A methodological review of faith-based health promotion literature: advancing the science to expand delivery of diabetes education to Black Americans.

Non-traditional avenues, such as faith-based organizations (FBOs), must be explored to expand delivery of diabetes self-management education (DSME) to benefit Black Americans with type 2 diabetes (T2D). The purpose of this study was to methodologically review the faith-based health promotion literature relevant to Blacks with T2D. A total of 14 intervention studies were identified for inclusion in the review. These studies detailed features of methods employed to affect health outcomes that DSME similarly targets. Analysis of the faith-based studies' methodological features indicated most studies used (1) collaborative research approaches, (2) pre-experimental designs, (3) similar recruitment and retention strategies, and (4) culturally sensitive, behaviorally oriented interventions with incorporation of social support to achieve positive health outcomes in Black Americans. Findings indicate FBOs may be a promising avenue for delivering DSME to Black Americans. Informed by the findings, a focused discussion on advancing the science of faith-based interventions to expand delivery of DSME to Black Americans with diabetes is provided.

State of research for Faith Community Nursing 2009.

The aim of this paper is to report the current state of research for Faith community Nursing (FCN), reviewing the related research literature dating back to 1993. Over 20 years old, the practice of FCN is a maturing specialty practice that links religious communities and health through professional nursing, but no review of research literature is published. The review of the literature was done utilizing the Cumulated Index to Nursing and Allied Health Literature (CINAHL) and PubMed. The keyword terms selected for search were: faith community nursing, parish nursing, and/or church nursing for the years 1993-2008. The review identifies four major content areas in the FCN research literature: (1) development and implementation of FCN practices; (2) roles and activities of faith community nurses; (3) FCN evaluation and documentation; and (4) congregation perceptions of FCN. Overall, findings indicate the FCN literature documents successful approaches for developing faith community programs, provides descriptive analyses of this specialty practice and perceptions associated with the practice, yet inadequately addresses the relationship of FCN to patient outcomes. To advance the effectiveness for this growing specialty, emphasis must be placed on measuring FCN components and related outcomes with analyses yielding evaluative data on the efficacy of this practice in terms of educational, psychosocial, spiritual, and physiological care.

Relationships of religion and spirituality to glycemic control in Black women with type 2 diabetes.

BACKGROUND: Although religion and spirituality are prominent in the lives of Black women with type 2 diabetes (T2DM), there is little research on the relationships of religion and spirituality to glycemic control (GC) in this population. OBJECTIVE: To examine the relations of religion and spirituality to GC. METHODS: Using a cross-sectional, descriptive, correlational design, a convenience sample of 109 Black women with T2DM was recruited. Measures of demographic (age, income, and education), clinical (body mass index and use of diabetes medications), psychosocial (emotional distress and social support), religion and spirituality (religious and existential well-being), and GC (hemoglobin A1c) factors were collected. A theoretical model, based on the work of Koenig, McCullough, and Larson (2001), informed linear regression analyses to examine the relations of religion and spirituality to GC, with psychosocial factors as putative mediators. RESULTS: With age (beta = -.133, SE = .020, p = .145), income (beta = .020, SE = .139, p = .853), education (beta = -.221, SE = .204, p = .040), body mass index (beta = -.237, SE = .031, p = .011), and diabetes medications (beta = .338, SE = .216, p < .001) held constant, religion and spirituality demonstrated significant relations with GC (beta = .289, SE = .032, p = .028 and beta = - .358, SE = .030, p = .006, respectively). Evidence of emotional distress and social support as mediators in the relationships of religion and spirituality to GC was lacking. DISCUSSION: Religion and spirituality were related to GC, with evidence of psychosocial mediation lacking, thereby forcing revision of the model for the study population. Research is warranted to validate the findings, with further examination of theoretical mediators linking religion and spirituality to GC. Findings suggest that religion and spirituality be addressed in diabetes care to improve GC in Black women with T2DM.

Recruitment of black women with type 2 diabetes into a self-management intervention trial.

The purpose of this study was to evaluate the relationship of recruitment methods to enrollment status in Black women with type 2 diabetes screened for entry into a randomized clinical trial (RCT). Using a cross-sectional study design with convenience sampling procedures, data were collected on recruitment methods to which the women responded (N=236). Results demonstrated that the RCT had a moderate overall recruitment rate of 46% and achieved only 84% of its projected accrual goal (N=109). Chi-square analysis demonstrated that enrollment outcomes varied significantly according to recruitment methods (P=.05). Recruitment methods such as community health fairs (77.8%), private practice referrals (75.0%), participant referrals (61.5%), community clinic referrals (44.6%), community advertising and marketing (40.9%), and chart review (40.4%) demonstrated variable enrollment yields. Results confirm previous findings that indicate that Black Americans may be successfully recruited into research studies at moderate rates when traditional recruitment methods are enhanced and integrated with more culturally sensitive methods. Lessons learned are considered.

The relationship of spirituality and health outcomes in Black women with type 2 diabetes.

