The family partners for health study: a cluster randomized controlled trial for child and parent weight management.

OBJECTIVE: The purpose of this study was to test a two-phased nutrition and exercise education, coping skills training, and exercise intervention program for overweight or obese low-income ethnic minority 2nd to 4th grade children and their parents in rural North Carolina, USA. METHODS: A cluster randomized controlled trial was carried out with 358 children (7-10 years) and a parent for each child (n=358). General linear mixed models were used to determine the effects of the intervention on weight, adiposity, health behaviors, and eating and exercise self-efficacy by examining changes in children and parents from baseline to completion of the study (18 months). RESULTS: At 18 months, children in the experimental group did not have a significantly decreased body mass index (BMI) percentile (P=0.470); however, they showed a reduction in the growth rate of their triceps (P=0.001) and subscapular skinfolds (P<0.001) and an improvement in dietary knowledge (P=0.018) and drank less than one glass of soda per day (P=0.052) compared with the control group. Parents in the experimental group had decreased BMI (P=0.001), triceps (P<0.001) and subscapular skinfolds (P<0.001) and increased nutrition (P=0.003) and exercise (P<0.001) knowledge and more often drank water or unsweetened drinks (P=0.029). At 18 months, children in the experimental group did not show significant improvement in eating (P=0.956) or exercise self-efficacy (P=0.976). Experimental parents demonstrated improved socially acceptable eating self-efficacy (P=0.013); however, they did not show significant improvement in self-efficacy pertaining to emotional eating (P=0.155) and exercise (P=0.680). CONCLUSION: The results suggest that inclusion of children and parents in the same intervention program is an effective way to decrease adiposity and improve nutrition behaviors in both children and parents and improve weight and eating self-efficacy in parents.

Developing socio-spatial knowledge networks: a qualitative methodology for chronic disease prevention.

Chronic disease is a significant and costly social problem. The burden is even more pronounced in communities with high rates of a particular chronic disease. Assessment of health belief systems and the local geographies of health beliefs can assist community health planners to create cost-effective strategic intervention programs where populations are at high risk for chronic diseases. In this paper, we elaborate the concept of socio-spatial knowledge networks (SSKNs) and demonstrate that SSKNs can be useful in informing the design of health care prevention strategies. In our project, we demonstrate how to identify key socio-spatial information for intervention strategies which will prevent or delay the onset of a particular chronic disease, Type 2 diabetes. Our qualitative framework allows us to determine which sites might be best characterized as socio-spatial knowledge network nodes for sharing diabetes information and which sites might be less suited to such exchange. Our strategy explores cross-cultural similarities, differences, and overlap in a multi-ethnic rural North Carolina context through simple techniques such as mapping social networks and sites in which people share their knowledge and beliefs about diabetes. This geographical analysis allows us to examine exactly where health knowledge coincides with other social support, and where such resources may be improved in a particular community. Knowing precisely what people in a community understand about a chronic disease and its treatment or prevention and knowing where people go to share that information helps to (1) identify strategic locations within a community for future interventions and, (2) evaluate the effectiveness of existing interventions. The geographical approach presented here is one that can serve other communities and health practitioners who hope to improve chronic disease management in diverse local environments.

Perceptions of health and their relationship to symptoms in African American women with type 2 diabetes.

Diabetes mellitus is an incurable disease and a major cause of mortality and morbidity. Diabetes disproportionately affects members of minorities who suffer from higher rates of complications and greater disability (Cowie & Eberhardt, 1996). The purpose of this study was to (a) describe the symptoms of African American women with Type 2 diabetes and examine the relationship among diabetes-related symptoms; (b) document complications of diabetes and perceptions of health and functioning; and (c) examine the relationship between duration of diabetes and age at diagnosis and perceived health. A convenience sample of 75 African American women with Type 2 diabetes were interviewed. A 44-item questionnaire measured selected demographic variables, symptoms, documented complications, and their perceived relationship to diabetes. The SF-20 was used to measure perceptions of health status. Data show that African American women with Type 2 diabetes have a wide variety of symptoms and poor perceptions of their general health and physical functioning.

Influences on day-to-day self-management of type 2 diabetes among African-American women: spirituality, the multi-caregiver role, and other social context factors.

OBJECTIVE: Many African-American women are affected by diabetes and its complications, and culturally appropriate lifestyle interventions that lead to improvements in glycemic control are urgently needed. The aim of this qualitative study was to identify culturally relevant psychosocial issues and social context variables influencing lifestyle behaviors--specifically diet and physical activity--of southern African-American women with diabetes. RESEARCH DESIGN AND METHODS: We conducted 10 focus group interviews with 70 southern African-American women with type 2 diabetes. Group interviews were audiotaped and transcripts were coded using qualitative data analysis software. A panel of reviewers analyzed the coded responses for emerging themes and trends. RESULTS: The dominant and most consistent themes that emerged from these focus groups were 1) spirituality as an important factor in general health, disease adjustment, and coping; 2) general life stress and multi-caregiving responsibilities interfering with daily disease management; and 3) the impact of diabetes manifested in feelings of dietary deprivation, physical and emotional "tiredness," "worry," and fear of diabetes complications. CONCLUSIONS: Our findings suggest that influences on diabetes self-management behaviors of African-American women may be best understood from a sociocultural and family context. Interventions to improve self-management for this population should recognize the influences of spirituality, general life stress, multi-caregiving responsibilities, and the psychological impact of diabetes. These findings suggest that family-centered and church-based approaches to diabetes care interventions are appropriate.

Development of a health status measure for older African-American women with type 2 diabetes.

