Mobile App Use in Adults with Comorbid Type 2 Diabetes and Depression.

The purpose of this preliminary study was to determine smartphone usage, expressed level of interest, and intent to use mHealth apps among adults with comorbid type 2 diabetes (T2D) and depression. A convenience sample of adults (N=35) completed a Demographic and Mobile App Survey and the CESD-R-10. A majority reported using mobile apps (n=23, 65.7%) and felt comfortable or very comfortable using mobile apps (n=14, 46.7%). However, few respondents used a health app (n=6, 17.1%) or a diabetes-specific app for diabetes management (n=3, 8.6%). Adjusted, age and education were the two variables that independently impacted app use; those aged less than 55 years as well as those with a graduate degree were more likely to use apps. Being younger and having an advanced degree increased the odds of using a diabetes-specific app. The findings suggest that adults with T2D are amenable to using mHealth apps to manage diabetes.

Social Support, Self-Efficacy, and Psychological Wellbeing of Adults with Type 2 Diabetes.

Social support improves self-efficacy, which in turns enhances self-management that lead to better psychological outcomes of persons with type 2 diabetes (T2D). The purpose of this study was to examine the relationship between social support and psychological outcomes of adults with T2D. A cross-sectional design was used to recruit a sample of 339 participants from a diabetes clinic. The participants responded to a series of questionnaires on demographics, social support dimensions, and self-management; self-efficacy; and psychological outcomes. The function and quality of social support were positively associated with self-efficacy. Self-efficacy was significantly associated with both self-management and psychological outcomes. In addition, self-efficacy demonstrated successful mediation role in the relationship between social support and psychological outcomes of T2D, however, self-management failed to mediate this relationship. The quality and functionality of social support are distinctive variables that should be recognized to promote social support interventions to reduce or prevent T2D-related psychological outcomes.

Self-Management as a Mediator of the Relationship between Social Support Dimensions and Health Outcomes of African American Adults with Type 2 Diabetes.

Social support promotes behavior change and self-management that leads to improved health outcomes. The purpose of this study was to evaluate the role of self-management in mediating the relationship between social support dimensions and health outcomes of African Americans with type 2 diabetes (T2D). Cross-sectional data were collected from 102 African Americans with T2D at an outpatient clinic. The majority of the participants were female, single, unemployed, and having low income. Functional support, the quality of the primary intimate relationship, and the number of support persons were negatively correlated with depression. Functional support and satisfaction with support explained a significant small amount of the variance in self-management. However, self-management did not mediate the relationships between social support dimensions and the health outcomes. The results of this study shed the light on the unique relationships of social support dimensions with health outcomes of African Americans with T2D.

Relationships of Depression, Anxiety, and Stress with Adherence to Self-Management Behaviors and Diabetes Measures in African American Adults with Type 2 Diabetes.

This study examines the relationships of depression, anxiety, and stress with adherence to self-management behaviors and diabetes measures in 42 African American adults with type 2 diabetes (T2D). Participants were recruited from an outpatient clinic located in an urban area of a midsized city in the southeastern USA. The mean age of the sample was 54.9 years (SD = 9.9) and the majority of the participants were female (73.2%), high school graduates (55.3%), unemployed (70.7%), and publicly insured (77.8%). Each participant completed a demographic survey and the Depression, Anxiety and Stress Scale 21. Adherence to self-management behaviors (physical activity, diet, and medication use) was assessed using surveys and self-reports. Glycated hemoglobin (A1c) and body mass index (BMI) were obtained from participants' medical records at the time of the participants' clinic visits. Depression, anxiety, and stress were not significantly correlated with self-management behaviors. Depression (r = 0.38, p = 0.03), anxiety (r = 0.56, p = 0.001), and stress (r = 0.36, p = 0.04) were positively correlated with A1c. The greater the dietary risk assessment score, the higher the A1c (r = 0.34, p = 0.05). Anxiety was the strongest correlate of A1c followed by depression, stress, and dietary risk assessment. Future studies to confirm this study's findings in a larger sample are warranted. Interventions to mitigate the effects of these correlates should be designed and tested to improve health outcomes in African American adults with T2D.

Comorbid Diabetes and Depression in African Americans: Implications for the Health Care Provider.

Health care providers (HCPs) face many obstacles as they undertake efforts to meet the challenges of caring for African American patients with comorbid diabetes and depression. This review article discusses the incidence of comorbid diabetes and depression in African Americans, cultural factors affecting diabetes self-management, and clinical practice implications for the HCP. The role of patient-centered care, engagement, and best-practice strategies are discussed to provide the HCP with guidelines regarding the minimal standards that support improved health care outcomes for African Americans with comorbid diabetes and depression.

