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INTRODUCTION: Research on associations between knowledge and health beliefs for women at risk for gestational diabetes mellitus (GDM) has focused on adults at risk for or having GDM. Gaps also exist in examining interpersonal associations with family members or peers. We examined dyadic associations between knowledge and health beliefs about the risk for GDM between and within American Indian and Alaska Native (AIAN) female adolescents and young adults (FAYAs) at risk for GDM and their mothers or adult female caregivers (FCs). METHODS: Grounded in the Expanded Health Belief Model, we employed a cross-sectional design using baseline data from 147 dyads of AIAN FAYAs at risk for GDM and their FCs who participated in the Stopping GDM in Daughters and Mothers trial. FAYAs were 12.0 to 24.5 years of age, and 89.1% were students. FCs had a mean (SD) age of 44.0 (9.3) years, 87.0% were AIAN, 44.9% were college educated, 19.7% had ever had GDM, and 81.0% were the FAYA's mother. FAYAs and FCs completed surveys about knowledge and health beliefs (benefits, barriers, severity, susceptibility) regarding GDM risk and prevention. Bivariate correlational analyses were performed to examine associations between and within dyad members. Dyadic associations were investigated using actor-partner interdependence modeling (APIM) assuming distinguishable dyad members. RESULTS: Compared with their FCs, FAYAs had lower health-related knowledge and perceived benefits of GDM prevention and susceptibility regarding GDM risk. APIM revealed actor and partner effects of health-related knowledge on health beliefs for dyads. In particular, positive actor effects were found for FAYAs and FCs for GDM-related knowledge with perceived benefits (P < .001), and positive partner effects of GDM-related knowledge for FCs were related to perceived susceptibility and severity for FAYAs (P < .05). DISCUSSION: As shown in these AIAN dyads, FAYAs and their FCs, as members of one another's social network, may influence each other's health beliefs regarding GDM risk and prevention.
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Nativos do Alasca , Cuidadores , Diabetes Gestacional , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Feminino , Diabetes Gestacional/psicologia , Gravidez , Estudos Transversais , Adolescente , Adulto Jovem , Adulto , Nativos do Alasca/psicologia , Cuidadores/psicologia , Mães/psicologia , Indígenas Norte-Americanos/psicologia , Criança , Fatores de Risco , Modelo de Crenças de SaúdeRESUMO
BACKGROUND: American Indians and Alaska Natives (AI/AN) are disproportionately affected by adolescent obesity, adolescent pregnancy and gestational diabetes mellitus (GDM). GDM is associated with increased risk for perinatal death, obesity, and subsequent type 2 diabetes (T2D) for the offspring. Moreover, mothers with GDM are also at increased risk for T2D post-partum. Yet few lifestyle interventions exist to reduce GDM risk prior to pregnancy. We describe the process of adapting an existing validated preconception counseling intervention for AI/AN adolescent girls at-risk for GDM and their mothers. Perspectives and recommendations were gathered from a diverse array of stakeholders to assure the new program called Stopping GDM was culturally responsive and developed with tribal voices and perspectives represented. METHODS: We conducted focus groups and individual interviews with multiple AI/AN stakeholders (n = 55). Focus groups and interviews were digitally recorded, transcribed verbatim, and analyzed using a thematic content approach to construct cross-cutting themes across the focus groups and interviews. RESULTS: Four key themes emerged reflecting issues important to planning a reproductive health intervention: 1) Limited awareness, knowledge, and health education resources about GDM; 2) The importance of acknowledging traditional AI/AN values and the diversity of traditions and culture among AI/AN tribes; 3) The need to cultivate healthy decision-making skills and empower girls to make safe and healthy choices; and 4) Lack of communication about reproductive health between AI/AN mothers and daughters and between AI/AN women and health care professionals. CONCLUSION: Findings have been used to inform the cultural tailoring and adaptation of an existing preconception counseling program, originally designed for non-AI/AN adolescent girls with diabetes, for AI/AN adolescents at-risk for GDM in future pregnancies.
