Perceptions and Prevalence of Alcohol and Cigarette Use Among American Indian Adults With Type 2 Diabetes.

IN BRIEF This study examined community perceptions and prevalence of alcohol use and cigarette smoking among American Indian adults with type 2 diabetes. Results revealed normative rates and perceptions of smoking and negative views and low rates of alcohol use. Participants reported high levels of household indoor smoking and comorbid high-risk drinking and smoking. The high smoking rate among the adult American Indians in this study is especially problematic given the increased risk of cardiovascular problems related to both smoking and type 2 diabetes. The results underscore the importance of considering substance use behaviors and beliefs as a component of overall health and well-being for people with diabetes.

Relationship between self-efficacy and patient knowledge on adherence to oral contraceptives using the Morisky Medication Adherence Scale (MMAS-8).

BACKGROUND: Preconception care, including family planning, is a vital component of healthcare for women of reproductive age. An average female spends the majority of her reproductive life trying to prevent a pregnancy. In order to prevent unintended pregnancy, women often rely on the use of hormonal contraceptives. In the United States, the majority of hormonal contraceptive users are prescribed oral contraceptive pills (OCPs). Reduced adherence to OCPs decreases their ability to prevent pregnancy. The study aimed to measure OCP adherence among female college students, and explore the relationship between OCP adherence, knowledge, and self-efficacy. METHODS: This cross-sectional study recruited a random sample of female college students to participate in an online survey. OCP adherence was based on the 8-item Morisky Medication Adherence Scale (MMAS-8). Secondary reporting of medication adherence included participant reports of the number of missed OCP doses in the previous month and typical month of use. RESULTS: Of the 5000 invited, 1559 (31.3%) completed the survey. Of those responding, 670 (41.3%) reported use of OCPs. A total of 293 (44.3%) OCP users met criteria for low adherence, 241 (36.4%) met criteria for medium adherence, and 128 (19.3%) met criteria for high adherence. Those with high adherence had higher self-efficacy (P < 0.001) and perceived knowledge (p < 0.001). After controlling for other factors, self-efficacy (b = .37) and perceived knowledge (b = .09) remained associated with OCP adherence. CONCLUSION: Less than 20% of respondents met the criteria for high adherence to OCPs. Self-efficacy and knowledge were associated with higher OCP adherence. Targeted interventions from healthcare providers, health educators, and other adherence related media to increase the knowledge and self-efficacy of patients using OCPs may improve adherence rates. Additional research is needed to evaluate the impact of innovative interventions focused on social and behavioral patient factors, like knowledge and self-efficacy, on adherence to OCPs.

Rates and consequences of posttraumatic distress among American Indian adults with type 2 diabetes.

This study examined the prevalence of screened posttraumatic stress disorder (PTSD) and associated diabetes-related outcomes. A sample of American Indian adults with type 2 diabetes (n = 218) participated in interviewer-administered surveys. Using a cutoff of 3 on the Primary Care PTSD screener, 21.8 % of participants screened positive for PTSD. PTSD symptoms were negatively associated with self-rated health status and positively associated with past year hospitalization after controlling for several demographic factors, but not after controlling for depressive symptoms. Past month frequency of hyperglycemia symptoms was not related to PTSD symptoms. When grouped by mental health conditions (neither screened PTSD nor depressive symptoms, screened PTSD only, depressive symptoms only, and both), those with both screened PTSD and depressive symptoms reported the highest proportion of any past month hyperglycemia, past year hospitalization, and low self-rated health status. Screened PTSD, especially in those with comorbid depressive symptoms, is an important consideration in diabetes care.

Commentary: Making Space for Reading as a Faculty Member.

In academia, significant emphasis is given to the importance of writing. However, reading may be given less prominence in faculty work lives. The purpose of this commentary is to explore the educator's relationship with academic reading, habits that support this practice, and points of reflection for creating space for reading in our professional lives. The authors engaged in a reflexivity exercise and discussion of our own motivations, emotions, and experiences associated with reading, and how these may change across our careers. We discuss the need to make space for reading in our work, and additionally, provide recommendations for better integrating the habit of reading into our professional lives.

Mining for Retention Gems and Unearthing Identity and Belonging.