The Relationships of Demographic Characteristics with Diabetes Biomarkers and Physical Activity Adherence in African American Adults.

OBJECTIVE: The objective of this study was to examine the relationships of demographic characteristics with diabetes biomarkers and physical activity adherence in African American adults with type 2 diabetes mellitus. METHODS: Data for this secondary analysis were collected in a controlled trial conducted at an ambulatory internal medicine clinic located in a mid-sized metropolitan area in the southeastern USA. Demographic information was obtained at baseline for all participants receiving a motivational interviewing intervention. Diabetes biomarkers and physical activity adherence were measured at baseline and 3-month follow-up. RESULTS: Being female, older, and having a higher education significantly predicted a decrease in serum glucose over time. Being female and older significantly predicted a slower decrease in body mass index over time. Being younger and more educated significantly predicted probability of improved physical activity adherence. CONCLUSION: Although older African American women had a significant decrease in serum glucose over time, they experienced a slower decrease in their body mass indices and were less likely to adhere to physical activity recommendations. Specific attention should be paid to the demographic characteristics of African Americans with type 2 diabetes mellitus in order to promote optimal clinical outcomes in this vulnerable population. This approach to treatment planning opens a window into the micro-level processes by which social determinants lead to a better response to treatment.

Implementation of childhood obesity identification and prevention strategies in primary care: A quality improvement project.

The high incidence and prevalence of childhood obesity, coupled with significant morbidity and financial burden, clearly suggest the need for identification and implementation of effective pediatric obesity prevention strategies in primary care. A solution to this problem includes evidence based clinical guidelines that provide concise, culturally appropriate information on the identification and prevention of childhood obesity in primary care settings. The objective of this quality improvement project was to implement childhood obesity identification and prevention guidelines from evidence-based recommendations into practice. Guidelines were implemented during preventative care visits through the use of a tracking form. The development of the tracking form included input from practice staff resulting in increased fidelity. The tracking form included directions for clear and concise guideline implementation and provided opportunities to record patient BMI, nutritional intake, physical activity, familial obesity prevention education and motivational interviewing and facilitated a practice increase in childhood obesity identification and education. Presence of chart indicators, including nutrition and exercise history, were analyzed to determine the fidelity of the practice change in obesity identification and prevention education. Key outcomes included a significant (p < .0001) practice increase in childhood obesity identification as well as a significant increase (p < .05) in documentation of obesity prevention education through motivational interviewing. Practice change incorporating childhood obesity identification and familial prevention guidelines had positive effects in a pediatric population. Implementation of evidence-based guidelines can result in increased identification of children at risk for childhood obesity and enhanced familial obesity prevention education; leading to the long-term goal of creating healthier lifestyles and decreasing risk factors in a vulnerable population.

Motivational interviewing to improve diabetes outcomes in African Americans adults with diabetes.

The purpose of this study was to determine the effect of a motivational interviewing intervention (MII) on regimen adherence and diabetes markers among African Americans with diabetes. Sixty-two participants were assigned to the usual care (UC; n = 36) or MII (n = 26) groups. UC participants received the usual clinic care. MII participants received a maximum of six motivational interviewing (MI) sessions over 3 months. Outcome variables were obtained at baseline and 3-month follow-up. Data were obtained using medical records, self-reports, and glucose monitor and accelerometer print-outs. MII significantly increased the odds of participants adhering to recommended physical activity level (66.7% vs. 38.8%, odds ratio = 2.92, 95% confidence interval = [1.6, 14.3], p = .018) and significantly decreased glucose levels (p = .043) and body mass index (p = .046) over time when compared with UC. Findings support using MI as an intervention for improving health outcomes and regimen adherence rates among the study population.

Gender differences in diabetes self-management among African American adults.

The rising incidence of diabetes complications among African Americans is a major health concern. Few studies have addressed gender differences in diabetes self-management in this population. The purpose of this study was to determine whether gender differences in facilitators and barriers to self-management exist among African American adults with type 2 diabetes. Thirty-eight participants were recruited from community agencies and each participated in one of seven audio-recorded focus group sessions. Regular health care visits, positive outlook, prioritization of health, and independence facilitated self-management behaviors in men, whereas acceptance of diabetes was a facilitator for women. Lack of time at work, lack of family support, and lack of knowledge were barriers for men, whereas lack of finances, embarrassment, negative outlook, perceived lack of disease control, and adverse effects of medications were barriers for women. Further research is necessary to design and test gender-specific tailored interventions to improve diabetes self-management in this population.