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Diabetes Mellitus Tipo 2 , Diabetes Gestacional , Indígenas Norte-Americanos , Obesidade Infantil , Gravidez , Adolescente , Feminino , Humanos , Diabetes Gestacional/prevenção & controle , Indígena Americano ou Nativo do Alasca , Diabetes Mellitus Tipo 2/prevenção & controle , Diabetes Mellitus Tipo 2/psicologia , Aconselhamento , Comportamento de Redução do RiscoRESUMO
PURPOSE: The purpose of the study was to describe, compare, and examine associations at baseline of reproductive health awareness, knowledge, health beliefs, communication and behaviors related to gestational diabetes (GDM) and GDM risk reduction in a vulnerable population of both American Indian/Alaska Native (AIAN) adolescent girls and their mothers. METHODS: Descriptive/comparative/correlational analyses examined multitribal baseline data on 149 mother-daughter (M-D) dyads (N = 298; daughter age = 12-24 years) enrolled in a longitudinal study to adapt and evaluate a culturally relevant diabetes preconception counseling (PC) program (Stopping-GDM). The associations between GDM risk reduction awareness, knowledge, health beliefs, and behaviors (eg, daughters' eating, physical activity, reproductive-health [RH] choices/planning, M-D communication, daughters' discussions on PC) were examined. Data collected online from 5 national sites. RESULTS: Many M-D lacked awareness/knowledge of GDM and risk reduction. Both M-D were unaware of the girl's risk for GDM. Mothers' knowledge and beliefs on GDM prevention/RH were significantly higher than daughters. Younger daughters had greater self-efficacy healthy living. Overall sample reported low to moderate scores for both M-D communication and daughters' GDM and RH risk-reduction behaviors. CONCLUSIONS: Knowledge, communication, and behaviors to prevent GDM were low in AIAN M-D, especially daughters. More than daughters, mothers perceive greater risk of GDM for daughters. Early culturally responsive dyadic PC programs could help decrease risk of developing GDM. Implications for M-D communication is compelling.
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Indígena Americano ou Nativo do Alasca , Diabetes Gestacional , Relações Mãe-Filho , Saúde Reprodutiva , Adolescente , Adulto , Criança , Feminino , Humanos , Gravidez , Adulto Jovem , Indígena Americano ou Nativo do Alasca/psicologia , Indígena Americano ou Nativo do Alasca/estatística & dados numéricos , Comunicação , Diabetes Gestacional/epidemiologia , Diabetes Gestacional/etnologia , Diabetes Gestacional/prevenção & controle , Diabetes Gestacional/psicologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Estudos Longitudinais , Relações Mãe-Filho/etnologia , Relações Mãe-Filho/psicologia , Mães/psicologia , Mães/estatística & dados numéricos , Núcleo Familiar/etnologia , Núcleo Familiar/psicologia , Saúde Reprodutiva/etnologia , Saúde Reprodutiva/estatística & dados numéricos , ConscientizaçãoRESUMO
Gestational diabetes mellitus is the most common complication of pregnancy and contributes to increased risk for type 2 diabetes in both the mother and offspring. We developed and evaluated a gestational diabetes risk reduction and preconception counseling program, Stopping GDM (SGDM), for American Indian females. The purpose of this study is to examine the experiences of American Indian mother-daughter dyad participants and the site coordinators who facilitated the SGDM randomized controlled trial to inform program revisions. We engaged mother-daughter dyads (n = 22 dyads) and site coordinators (n = 6) in focus group interviews. Four themes emerged: (1) SGDM sparked valuable quality conversation for dyads; (2) gestational diabetes risk factors and risk reduction was new information for most dyads; (3) all trial sites experienced challenges to recruitment and engagement; and (4) study-improvement recommendations. These findings will be used to enhance SGDM to decrease adverse intergenerational health impacts of gestational diabetes in American Indian communities.
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BACKGROUND: Outcomes data are deficient in demonstrating the impact of faculty practice on education. PURPOSE: To examine nurse practitioner (NP) student, faculty, and administrator perspectives on faculty practice as an educational strategy. METHODS: NP students, faculty, and administrators from 6 different universities were surveyed. RESULTS: A total of 173 students, 25 faculty members, and 11 administrators participated. Results provide information on perspectives of faculty practice as an educational strategy pertaining to evaluation of education outcomes, overall education, didactic education, and clinical education. CONCLUSION: Faculty practice has educational benefits and brings value to nursing education, although evidentiary support is lacking.