OBJECTIVE: To determine the relationship between first-year retention and variables related to professional engagement and professional, academic, and personal identities. METHODS: This study evaluated data from 3 cohorts of students at a private 0-6 college of pharmacy. A theoretical and conceptual framework linking professional identity and retention informed the study. Professional engagement scores from the first semester of pharmacy school served as a surrogate of professional identity. Grade point average (GPA) and traditional demographic variables (eg, gender, race/ethnicity, in-state resident) served as surrogates of academic and personal identities, respectively. Logistic regression models were used to determine the relationship between first-year retention and identity variables. RESULTS: Belonging, a domain of professional engagement, was positively related to first-year retention. In multivariable models, belonging and cumulative GPA were associated with increased odds of retention, while in-state status was associated with decreased odds. In separate models for those with GPA ≥3.00, and<3.00, belonging was associated with first-year retention in both. Belonging was also associated with first-semester retention, but not second-semester retention. CONCLUSION: A decision to leave a Doctor of Pharmacy program is complex, but the vast majority of the literature in pharmacy education appears to focus most intently on academic variables, including GPA. This study demonstrates that belonging, an important element in professional identity formation, remains related to first-year retention, even after controlling for grades and other personal variables. This finding unearths several theory-informed gems and strategies that educators may employ to enhance retention.

Well-being Content Inclusion in Pharmacy Education Across the United States and Canada.

Objective. To describe the landscape of well-being content inclusion across schools and colleges of pharmacy in the United States and Canada through identification of content implementation, incorporation, and assessment.Methods. A cross-sectional survey was distributed to all accredited schools and colleges of pharmacy in the United States (n=143) and Canada (n=10). Survey questions included curricular and cocurricular timing, frequency, assessment strategies, and support for well-being initiatives, using a framework of eight dimensions (pillars) of wellness to categorize content.Results. Descriptive data analyses were applied to 99 completed surveys (65%), 89 (62%) in the United States and 10 (100%) in Canada. Well-being content was most prevalent within the cocurricular realm and incorporated into didactic and elective more than experiential curricula. The most content came from intellectual, emotional, and physical pillars, and the least content came from financial, spiritual, and environmental pillars. Less than 50% of schools and colleges of pharmacy include well-being within their strategic plans or core values. Funding is primarily at the level of the university (59%) or the school or college of pharmacy (59%). Almost half of respondents reported inclusion of some assessment, with a need for more training, expertise, and standardization.Conclusion. Survey results revealed a wide range of implementation and assessment of well-being programs across the United States and Canada. These results provide a reference point for the state of well-being programs that can serve as a call to action and research across the Academy.

The Role of Social Support in the Management of Type 2 Diabetes Mellitus among American Indians: A Qualitative Study.

The purpose of this study is to gain insights of American Indian (AI) communities on the role of social support in type 2 diabetes (T2D) management. Social support is a means of enhancing social and personal resources that can address underlying stressors that contribute to T2D inequities and represents a potential channel of intervention to improve management of T2D in these communities. This community-based participatory research included AI adults from the Bois Forte and Lac Courte Oreilles Bands of Ojibwe and consisted of focus groups that were conducted with people with T2D, social support persons, and service providers. Overall findings underscore the importance of social support in T2D management, especially in providing emotional support, fulfilling an appraisal function, and enabling positive health behaviors. It is also important for policies and practices to consider the social and cultural contexts, particularly the socio-historical context of life within AI communities that has inevitably shaped certain mindsets that may present barriers to care-seeking and optimal T2D management. These findings can inform interventions related to T2D management, especially in incorporating social support and complementing community strengths in achieving a broader goal of reducing diabetes inequities in AI communities.

Identifying Low Pharmaceutical Calculation Performers Using an Algebra-Based Pretest.

Objective. To determine whether a pretest assessing algebra-based problem-solving skills could aid in identifying those who may underperform in calculations course assessments and whether this provides additional value beyond preadmission and demographic characteristics.Methods. Student pharmacists were screened for algebraic problem-solving skills using an 18-item pretest taken the semester prior to a course containing pharmaceutical calculations content. These scores were compared to students' later performance on pharmaceutical calculations assessments. Linear regression models were computed to determine the relationship between pretest scores and pharmaceutical calculations performance after controlling for preadmission factors and demographic characteristics.Results. The median pretest score was 15 out of 18 possible points, with scores ranging from 5 to 18 points. After controlling for age, gender, American College Testing (ACT) scores, and high school grade point average (GPA), scores on the algebra-based, word-problem pretest were associated with performance on pharmaceutical calculation assessments.Conclusion. This research demonstrates the ability of a pretest aimed at identifying deficiencies in algebraic problem-solving skills to identify those at risk of failing to obtain mastery of pharmaceutical calculations, even after controlling for demographics, prior grades, and prior standardized test scores. Identifying these students is a first step towards implementing tailored interventions to improve students' algebra-based word problem skills to prevent deficiencies in pharmaceutical calculations mastery before class even begins.

