eDECIDE a web-based problem-solving interventions for diabetes self-management: Protocol for a pilot clinical trial.

Background: In the US, diabetes affects 13.2% of African Americans, compared to 7.6% of Caucasians. Behavioral factors, such as poor diet, low physical activity, and general lack of good self-management skills and self-care knowledge are associated with poor glucose control among African Americans. African Americans are 77% more likely to develop diabetes and its associated health complications compared to non-Hispanic whites. A higher disease burden and lower adherence to self-management among this populations calls for innovative approaches to self-management training. Problem solving is a reliable tool for the behavior change necessary to improve self-management. The American Association of Diabetes Educators identifies problem-solving as one of seven core diabetes self-management behaviors. Methods: We are using a randomized control trial design. Participants are randomized to either traditional DECIDE or eDECIDE intervention. Both interventions run bi-weekly over 18 weeks. Participant recruitment will take place through community health clinics, University health system registry, and through private clinics. The eDECIDE is an 18-week intervention designed to deliver problem-solving skills, goal setting, and education on the link between diabetes and cardiovascular disease. Conclusion: This study will provide feasibility and acceptability of the eDECIDE intervention in community populations. This pilot trial will help inform a powered full-scale study using the eDECIDE design.

A Geo-Stratified Analysis of Associations Between Socio-Economic Factors and Diabetes Risk.

Introduction: In 2019, diabetes was the seventh leading cause of death in the United States. The association between diabetes risk and socio-economic factors in the U.S. has been examined primarily at the national level; little is known about this association at the regional level. This study examined and compared the association between diabetes risk and previously established socio-economic factors across four geographic regions (South, Midwest, West, and Northwest). Methods: This study analyzed the 2014 Behavioral Risk Factor Surveillance System (BRFSS) data stratified by four geographic regions of the U.S. The risk estimates of diabetes associated with previously established socio-economic factors, as well as diabetes prevalence, were compared across four geographic regions. Results: There was marked variation in association between diabetes risk and previously established risk factors across the four geographic regions. In the South, rural residency was associated with increased diabetes risk, whereas in the other geographic regions rural residency had a protective effect. In the South, the diabetes risk for males was 22% higher compared to females, whereas the risk for males was 41% higher than females in the Northeast. Independently, age had the strongest discriminative ability to distinguish between a person with diabetes and a person without diabetes, whereas ethnicity, race, and sex had the weakest discriminative abilities. Conclusions: These findings suggested a higher prevalence of diabetes by race/ethnicity (non-Hispanic Black and Hispanic) and income across all four regions. Rural residency was highest in the South, but protective in other regions. Overall, age and income provided the highest predictive ability for diabetes risk. This study highlighted differences in diabetes prevalence in association between previously established socio-economic variables and diabetes risk across four geographic regions. These findings could help public health professionals and policy makers in understanding the dynamic relationship between diabetes and risk factors at the regional level.

Learning from maternal voices on COVID-19 vaccine uptake: Perspectives from pregnant women living in the Midwest on the COVID-19 pandemic and vaccine.

The aim of this study was to understand COVID-19 vaccine perceptions and decision-making among a racially/ethnically diverse population of pregnant and lactating women in the Midwest. Pregnant female participants (N = 27) at least 18 years. or older living in the Midwest were recruited to participate in a maternal voices survey. A mix-methods approach was used to capture the perceptions of maternal voices concerning the COVID-19 vaccine. Participants completed an online survey on COVID-19 disease burden, vaccine knowledge, and readiness for uptake. A total of 27 participants completed the Birth Equity Network Maternal Voices survey. Most participants were African American (64%). Sixty-three percent intend to get the vaccine. Only 25% felt at-risk for contracting COVID-19, and 74% plan to consult their provider about getting the COVID-19 vaccine. At least 66% had some concerns about the safety of the vaccine. Participants indicated a willingness to receive the COVID-19 vaccine, especially if recommended by their provider. We found little racial/ethnic differences in perceptions of COVID-19 and low vaccine hesitancy.