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Educação em Enfermagem , Estudantes de Enfermagem , Humanos , Pesquisa em Educação em Enfermagem , Docentes , Estudantes , Docentes de EnfermagemRESUMO
BACKGROUND: Many challenges are inherent in academic nursing, and additional unique challenges exist for faculty and nursing programs that simultaneously engage in or offer faculty practice. To date, little has been published on faculty practice and academic nursing outside of the mission of education. PURPOSE: To describe faculty practice within the context of academic nursing as it pertains to scholarship and research, annual evaluations, promotion, support of faculty practice, and additional benefits and challenges. METHODS: A convenience sample of faculty and administrators was surveyed from 6 different universities in the United States. RESULTS: A total of 25 faculty members and 11 administrators participated. Results indicate faculty practice offers both benefits and challenges to the noneducational aspects of academic nursing. CONCLUSION: The benefits and challenges should be carefully considered within the context of the future of academic nursing and faculty practice.
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Atitude do Pessoal de Saúde , Prática do Docente de Enfermagem , Humanos , Estados Unidos , Pesquisa em Educação em Enfermagem , Bolsas de Estudo , Docentes de EnfermagemRESUMO
BACKGROUND: The adverse impact of COVID-19 on marginalized and under-resourced communities of color has highlighted the need for accurate, comprehensive race and ethnicity data. However, a significant technical challenge related to integrating race and ethnicity data in large, consolidated databases is the lack of consistency in how data about race and ethnicity are collected and structured by health care organizations. OBJECTIVE: This study aims to evaluate and describe variations in how health care systems collect and report information about the race and ethnicity of their patients and to assess how well these data are integrated when aggregated into a large clinical database. METHODS: At the time of our analysis, the National COVID Cohort Collaborative (N3C) Data Enclave contained records from 6.5 million patients contributed by 56 health care institutions. We quantified the variability in the harmonized race and ethnicity data in the N3C Data Enclave by analyzing the conformance to health care standards for such data. We conducted a descriptive analysis by comparing the harmonized data available for research purposes in the database to the original source data contributed by health care institutions. To make the comparison, we tabulated the original source codes, enumerating how many patients had been reported with each encoded value and how many distinct ways each category was reported. The nonconforming data were also cross tabulated by 3 factors: patient ethnicity, the number of data partners using each code, and which data models utilized those particular encodings. For the nonconforming data, we used an inductive approach to sort the source encodings into categories. For example, values such as "Declined" were grouped with "Refused," and "Multiple Race" was grouped with "Two or more races" and "Multiracial." RESULTS: "No matching concept" was the second largest harmonized concept used by the N3C to describe the race of patients in their database. In addition, 20.7% of the race data did not conform to the standard; the largest category was data that were missing. Hispanic or Latino patients were overrepresented in the nonconforming racial data, and data from American Indian or Alaska Native patients were obscured. Although only a small proportion of the source data had not been mapped to the correct concepts (0.6%), Black or African American and Hispanic/Latino patients were overrepresented in this category. CONCLUSIONS: Differences in how race and ethnicity data are conceptualized and encoded by health care institutions can affect the quality of the data in aggregated clinical databases. The impact of data quality issues in the N3C Data Enclave was not equal across all races and ethnicities, which has the potential to introduce bias in analyses and conclusions drawn from these data. Transparency about how data have been transformed can help users make accurate analyses and inferences and eventually better guide clinical care and public policy.
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The reach (i.e., enrollment, engagement, and retention) of health promotion evidence-based programs (EBPs) at the participant level has been challenging. Incentives based on behavioral economics may be used to improve EBP reach. We aimed to systematically review and synthesize the evidence of the effectiveness of incentives as a dissemination strategy to increase EBP reach. We conducted a literature search in PubMed, SCOPUS, EMBASE, Cochrane Review and Cochrane CENTRAL for articles published between January 2000 and March 2020 to identify incentive strategies used to increase program reach among health promotion EBPs. Inclusion criteria included studies published in English, experimental or quasi-experimental designs, comparison of incentive to non-incentive or control strategies, and reported on reach (n = 35 health promotion studies). Monetary incentives using cash and a fixed schedule of reinforcement were the most used incentive schemes (71%). Incentives alone or combined with other strategies as a multicomponent approach were effective in improving program enrollment, engagement, and retention. Specifically, incentive strategies were associated with higher odds of program enrollment (odds ratio [OR], 2.78; 95% confidence interval [CI], 1.82-4.24; n = 10) and retention (OR, 2.54, 95% CI, 1.34-4.85; n = 9) with considerable heterogeneity (I2 = 94% and 91%, respectively). Incentives are a promising individual-level dissemination strategy to improve the reach of health promotion EBPs. However, understanding the optimal amount, type, frequency, and target of incentives, and how incentives fit in a multicomponent approach in different contexts requires further research.