Evaluation and Revision of the Kiersma-Chen Empathy Scale.

Objective. This study aimed to provide further validity evidence for the Kiersma-Chen Empathy Scale (KCES) by analyzing data collected from multiple administrations of the scale and conducting cognitive interviews of students in pharmacy and nursing programs to identify needed revisions.Methods. De-identified data from previous administrations of the KCES were used to evaluate the scale. Evidence of response process was enhanced through cognitive interviews with 20 pre-pharmacy and pharmacy students at Cedarville University. After survey revisions, the cognitive interview process was repeated with 10 University of Wyoming nursing students.Results. Based on psychometric data and cognitive interviews, the KCES was revised as follows: key components of cognitive and affective empathy were retained, scaling was changed to reflect necessity and empathy ability, negatively worded items were removed, and the single scale was converted into two parallel subscales.Conclusion. This study used data from thousands of geographically and professionally diverse samples. Based on potential problems identified in quantitative analyses, cognitive interviews with nursing and pharmacy students were conducted, and modifications to the KCES were made. Further psychometric validation is needed regarding the KCES-R.

Management, entrepreneurship, continuing professional development, and leadership education in United States doctor of pharmacy curricula: A scoping review.

BACKGROUND: As doctor of pharmacy (PharmD) curricula must fulfill accreditation standards emphasizing managerial skills, entrepreneurship, continuing professional development (CPD), and leadership, there is interest among faculty to incorporate high-quality, evidence-based educational strategies. To date there has not been a comprehensive review of these four topics in one paper; therefore, we aimed to describe the landscape of the published literature and areas for future research. METHODS: A keyword search of Academic Search Complete/Premier and OvidMedline databases identified articles published between 1 January 2000 and 31 December 2020. Inclusion criteria included primary, peer-reviewed literature describing the implementation and evaluation of teaching methodologies on aspects of management, entrepreneurship, CPD, or leadership in United States PharmD programs. Titles and abstracts were screened for inclusion. Key information regarding instructional design and assessment were retrieved to develop narrative summaries of activities and outcomes and to chart the student year of study, sample size, mode of delivery (didactic/experiential/co-curricular), type of experience (required/optional), and learning activity. RESULTS: Thirty-five articles met inclusion criteria and were categorized: management (n = 12), entrepreneurship (n = 2), CPD (n = 7), and leadership (n = 14). The articles provided example activities that faculty across the country can consider implementing. Identified gaps included a focus on episodic and/or optional experiences and a relative lack of objective and longitudinal assessment practices. IMPLICATIONS: This review describes educational methodologies for management, entrepreneurship, CPD, and leadership that can be replicated or adapted. Additional reports of innovative educational practices assessed through valid and reliable methods are needed.

Establishing Validity Evidence for Parallel Patient-Provider Empathy Scales to Drive Self-reflection.

Objective. Student pharmacists must cultivate self-awareness to ensure that they can assess their skill development and abilities, including affective domain skills such as empathy. External feedback can augment development, but validated assessments are needed for accuracy. Thus, the objectives of this study were to establish validity evidence for the revised version of the Kiersma-Chen Empathy Scale (KCES-R), compare student self-perceptions and simulated patient perceptions of student empathy using a parallel patient scale (KCES-PV), and evaluate student reflections on the encounter.Methods. Student pharmacists completed an assessment of their self-perceptions of empathy (KCES-R) before and after the patient encounter. Simulated patients completed the KCES-PV regarding the student pharmacists' empathy immediately after the encounter. Student pharmacists also watched their encounter videos and completed a self-reflection on their use of empathy. Responses were analyzed using statistical tests, whereas students' reflections were examined using thematic analysis.Results. Results showed that the KCES-R contains two factors with high internal consistency and can detect changes in empathy. Student pharmacists' self-perceptions of their empathy abilities appeared higher than when their empathy abilities were evaluated by simulated patients. Student pharmacists had a strong belief in the importance of expressing empathy during patient encounters and indicated a need for further development.Conclusion. This study provides validity evidence for the use of the KCES-R and presents a parallel scale that may be used by simulated patients. Validated parallel scales along with reflective practice could be a potential avenue to grow self-awareness and empathy by allowing students to receive feedback and then reflect on their perceived versus actual demonstration of the skill.

A longitudinal study of the stress of poor glucose control and diabetes distress.