OBJECTIVE: To develop a health status measure in older African-American women with type 2 diabetes. RESEARCH DESIGN AND METHODS: African-American women, age > or =40 years with type 2 diabetes, were recruited from central North Carolina to participate in three sequential phases: 1) Seven focus groups were convened and transcripts evaluated to generate questions and identify plausible domains; 2) Ten one-on-one cognitive response interviews were performed to ensure clarity and cultural appropriateness of the questions; and 3) 217 women participated in psychometric evaluation to establish the internal consistency and validity of the instrument. RESULTS: Three broad categories--mental, physical, and social well-being--captured important issues generated during the focus groups. "My diabetes" was added during the cognitive response interviews as a way of separating the impact of diabetes from coexisting issues that affect health status. The response option was changed from a six- to a four-point Likert scale to accommodate subject preference. Using principal components and subsequent promax rotation, we identified two hierarchical domains (mental and social well-being) and a physical symptom index. The internal consistency (Cronbach's alpha) of the mental and social well-being subscales are 0.83 and 0.93, respectively. A priori hypothesized correlations between subscales along with each subscale and glycated hemoglobin, diabetes duration, physical activity, and a perceived health competence scale helped establish the construct validity of the instrument. CONCLUSIONS: A culturally appropriate disease-specific health status measure for older African-American women with type 2 diabetes has been developed. We have established the internal consistency, construct validity, and factor analytic properties of the measure. This measure should prove useful for investigators who seek a health status instrument that addresses issues germane to African-American women with type 2 diabetes.

A diabetes management program for African American women with type 2 diabetes.

PURPOSE: This paper describes a clinic- and community-based diabetes intervention program designed to improve dietary, physical activity, and self-care behaviors of older African American women with type 2 diabetes. It also describes the study to evaluate this program and baseline characteristics of participants. METHODS: The New Leaf ... Choices for Healthy Living With Diabetes program consists of 4 clinic-based health counselor visits, a community intervention with 12 monthly phone calls from peer counselors, and 3 group sessions. A randomized, controlled trial to evaluate the effectiveness of this intervention is described. RESULTS: Seventeen focus groups of African American women were used to assessed the cultural relevance/acceptability of the intervention and measurement instruments. For the randomized trial, 200 African American women with type 2 diabetes were recruited from 7 practices in central North Carolina. Mean age was 59, mean diabetes duration was 10 years, and participants were markedly overweight and physically inactive. CONCLUSIONS: Participants found this program to be culturally relevant and acceptable. Its effects on diet, physical activity, and self-care behaviors will be assessed in a randomized trial.

Evolution of the nursing process.

The nursing process, long considered the basic intellectual tool for nursing, has continued to evolve through use by advanced practice nurses (APNs). Traditionally, the nursing process has been comprehensive in guiding the assessment and intervention phases but has left unspecified the cognitive processes involved in clinical decision making. In an effort to compensate for that weakness, nurses in advanced practice have typically integrated medical diagnostic reasoning into the nursing process. The work of Benner and colleagues (1984, 1996) in explicating the unique reasoning process used by APNs has helped further our understanding of clinical decision making in advanced practice. The evolved nursing process, as described in this article, includes the array of clinical decisions that must be made during a patient encounter, including assessment decisions, diagnosis, choice of interventions, and identification of outcomes. This article reviews the nursing and medical literature related to both clinical decision making and diagnostic reasoning, and applies that literature to the evolution of the nursing process.

Self-efficacy and confidence in outcomes as determinants of self-care practices in inner-city, African-American women with non-insulin-dependent diabetes.

The purpose of this study was to examine the extent to which perceived self-efficacy and confidence in outcomes, selected demographic variables, and disease characteristics (age, duration of diabetes, presence of documented complications) affect an individual's adherence over time to a diabetes regimen of home glucose testing, medication/insulin administration, diet, and exercise. A convenience sample of 118 inner-city, African-American women with type II, non-insulin-dependent diabetes mellitus receiving outpatient care at a large urban hospital were asked to complete measures of each of the psychosocial variables on two occasions, separated by an interval of 4 to 5 months, and coinciding with their next scheduled clinic visit. Bivariate and multivariate analyses at Times 1 and 2 demonstrated the ability of self-efficacy alone to explain diet, exercise, and home-testing behaviors while suggesting variability within individuals in sense of self-efficacy over time.

Health perceptions of the homeless: a survey of Buffalo's City Mission.

Several faculty members at the State University of New York at Buffalo School of Nursing were interested in developing a nursing center in Western New York to serve the homeless population. The City Mission in Buffalo was selected as a site to conduct a survey to identify the demographic characteristics of one group of homeless subjects and their perceived needs. One hundred and twenty-four questionnaires were completed and analyzed statistically. The profile of the respondents was that of a young, single, Protestant white male from the Buffalo area with a history of local residence. A large proportion of the subjects perceived themselves as experiencing health problems. Both disease prevention and health promotion needs were recognized. The findings of this study were consistent with those of earlier studies including those completed in Boston, Massachusetts (1984). These data have served as a base for the provision of primary nursing interventions for this population within a nursing center model.

Insulin allergy in clinical practice.

Insulin allergy, either localized or systemic, is a clinical problem that may be encountered by nurse practitioners. Studies have shown that 10 to 37 percent of patients started on animal-source insulin developed an allergic reaction to the agent. With the advent of purified animal-source insulins and of human insulin, this number has decreased, but the problem is unlikely to be completely eradicated. This article presents information about the diagnosis, treatment and management of patients presenting with localized or systemic insulin allergy. A brief discussion of the antigenicity of insulin and the basic immune processes operating in insulin allergy will be included. It is hoped that by acquainting nurse practitioners with the manifestations of insulin allergy and the treatment involved, earlier recognition and intervention will occur. This will help remove an extra burden from a patient who is already trying to adjust to the necessity of daily insulin injections.