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Promoção da Saúde , Motivação , Economia Comportamental , HumanosRESUMO
This formative research study was designed to collect opinion data from adolescents historically underrepresented in adolescent dating abuse (ADA) research measure development. Eight in-person focus groups and 7 telephone-based one-on-one interviews were conducted with U.S. youth aged from 11 to 20 years (N=48). We conducted two focus groups with Black, Multiracial, Latinx, Native American, and LGBTQ+ youth. Seven LGBTQ+ youth participated in one-on-one telephone-based interviews. Focus group participants and interview subjects were asked the same 11 questions from a semi-structured focus group question guide. Five questions were on the topic of dating behaviors in general. In addition, six questions were asked for reactions to a paper-based list of 75 abusive acts. Youth generated ideas for 10 new possible cyber-ADA items and 14 emotionally abusive items for inclusion on the ADA measurement instrument. They did not generate any new physical or sexual ADA items. Youth identified 14 acts that they felt should not be on the measure, either because the acts were not abusive and too common, because they could not understand the item, or because it seemed unrealistic as an act of ADA. The study faced several limitations and was a good first step toward enriching the cultural inclusivity of ADA measurement instrument. Continued attention to inclusionary research that seeks to understand the cultural milieux of diverse participants is essential for violence prevention scholarship and subsequent health programming and policy that derive from it.
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Comportamento do Adolescente , Vítimas de Crime , Minorias Sexuais e de Gênero , Adolescente , Comportamento do Adolescente/psicologia , Vítimas de Crime/psicologia , Humanos , Violência , Indígena Americano ou Nativo do AlascaRESUMO
BACKGROUND: American Indian and Alaska Native (AI/AN) adults have a higher prevalence of type 2 diabetes (T2D) and related complications than non-AI/AN adults. As healthy eating is a cornerstone of diabetes self-management, nutrition education plays an important role in diabetes self-management education. OBJECTIVE: To understand stakeholder perspectives on facilitators and barriers to healthy eating for AI/AN adults with T2D in order to inform the cultural adaptation of an existing diabetes nutrition education curriculum. METHODS: Individual interviews were conducted with 9 national content experts in diabetes nutrition education (e.g. registered dietitians, diabetes educators, experts on AI/AN food insecurity) and 10 community-based key informants, including tribal health administrators, nutrition/diabetes educators, Native elders, and tribal leaders. Four focus groups were conducted with AI/AN adults with T2D (n = 29) and 4 focus groups were conducted with their family members (n = 22). Focus groups and community-based key informant interviews were conducted at 4 urban and reservation sites in the USA. Focus groups and interviews were recorded and transcribed verbatim. We employed the constant comparison method for data analysis and used Atlas.ti (Mac version 8.0) to digitalize the analytic process. RESULTS: Three key themes emerged. First, a diabetes nutrition education program for AI/ANs should accommodate diversity across AI/AN communities. Second, it is important to build on AI/AN strengths and facilitators to healthy eating (e.g. strong community and family support systems, traditional foods, and food acquisition and preparation practices). Third, it is important to address barriers to healthy eating (e.g. food insecurity, challenges to preparation of home-cooked meals, excessive access to processed and fast food, competing priorities and stressors, loss of access to traditional foods, and traditional food-acquisition practices and preparation) and provide resources and strategies for mitigating these barriers. CONCLUSIONS: Findings were used to inform the cultural adaptation of a nutrition education program for AI/AN adults with T2D.
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Objectives: To examine the association of perceived discrimination with participant retention and diabetes risk among American Indians and Alaska Natives. Methods: Data were drawn from the Special Diabetes Program for Indians-Diabetes Prevention Demonstration Project (N = 2553). Results: Perceived discrimination was significantly and negatively associated with short-term and long-term retention and diabetes risk without adjusting. After controlling for socioeconomic characteristics and clinical outcomes, perceived discrimination was not associated with retention but was significantly associated with less improvement in body mass index (BMI) and high-density lipoprotein (HDL) cholesterol. Every unit increase in the perceived discrimination score was associated with 0.14 kg/m2 less BMI reduction (95% CI: [0.02, 0.26], p = 0.0183) and 1.06 mg/dl lower HDL at baseline (95% CI: [0.36, 1.76], p = 0.0028). Discussion: Among racialized groups, improving retention and health in lifestyle interventions may require investigating perceived discrimination and the broader context of structural racism and colonialism.
