Knowledge, Perceptions, Needs and Challenges of Dominican Adolescents with Type 1 Diabetes Mellitus / Conocimientos, percepciones, necesidades y desafíos de los adolescentes dominicanos con diabetes mellitus tipo 1

Introduction: The lack of metabolic control in patients with Type 1 Diabetes Mellitus (T1DM) can cause severe complications and reduce their life expectancy. Transition into adolescence among children with T1DM effects important changes that could negatively influence their metabolic control. Purpose: To determine knowledge, perceptions, needs and challenges of Dominican adolescents with T1DM. Methodology: Phone interviews to adolescents with T1DM between 14 and 18 years. Analysis included coding using the Health Belief Model, and using Nvivo, with a deductive and inductive approach. Results: Participants reported a high level of perceived susceptibility to complications, and severity associated to an incurable disease that causes severe complications. Within modifying factors, the family socioeconomic level was identified as relevant, and the role of support networks in managing their disease was mentioned as an external variable. Conclusions: Culturally, relevant interventions are needed to improve metabolic control and psychosocial aspects among Dominican adolescents with T1DM, including the use of a self-management mobile application; in addition, incorporating perspectives, context realities and knowledge of adolescents in developing therapeutical education strategies about T1DM could improve the impact of these strategies

Introducción: el descontrol metabólico en pacientes con diabetes tipo 1 (DMT1) puede provocar complicaciones severas y reducir la esperanza de vida. La transición a la adolescencia en jóvenes con DMT1 determina cambios importantes que pueden influenciar negativamente el control metabólico. Propósito: determinar el nivel de conocimiento, las percepciones, las necesidades y los desafíos de los adolescentes dominicanos con DMT1. Metodología: entrevistas telefónicas a adolescentes con DMT1, entre 14 y 18 años. El análisis incluyó la codificación con base al Modelo de Creencias de Salud, utilizando NVivo, a través de un abordaje deductivo e inductivo. Resultados: participantes reportaron un alto nivel de susceptibilidad percibida de sufrir complicaciones y una percepción de severidad asociada a una enfermedad incurable que causa complicaciones severas. En los factores modificadores se destacan determinantes sociales como el nivel socioeconómico de la familia y, en las variables externas, el rol de las redes de apoyo en el manejo de la enfermedad. Conclusiones: se requieren intervenciones culturalmente relevantes para mejorar el control metabólico y los aspectos psicosociales en los adolescentes dominicanos con DMT1, como sería una aplicación móvil para el automanejo; además, incorporar las perspectivas, las realidades contextuales y los conocimientos de los adolescentes en las estrategias de educación terapéutica sobre la DMT1 favorecería su impacto

A Contribution to Measure Partnership Trust in Community-Based Participatory Research and Interventions With Latinx Communities in the United States.

Given the growing diversity in the United States, responsiveness to the needs of diverse communities is paramount. Latinx communities in the United States often state mistrust in outside institutions because of adverse experiences. Community-based participatory research (CBPR) is considered a trust-building process and is one approach to understand disparities. However, the conceptualization and evaluation of trust as a CBPR outcome are understudied. This article summarizes a community-engaged research process conducted for the cultural and linguistic refinement of a partnership trust survey tool to assess partnership trust as an outcome of CBPR (CBPR-PTS), by using Perinatal Awareness for Successful Outcomes (PASOs) as a case study and cross-cultural cognitive interviewing (CCCI) methodology. The participants were 21 diverse stakeholders of PASOs, a community-based health organization that serves the Latinx population in South Carolina. A modified version of the multidimensional measure of trust model informed instrument development. The team analyzed the CCCI data using compiling informal analysis to identify which survey items' wordings must be changed or adapted based on the participants' accounts. Sixteen of 28 questions subjected to CCCI required modifications due to translation errors, culturally specific errors, or general cognitive problems. The new survey instrument has 19 scales and 195 items categorized into nine dimensions of the modified multidimensional measure of trust model. CCCI was a useful tool to address the cross-cultural understanding issues of the CBPR-PTS. Measurement instruments should be able to capture the socioeconomic, cultural, and geographic/environmental variability of community stakeholders to help understand the diversity of the comprehension and views of the communities involved in disparities' reduction efforts.

The Influence of Adverse Childhood Experiences (ACEs), Including the COVID-19 Pandemic, and Toxic Stress on Development and Health Outcomes of Latinx Children in the USA: a Review of the Literature.