Poor glucose control can be viewed as a stressor, possibly promulgating diabetes distress. We examined the relationship between perceived blood glucose control and diabetes distress over time using a partially controlled cross-lagged path analysis model. After controlling for demographics, control at 6 months was directly related to change in distress at 12 months. Subsequently, distress at 12 months was directly related to change in control at 18 months. Both 6-month control and distress had significant indirect effects on 18-month control and distress. This demonstrates the nuanced bi-directional relationship between the stress of poor perceived control and diabetes distress.

The Mediating Role of Diabetes Distress and Depressive Symptoms in Type 2 Diabetes Medication Adherence Gender Differences.

Background. Medication adherence is negatively related to both diabetes distress (DD) and depressive symptoms (DS). Past research suggests gender differences in adherence, DD, and DS. A gap exists in determining if gender differences in adherence are mediated by DD and DS, or if gender moderates differences in adherence by DD/DS. Aims. This study investigated the relationship between gender, DD, DS, and medication adherence and tested for mediating and moderating effects on medication adherence among American Indian adults with type 2 diabetes. Method. The Maawaji idi-oog mino-ayaawin (Gathering for Health) study was a community-based participatory research collaboration with five American Indian tribes. Participants, randomly recruited from clinic records, shared information during computer-assisted personal interviews. This study includes the 166 participants who reported using medications to treat their diabetes. The relationship between gender, DD, DS, and medication adherence are explored. Possible mediating and moderating effects on medication were tested using regression and path analysis. Results. Females had higher levels of DD and DS and lower levels of medication adherence. Higher levels of DD and DS were both associated with lower medication adherence. No evidence was found that gender moderates the relationship between DD or DS and medication adherence. Instead, DD and DS mediated the relationship between gender and medication adherence. Conclusions. Medication adherence differences in male and female patients may be attributable to DD and DS. The present research highlights both DD and DS as targets for clinicians and researchers alike.

Sources of Stress Among Midwest American Indian Adults with Type 2 Diabetes.

Despite alarming health disparities among American Indians (AIs) and acknowledgement that stressors negatively influence health, conceptualization of the full spectrum of stressors that impact Indigenous communities is underdeveloped. To address this gap, we analyze focus group transcripts of AI adults with type 2 diabetes from five tribal communities and classify stressors using an inductive/deductive analytical approach. A Continuum of American Indian Stressor Model was constructed from categorization of nineteen stressor categories within four domains. We further identified poverty, genocide, and colonization as fundamental causes of contemporary stress and health outcomes for AIs and conclude that stressors are generally experienced as chronic, regardless of the duration of the stressor. This work on AI-specific stressors informs future health research on the stress burden in AI communities and identifies target points for intervention and health promotion.

Self-reported eye diseases among American Indian individuals with type 2 diabetes from the northern Midwest.

PURPOSE: To determine the prevalence of eye diseases and utilization of dilated eye exams among a sample of American Indian (AI) individuals with type 2 diabetes. METHODS: AI adults with type 2 diabetes utilizing health care at two reservation clinics were randomly sampled and recruited for interviewer-assisted paper surveys. The prevalence of eye diseases was compared across gender, age, income, and educational attainment. RESULTS: The prevalence of retinopathy, cataracts, macular degeneration, and glaucoma were 9.4%, 26.7%, 5.2%, and 10.6% respectively, and 59.2% reported past year dilated eye exams. Older participants were more likely to report cataracts (p < 0.001) and glaucoma (p = .003). Those with lower income were more likely to report cataracts (p = 0.001). CONCLUSIONS: Rates of self-reported eye diseases in this sample were higher, and dilated eye exams lower than other samples of the general United States population with diabetes, suggesting improvement can be made to improve the provision of care for AI individuals with type 2 diabetes.

Measuring a state of mind indicative of thriving using the Student Pharmacist Inventory of Professional Engagement (S-PIPE).

BACKGROUND: Professional engagement has importance to the professional of pharmacy, and in particular the growth of student pharmacists. Measurement of this construct would allow investigation of factors that may increase or decrease professional engagement. OBJECTIVES: To describe the development of the Student Pharmacist Inventory of Professional Engagement (S-PIPE), assess the factor structure and convergent validity, and test for differences in professional engagement based upon demographic and background factors. METHODS: Potential items for the S-PIPE were developed iteratively through inductive and deductive item-writing, 2 pilot administrations, expert review of items, and assessment of the content validity index, and cognitive interviews with students. The S-PIPE was administered to a cohort of 164 first year student pharmacists at University of Minnesota, along with items querying types and level of involvement in professional experiences and activities. An exploratory factor analysis was conducted using principal axis factoring extraction and Promax rotation. The number of factors to retain was based upon eigenvalues, examination of the scree plot, and a parallel analysis. Factors of the S-PIPE were compared to self-rated level of involvement and other demographic factors. RESULTS: Three factors were retained accounting for 70.7% of the variance, and named Belonging (α = 0.942, 9 items), Connectedness (α = 0.864, 3 items), and Meaningful Experience (α = 0.760, 4 items). All 3 factors were significantly correlated to self-rated involvement (r = 0.291 to 0.370). Level of professional engagement differed in this study by gender, and pharmacy work experience. CONCLUSIONS: This study lays the foundation for quantitative research in professional engagement among student pharmacists. Future work is needed to further validate and extend these findings.

