostraron una distribución más aceptable de macronutrientes pero baja ingesta de micronutrientes e incumplimiento de recomendaciones; el aumento de la aculturación y el tiempo de residencia se relacionó con un patrón dietético más saludable, significativamente asociado con el tipo de trabajo. Los inmigrantes de países mediterráneos muestran una alimentación más saludable que otros grupos, aunque la calidad de su dieta es peor que en el país de origen, mientras que los no mediterráneos mejoran la calidad de su dieta al residir en España

Diet is a principal determinant of health and is interrelated with socioeconomic factors and the acculturation of immigrants. The aim of this study was to examine the existing evidence on food, nutrition, and diet amongst immigrant populations in Spain, its relationships with their countries of origin, and to evaluate the methodological quality of these studies. A systematic review was carried out that included seventeen cross-sectional studies, 71% of them were of average quality and only one was excellent; seven dealt with adolescents and ten dealt with adults, with a total of 9,871 participants. Insights on immigrant diet and nutrition were heterogeneous because the participant groups in these studies were from several different countries, each of which has distinct cultural and geographical characteristics. Adolescent diet was of lower quality, positively correlated to socioeconomic level; acculturation and length of residence were related to both positive (such as healthier dietary patterns, better adhesion to intake recommendations) and negative aspects (higher intake of meat or bakery products, lower intake of vegetables or fish, among others). Adults show a better intake of macronutrients, but a lower intake of micronutrients and non-observance of some intake recommendations; acculturation and length of residence were related to healthier dietary patterns, significantly related to type of employment. Immigrants from Mediterranean countries show a healthier diet than other immigrants, although the quality of their diet is worse than that of their peers in their countries of origin. Finally, the quality of the diet of non-Mediterranean immigrants improves when they become resident in Spain

Factores que influyen en la dieta y los hábitos alimentarios de la población inmigrante china en Cataluña / Factors that influence the diet and eating habits of Chinese immigrant population in Catalonia (Spain)

OBJETIVO: Caracterizar la dieta y los hábitos alimentarios de las personas adultas inmigrantes de origen chino residentes en Santa Coloma de Gramenet (Barcelona), e identificar los factores que influyen en los posibles cambios en la dieta y en los hábitos alimentarios. MÉTODO: Estudio cualitativo realizado en 2017 mediante un grupo de discusión con ocho personas adultas de origen chino (un hombre y siete mujeres). Se complementó la información con cinco entrevistas a informantes clave (tres hombres y dos mujeres) y observación no participante en talleres monográficos de promoción de la salud realizados a población china en un centro sanitario en Santa Coloma de Gramenet. RESULTADOS: Las personas adultas chinas realizaban tres comidas al día y tendían a picar entre horas. Su dieta se basaba en el consumo de arroz, soja y proteínas de origen vegetal. Raramente consumían leche y derivados, y destacó el consumo de aperitivos, bebidas azucaradas y bollería, así como la incorporación de alimentos del país de acogida, nuevos platos y técnicas de cocción. Intentaban mantener su dieta de origen, pero se identificaron barreras para lograrlo, como la preferencia de la dieta local por parte de los/las hijos/as, los horarios laborales y la falta de tiempo. CONCLUSIONES: Se observa una tendencia hacia la aculturación dietética. Es necesario realizar actividades de promoción de la salud dirigidas a las familias chinas para mejorar los aspectos más deficientes de su dieta y de sus hábitos alimentarios, y alentarles a reducir el consumo de aperitivos y productos azucarados

OBJECTIVE: To characterize the diet and eating habits of adult immigrants of Chinese origin residing in Santa Coloma de Gramenet (Barcelona, Spain), and to identify the factors that influence the changes in diet and eating habits. METHOD: Qualitative study conducted in 2017 through a discussion group with eight adults of Chinese origin (one man and seven women). The information was complemented by five interviews with key informants (three men and two women) and non-participant observation in health promotion workshops aimed at Chinese patients of a health center in Santa Coloma de Gramenet. RESULTS: Chinese adults made three meals a day and tended to snack between meals. Their diet was based on rice, soy and proteins of vegetable origin. Participants rarely consumed milk and milk derivatives but highlighted their consumption of snacks, sugary drinks and pastries, as well as the incorporation of foods, new dishes and cooking techniques from the host country. The Chinese immigrants tried to maintain their diet of origin, however there were various barriers to this, such as the preference of the local diet by the children, work schedules and lack of time. CONCLUSIONS: A tendency towards dietary acculturation is observed among the participants. Health promotion activities aimed at Chinese families are needed to improve aspects of their diet and eating habits, aiming to reduce the consumption of snacks and sugary products