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/psicologia , Indígena Americano ou Nativo do Alasca/psicologia , Diabetes Mellitus Tipo 2/prevenção & controle , Discriminação Psicológica , Indígenas Norte-Americanos/psicologia , Indígenas Norte-Americanos/estatística & dados numéricos , Diabetes Mellitus Tipo 2/etnologia , Comportamentos Relacionados com a Saúde/etnologia , Humanos , Estilo de Vida , Retenção nos Cuidados , Comportamento de Redução do RiscoRESUMO
Objective: To build on Evans-Campbell's [2008. "Historical Trauma in American Indian/Native Alaska Communities: A Multilevel Framework for Exploring Impacts on Individuals, Families, and Communities." Journal of Interpersonal Violence 23 (3): 316-338. doi:10.1177/0886260507312290.] multilevel framework of historical trauma and health by focusing on the cycle of fetal alcohol spectrum disorders (FASD) in the socio-cultural, historical, and interpersonal context of trauma shared by American Indian and Alaska Native (AI/AN) peoples.Methods: We analyzed qualitative data from focus groups with seventy four urban AI/ANs who were 15 years of age and older. Community-based participatory research methods were used for data collection and analysis. Our study explored knowledge and attitudes about FASD, perspectives on FASD risk factors, and culturally relevant approaches to FASD prevention and healthcare.Results: According to our study's participants, efforts to address FASD among urban AI/ANs should align with and emerge from community values, promote healing, consider the broader context that influences behaviors, and reflect the community's understanding that FASD risk behaviors are inextricably linked with historical and contemporary trauma.Conclusion: Effective, multiple-level FASD prevention approaches for AI/ANs may include prioritizing Indigenous culture, supporting intergenerational cohesion, focusing on non-stigmatic healing of traumas, and authentically engaging community knowledge. This work draws on community and cultural strengths in an effort to reduce the occurrence of substance-exposed pregnancies, and encourages transformational changes in systems that serve AI/AN peoples to promote a healthy and thriving community and future generations.
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Transtornos do Espectro Alcoólico Fetal , Trauma Histórico , Indígenas Norte-Americanos , Feminino , Transtornos do Espectro Alcoólico Fetal/prevenção & controle , Humanos , Gravidez , Indígena Americano ou Nativo do AlascaRESUMO
BACKGROUND: Faculty practice is believed to positively affect health education, however limited research exists on the impact of faculty practice on nurse practitioner education. PURPOSE: The purpose was to explore the perceived impact of faculty practice on nurse practitioner education. METHODS: A preliminary mixed methods approach was used to evaluate nurse practitioner student and faculty perspectives on the impact of faculty practice on nurse practitioner education. Student group interviews were conducted and practicing faculty were surveyed. RESULTS: Study findings included student and faculty-perceived benefits and challenges of faculty practice on nurse practitioner education. Specific benefits were increased access to faculty preceptors and clinical sites for nurse practitioner students, influencing faculty-developed education materials, increased number of real-world examples, faculty credibility, applying evidence-based practice, and overall improvement in the quality of teaching. Specific challenges were time, faculty availability to students, managing multiple roles, and clinical sites not conducive to precepting. CONCLUSION: This study provided preliminary information on the perceived impact of faculty practice on nurse practitioner education including the benefits and challenges. Findings support faculty practice as having a positive perceived impact on nurse practitioner education.