Using a mock board of pharmacy disciplinary hearing to teach concepts related to administrative law, addiction, empathy, and professionalism.

BACKGROUND AND PURPOSE: The purpose of this project was to impact pharmacy students' personal and professional development through simulation of a board of pharmacy disciplinary hearing regarding addiction. EDUCATIONAL ACTIVITY AND SETTING: The mock board hearing was conducted as part of the required curriculum. Faculty obtained materials from a prior board hearing. The actual respondent, lawyer, former executive director, and a board agent participated. Students served as board members and president, asked questions of the witnesses, and deliberated per board procedure. After the event, student learning and perceptions were assessed through knowledge-based, opinion-based questions, and open-ended questions. FINDINGS: Of the 141 students who attended the event, 97% completed the assessment. The average score on the knowledge-based questions was 95%. Ratings of perceptions and reflections of the experience were used in tandem to understand the experience. In general, students indicated the experience was positive and impactful towards their education. Students indicated they felt that the experience allowed them to better understand addiction and empathize with someone called before the board. In fact, there were fundamental differences in perceptions regarding the "addicted person," going from a penalizing and stigmatized perspective to one of caring and compassion. SUMMARY: Students were knowledgeable about the board and its regulatory process after the event. More than knowledge, students indicated fundamental changes in their views of addiction. Other institutions may consider implementing similar exercises to engender empathy and professionalism regarding drug addiction and regulatory compliance.

Evaluating Factors Impacting Medication Adherence Among Rural, Urban, and Suburban Populations.

PURPOSE: To evaluate differences in prescription medication adherence rates, as well as influencing factors, in rural and urban adults. METHODS: This is a retrospective analysis of the 2015 National Consumer Survey on the Medication Experience and Pharmacists' Role. A total of 26,173 participants completed the survey and provided usable data. Participants using between 1 and 30 prescription medications and living more than 0 miles and up to 200 miles from their nearest pharmacy were selected for the study, resulting in a total of 15,933 participants. Data from the 2010 US Census and Rural Health Research Center were used to determine the population density of each participant's ZIP code. Participant adherence to reported chronic medications was measured based on the 8-item Morisky Medication Adherence Scale (MMAS-8). FINDINGS: Overall adherence rates did not differ significantly between rural and urban adults with average adherence based on MMAS-8 scores of 5.58 and 5.64, respectively (P = .253). Age, income, education, male sex, and white race/ethnicity were associated with higher adherence rates. While the overall adherence rates between urban and rural adults were not significantly different, the factors that influenced adherence varied between age-specific population density groupings. CONCLUSION: These analyses suggest that there is no significant difference in adherence between rural and urban populations; however, the factors contributing to medication adherence may vary based on age and population density. Future adherence intervention methods should be designed with consideration for these individualized factors.

Stress Exposure and Physical, Mental, and Behavioral Health among American Indian Adults with Type 2 Diabetes.

American Indian (AI) communities experience disproportionate exposure to stressors and health inequities including type 2 diabetes. Yet, we know little about the role of psychosocial stressors for AI diabetes-related health outcomes. We investigated associations between a range of stressors and psychological, behavioral, and physical health for AIs with diabetes. This community-based participatory research with 5 AI tribes includes 192 AI adult type 2 diabetes patients recruited from clinical records at tribal clinics. Data are from computer-assisted interviews and medical charts. We found consistent bivariate relationships between chronic to discrete stressors and mental and behavioral health outcomes; several remained even after accounting for participant age, gender, and income. Fewer stressors were linked to physical health. We also document a dose-response relationship between stress accumulation and worse health. Findings underscore the importance of considering a broad range of stressors for comprehensive assessment of stress burden and diabetes. Policies and practices aimed at reducing stress exposure and promoting tools for stress management may be mechanisms for optimal health for AI diabetes patients.