The purpose of this review is to synthesize existing literature to analyze the influence of the Adverse Childhood Experiences (ACEs), including the COVID-19 pandemic, and toxic stress on child development and lifelong health outcomes of Latinx children in the USA, utilizing the ACE framework. Without adequate protective factors, children's early experiences with adversity and toxic stress have implications for their physiological, psychological, and social health. The COVID-19 pandemic has shown to exacerbate childhood adversity and toxic stress and has disproportionately harmed Latinx communities. In applying the ACE framework to US-Latinx populations, relevant findings concerning a potential failure of ACEs to accurately capture Latinx experiences of adversity were highlighted, as well as the need to classify the COVID-19 pandemic as an ACE. Research suggest that first-generation Latinx immigrants report lower-than-average rates of ACEs despite the various disparities ethnic minorities face in the USA. A discussion on whether this health paradox arises because of the failure of ACEs to properly identify adverse experiences unique to immigrants or if it is related with immigrant families' protective cultural factors. The compounding experiences of discrimination, immigration anxieties, and now also pandemic-related hardship that have the potential to harm Latinx children's cognitive, emotional, and physical development were highlighted. Evidence-based interventions that were discussed in this report include promotion of resiliency through healthy adult relationships, policies that screen for ACEs early on in a child's life, trauma-informed care and innovative treatment programs, and strengthening existing protective services through financial and political support.

Using Community-Engaged Research to Explore Social Determinants of Health in a Low-Resource Community in the Dominican Republic: A Community Health Assessment.

INTRODUCTION: Previously published community health assessments (CHA) have explored social determinants of health in low-resource, Haitian-majority Dominican communities. The present CHA was conducted in Las Malvinas II, a Dominican-majority low-resource community, and represented a first step for developing a building a healthier community process. METHOD: A binational community-academic partnership adapted the Centers for Disease Control and Prevention's CHANGE (Community Health Assessment and Group Evaluation) guide to conduct a CHA through community-engaged, mixed-methods research. Data were collected on five community selected public health priorities (i.e., education, sanitation, unwanted pregnancies, chronic disease management, and vaccine-preventable diseases) and community assets through focus groups, interviews with key informants, and a household survey using GIS (geographical information systems) technology. RESULTS: Of all five priorities, unwanted pregnancies and sanitation received the lowest average CHANGE tool ratings for both policies and Systems and Environment. However, data gathered on the five public health priorities reflect the perceived needs and assets of Las Malvinas II, and are equally important in improving the community's health and well-being status. Community members identified as important goals the construction of a primary health clinic, as well as a bigger school, that includes pre-school and high school levels. CONCLUSION: A coalition emerged from the CHA to address the identified issues. The coalition used CHA findings to develop a community health improvement plan. The establishment of a primary health care center and a bigger school were identified as primary goals.

Cues to Cervical Cancer Screening Among U.S. Hispanic Women.

INTRODUCTION: Hispanic women's cervical cancer rates are disproportionately high. Cues to cervical cancer screening (Cues to Action) are strategies to activate the decision-making process to get screened for cervical cancer. This study used the health belief model to examine which cues prompt Hispanic women to undergo cervical cancer screening and how perceptions could be potentiated by cues to cervical cancer screening. METHOD: A cross-sectional survey was conducted among Hispanic women 18 to 65 years old ( n = 220). Generalized linear modeling was used. RESULTS: Spanish media and reminders by mother and doctors were relevant cues. Generalized linear modeling showed cues to action modified significantly the predictive effect of Perceived Threats (i.e., Susceptibility, Severity), benefits, barriers, and self-efficacy on Hispanic women's cervical cancer screening behavior. "Mother told me" and Spanish media messages were significant covariates. CONCLUSION: Cues to Action influenced Hispanic's women participation in cervical cancer screening. Cues to Action increased the strength of the health belief model as an explanatory model, and must be considered in designing culturally appropriate cervical cancer screening interventions.

Factors Affecting Hispanic Women's Participation in Screening for Cervical Cancer.

Hispanic women's cervical cancer rates are disproportionately high. The Health Belief Model (HBM) was used as a theoretical framework to explore beliefs, attitudes, socio-economic, and cultural factors influencing Hispanic women's decisions about cervical cancer screening. A cross-sectional survey was conducted among Hispanic women 18-65 years old (n = 205) in the Upstate of South Carolina. Generalized Linear Modeling was used. Across all models, perceived threats (susceptibility and severity), self-efficacy, and the interaction of benefits and barriers were significant predictors. Significant covariates included age, marital status, income, regular medical care, and familism. A modified HBM was a useful model for examining cervical cancer screening in this sample of Hispanic women. The inclusion of external, or social factors increased the strength of the HBM as an explanatory model. The HBM can be used as a framework to design culturally appropriate cervical cancer screening interventions.