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Educação de Pós-Graduação em Enfermagem , Profissionais de Enfermagem , Docentes , Humanos , Preceptoria , Inquéritos e QuestionáriosRESUMO
Type 2 diabetes is a serious global epidemic that disproportionately affects disadvantaged populations. American Indians and Alaska Natives (AIs/ANs) have the highest rates of diabetes in the nation with a prevalence of 14.7% in 2018, more than twice that of non-Hispanic Whites. AI/AN men have the highest prevalence of diagnosed type 2 diabetes (14.5%) compared to non-Hispanic Black (11.4%), non-Hispanic Asian (10.0%), and non-Hispanic White (8.6%) men. Several landmark clinical trials have shown that lifestyle interventions can effectively prevent or delay the onset of diabetes among those at risk, including in AIs/ANs. Despite positive outcomes for AIs/ANs in these studies, very few were men. To date, there have been no concerted efforts to recruit and retain AI/AN men in interventions that promote weight loss and healthy lifestyles to prevent diabetes, and they remain underrepresented in these types of studies. This article describes the design and methods of the first randomized controlled trial of a diabetes prevention program with a study sample comprised entirely of AI/AN men. Research to date has demonstrated suboptimal patterns of recruitment and retention of AI/AN men, resulting in their virtual absence in health and intervention research. Effective methods to recruit and retain AI/AN men, and potential benefit gained from participation in diabetes prevention research, are unknown for this population who experience a high prevalence of type 2 diabetes. The study design presented in this article offers promising insights to help remedy these important shortcomings in the science of recruitment and retention of AI/AN men in research.
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Indígena Americano ou Nativo do Alasca , Redes Comunitárias , Diabetes Mellitus Tipo 2/prevenção & controle , Projetos de Pesquisa , Adulto , Equidade em Saúde , Humanos , Estilo de Vida , MasculinoRESUMO
OBJECTIVE: The purpose of this study is to assess the validity and reliability of the English version of the FCCHL tool in urban and rural, socioeconomically vulnerable or unstable, chronic comorbid adults in the United States. METHODS: A cross-sectional study measuring both validity and reliability. RESULTS: A total of 276 participants were recruited. Internal consistency was measured using Cronbach's alpha of α = 0.87. External reliability was measured by test-retest methodology. Construct validity was measured using Confirmatory Factor Analysis that showed good fit. Criterion validity was measured by comparing the mean scores of the FCCHL tool sub-scales. Concurrent validity was measured by comparison of means of the FCCHL tool and education level compared to the NVS and s-TOFHLA. CONCLUSION: The results demonstrated that the FCCHL tools is measuring three different concepts. Overall, the FCCHL tool was seen to have good validity and reliability in the identified population. PRACTICE IMPLICATIONS: The FCCHL tool is a 14-item, self-report health literacy tool measuring more than functional health literacy. The tool can be used in practice to improve not only functional health literacy, but also communicative and critical which is highly applicable.
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Letramento em Saúde , Inquéritos e Questionários/normas , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria , Reprodutibilidade dos TestesRESUMO
Nursing faculty practice encompasses multiple roles including direct and indirect provision of nursing/clinical services, research, education, consultation, administration, and other collaborative agreements. While faculty practice is encouraged by both American Association of Colleges of Nursing and National Organization of Nurse Practitioner Faculties, not all universities and colleges incorporate faculty practice as part of academia. The purpose of this paper is to discuss how one midwestern University optimized faculty practice over a four-year period by improving supporting infrastructure, contracts, aligning faculty and practice partners, and accountability. Pertinent data, decisions, and processes for each area are described here as well as the management of revenue generated.
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Docentes de Enfermagem/normas , Prática do Docente de Enfermagem/normas , Competência Profissional/normas , Docentes de Enfermagem/organização & administração , Humanos , Prática do Docente de Enfermagem/economia , Objetivos Organizacionais/economia , Universidades/economiaRESUMO
BACKGROUND: American Indian/Alaska Native (AI/AN) adolescents are at higher risk for gestational diabetes (GDM), type 2 diabetes, and pregnancy complications than the general population. OBJECTIVE: To inform cultural adaptation of a validated evidence-based intervention (VEBI) originally designed to deliver preconception counseling and diabetes education to non-AI/AN teens with diabetes. DESIGN: Qualitative data were collected using focus group and individual interview methods with health care professionals and experts (n = 16) in AI/AN health, GDM, adolescent health, and/or mother-daughter communication. A semistructured discussion guide elicited responses about provision of care for AI/AN girls at risk for GDM, experience with successful programs for AI/AN teens, comfort of mother/daughter dyads in talking about diabetes and reproductive health and reactions to video clips and booklet selections from the VEBI. All interviews were recorded and transcribed verbatim, and data analysis included inductive coding and identification of emergent themes. RESULTS: Providers felt teens and their moms would be comfortable talking about the VEBI topics and that teens who did not feel comfortable talking to their mom would likely rely on another adult female. Participants suggested including: AI/AN images/motifs, education with a community focus, and avoiding directive language. Concerns included: socioeconomic issues that affect AI/AN people such as: food and housing insecurity, abuse, and historical trauma. CONCLUSIONS: Perspectives from these participants have been used to guide the development of a culturally tailored GDM risk reduction program for AI/AN girls. This program will be available to health care providers who serve the AI/AN population.