Promoting nurse interventionist fidelity to motivational interviewing in a diabetes self-care intervention.

We describe interventionist training procedures for a pilot intervention study that tested the effects of a nurse-delivered Motivational Interviewing (MI) intervention on diabetes self-care among adults diagnosed with type 2 diabetes mellitus. It reports on findings from MI fidelity assessments. Training consisted of didactic workshops plus practicum. Fidelity of MI was assessed using the MI Treatment Integrity (MITI) Scale. Fidelity assessments were conducted on 18 (25%) audiotaped MI sessions, which were randomly selected from a total of 72 sessions with 26 participants. Scores of the MITI were in the proficient and competent range. Results suggest that training strategies were sufficient to promote satisfactory interventionist fidelity to MI.

Facilitators and barriers to self-management of type 2 diabetes among urban African American adults: focus group findings.

PURPOSE: The purpose of this study was to identify facilitators and barriers to self-management of type 2 diabetes mellitus (T2DM) among urban African American adults. METHODS: Thirty-eight African American adults with T2DM were recruited from 1 of 3 health care agencies in a midsized city in the southeastern United States. Qualitative data were obtained using focus groups, wherein each participant engaged in a 60- to 90-minute audio-recorded session. Focus group data were transcribed and analyzed using Atlas ti 6(®) data analysis software. Demographic and medical history information was also collected. RESULTS: Factors relating to external locus of control primarily facilitated adherence to T2DM self-management behaviors. Support from family, peers, and health care providers positively influenced adherence behaviors by providing cues to action, direct assistance, reinforcement, and knowledge. Internal factors were primarily described as barriers to self-management behaviors and included fears associated with glucose monitoring, lack of self-control over dietary habits, memory failure, and perceived lack of personal control over diabetes. CONCLUSIONS: African Americans perceived external factors as facilitators of their T2DM management behaviors and internal factors as barriers to self-management. Further research is necessary to design and test interventions that capitalize on the external facilitators while helping African Americans to overcome perceived barriers identified in this study.

Social support, self-efficacy, and outcome expectations: impact on self-care behaviors and glycemic control in Caucasian and African American adults with type 2 diabetes.

PURPOSE: The purpose of this study was to examine the relationships of psychosocial variables (social support, self-efficacy, and outcome expectations) to diabetes self-care behaviors and glycemic control in Caucasian and African American adults with type 2 diabetes. METHODS: Study participants were scheduled for outpatient visits at 1 of 3 clinical sites in the southeastern United States. All 91 participants completed 4 self-report measures: Social Support Questionnaire (SSQ), Self-efficacy Questionnaire (SEQ), Outcome Expectancy Questionnaire (OEQ), and The Diabetes Activities Questionnaire (TDAQ) at the time of the clinic visit. Long-term glycemic control was assessed by glycosylated hemoglobin analyses at the time of the clinic visit. Pearson product-moment correlations were used to determine whether significant relationships existed between scores on the SSQ, SEQ, OEQ, and TDAQ and glycosylated hemoglobin values. Two-sample t tests were used to detect differences in scores on the self-report measures and glycosylated hemoglobin values between the 2 racial groups. RESULTS: In all participants, no significant relationships were found between (1) social support and self-care behaviors and (2) self-efficacy and self-care behaviors. Self-care behaviors were significantly, positively correlated with outcome expectancy scores for the total group and for African Americans. No significant relationships were found between (1) social support and glycemic control, (2) self-efficacy and glycemic control, and (3) outcome expectations and glycemic control. African Americans reported less social support satisfaction than Caucasians did. CONCLUSIONS: Psychosocial variables investigated in this study were not related to health outcomes of type 2 diabetes. Caucasians and African Americans were similar in these variables. It is important to investigate the relationships between other variables (eg, age, duration of diabetes, education) and self-care behaviors and glycemic control. Although African Americans experience higher rates of diabetes-related complications than Caucasians do, this may possibly be due to other factors (eg, heredity, financial barriers, inadequate health care). Additional investigations to study the relationships of these variables to diabetes control are warranted.

Sponsored professional seminars: enhancing professionalism among baccalaureate nursing students.

If we are to emphasize professionalism within nursing, students need to understand the opportunities, responsibilities, and concerns that are integral to the nursing profession. Sharing ideas related to nursing practice in a specified area with practicing nurses, expert faculty, and a speaker provide students with a sense of excitement about their chosen career. The sponsored seminar series permits undergraduate nursing students to converse with their future colleagues over dinner, develop lasting relationships, and advance their learning in an area of interest.