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Diabetes Gestacional/prevenção & controle , Indígenas Norte-Americanos/educação , Educação de Pacientes como Assunto/normas , Prevenção Primária/normas , Comportamento de Redução do Risco , Adolescente , Serviços de Saúde do Adolescente/organização & administração , Serviços de Saúde do Adolescente/normas , Adulto , Diabetes Gestacional/etnologia , Diabetes Gestacional/etiologia , Prova Pericial/normas , Feminino , Grupos Focais , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Pessoal de Saúde/organização & administração , Pessoal de Saúde/normas , Humanos , Entrevistas como Assunto , Relações Mãe-Filho , Núcleo Familiar , Educação de Pacientes como Assunto/métodos , Educação de Pacientes como Assunto/organização & administração , Guias de Prática Clínica como Assunto/normas , Gravidez , Gravidez na Adolescência/prevenção & controle , Prevenção Primária/métodos , Prevenção Primária/organização & administração , Adulto Jovem , Indígena Americano ou Nativo do Alasca/educaçãoRESUMO
This study used a parallel convergent mixed methods design with TribalCrit theory and intersectionality as analytical frameworks to identify how American Indian men's identities intersect with broader structures and systems to shape their eating and physical activity choices and behaviors, and to elicit recommendations for a men's lifestyle intervention. AI men were recruited in Minneapolis, Minnesota and Portland, Oregon between March and December 2017 and in Phoenix, Arizona in December 2019 to participate in a survey and focus groups. The survey included demographic questions and questions about physical and cultural activities men engage in, perceived social support for lifestyle behaviors, masculine characteristics, and values important to American Indian men. The 6-item Kessler Psychological Distress Scale was used to assess psychological distress. Focus groups were audio recorded and transcribed for a phenomenological analysis. Descriptive statistics and correlations were computed for survey data. We conducted 15 focus groups with 151 adult American Indian men in three urban sites. The mean age of participants ranged from 36-51 across the sites; 7%-32% were college graduates; 13%-22% were currently married and 28%-41% were working full time. The most important values reported by participants were being: strong mentally and emotionally, a good parent, responsible, spiritual, and a good spouse or partner. On the K6 psychological distress scale, 63%-70% scored ≥5 but <13 (moderate mental distress), and 8%-15% scored ≥13 indicating severe mental distress. Younger age was significantly correlated with higher mean K6 score (p < .0001). Colonizers and missionaries that settled in the U.S. imposed cultural and gender hegemony which enforced a patriarchal capitalist system that have had long-lasting and deleterious effects on American Indians, particularly American Indian men.
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Malnutrition has been documented in approximately one-third of patients in developed countries on hospital admission and is associated with negative clinical outcomes. The need to identify and intervene in at-risk patients is critical to minimize these negative outcomes. A consensus approach for diagnosing and documenting malnutrition in hospitalized adult and pediatric patients was published jointly by the Academy of Nutrition and Dietetics (Academy) and the American Society for Parenteral and Enteral Nutrition (ASPEN) in 2012 and 2014, respectively. The purpose of this paper is to review the available literature on the usability, feasibility, validity, and reliability of both the adult and pediatric consensus malnutrition diagnostic approaches, as well as to evaluate their use in studying clinical outcomes. In adults, abstracts and published studies have shown the diagnostic tool is a usable, feasible, and reliable method for the identification of severe and non-severe or moderate malnutrition. In pediatrics, only 1 published study to date used the pediatric malnutrition indicators, indicating the need to demonstrate that the tool is feasible, valid, and reliable. Both the adult and pediatric tools have shown significant correlation with negative clinical outcomes in malnourished patients, including increased mortality, increased hospital length of stay (adults), increased complications (pediatrics), and increased hospital readmissions. Further large-scale studies are needed to evaluate the feasibility, usability, validity, and reliability of both the adult and pediatric malnutrition diagnostic approaches.