The purpose of this pilot study was to explore the relationships between spiritual well-being emotional distress, HbA1c values, and blood pressure levels in a convenience sample of 22 Black women with type 2 diabetes. Results revealed significant inverse correlations between diastolic blood pressure (BP) and both total spiritual well-being (r=-.51, P=.02) and religious well-being (RWB) (r=-.55, P=.01). Women with higher RWB scores tended to have lower diastolic BP, as compared to their counterparts with lower RWB scores (z=2.78, P=.005). Emotional distress was positively related to systolic BP (r=.48, P=.03). These finding suggest that holistic care, addressing the spiritual and emotional dimensions, may foster improved BP levels among Black women with type 2 diabetes, thereby potentially reducing their high risk for secondary complications.

Culture within the context of care: an integrative review.

The purpose of this integrative review was to examine the literature on culturally relevant healthcare interventions, and their effect on health outcomes, in an attempt to determine whether culture matters in the context of healthcare delivery. Research literature on culturally relevant interventions from the past 20 years was reviewed using computerized searches of Medline and CINAHL databases. Results of the review indicate that culturally relevant interventions significantly improve health outcomes for patients with diabetes mellitus (DM), drug addiction, sexually transmitted infections (STIs), and other health problems. It appears that the design of culturally relevant interventions does not require specific knowledge of particular ethnic or cultural groups, but of cross-cultural process principles. Because the studies are highly variable with respect to design and method, it is difficult to isolate which particular aspects of the interventions are specifically associated with favorable outcomes. In addition, few of the studies examined long-term effects of the interventions on outcomes.

African-American spirituality: a concept analysis.

Culturally competent care for African Americans requires sensitivity to spirituality as a component of the cultural context. To foster understanding, measurement, and delivery of the spiritual component of culturally competent care, this article presents an evolutionary concept analysis of African-American spirituality. The analysis is based on a sample of multidisciplinary research studies reflecting spirituality of African Americans. Findings indicate that African-American spirituality involves quintessential, internal, external, consoling, and transformative attributive dimensions. Findings are considered in relation to previous conceptual analyses of spirituality and suggest that defining attributes of African-American spirituality are both global and culturally prominent. Implications for practice and research are discussed.

Beyond the medical model: interdisciplinary programs of community-engaged health research.

This report describes four diverse programs of community-engaged research, all of which demonstrated positive health outcomes. Three of the programs were focused on communities of people with diabetes, and one program targeted at-risk young families raising infants and young children. Brief descriptions of each research study and outcomes are presented as well as a discussion of the processes and lessons that were learned from each model of successful interdisciplinary community-university health research partnerships.

Willingness to be screened and tested for cognitive impairment: cross-cultural comparison.

OBJECTIVE: The purpose was to describe (a) individuals' reasons for participating in cognitive screening and (b) reasons to pursue testing after screening across 4 ethnic groups: African American, Afro-Caribbean, European American, and Hispanic American. METHODS: Prior to memory screening, 119 adults were interviewed regarding their thoughts about memory screening and follow-up testing. Interviews were coded and differences between ethnic groups were compared. RESULTS: More African Americans and European Americans were concerned about their memory. More Hispanic Americans planned to seek professional help if needed. Hispanic Americans were most optimistic about treatment. CONCLUSIONS: Future research is needed to better understand cultural factors that influence older adults' willingness to be screened for cognitive impairment and to pursue follow-up testing when recommended.

Coping as a mediator in the relationships of spiritual well-being to mental health in black women with type 2 diabetes.

OBJECTIVE: Examine coping as a mediator in the relationships of spiritual well-being to mental health in Black women with type 2 diabetes (T2DM). METHODS: Using a cross-sectional design, data were collected from a convenience sample of 45 Black women with T2DM. Measures of coping strategies, spiritual well-being (religious and existential well-being), and mental health, as measured by diabetes-specific distress (DSED), were collected. Bivariate findings informed mediational, trivariate model development. RESULTS: Religious well-being was significantly related to cognitive reframing (CR) coping strategies (p = 0.026) but not DSED (p = 0.751). Existential well-being was significantly related to CR (beta = 0.575,p < 0.001), direct assistance (DA) coping (beta = 0.368, p = 0.006) and DSED (beta = -0.338, p = 0.023). Although CR (beta = -0.305, p = 0.021) and DA (beta = -0.262, p = 0.041) had significant bivariate associations with DSED, the relationships were not significant when existential well-being was controlled. However, the relationship of existential well-being to DSED was mediated by specific CR and DA strategies that were associated with DSED to varying degrees -"I came up with a couple different solutions to the problem" (beta = -0.301, p = 0.049); "I came out of the experience better than I went in" (beta = -0.308, p = 0.061); and "I talked to someone who could do something concrete about the problem" (beta = -0.272, p = 0.078). CONCLUSION: Findings indicate that diabetes care address spiritual well-being, both its religious and existential components, in Black women with T2DM.

The effect of a diabetes education, coping skills training, and care intervention on physiological and psychosocial outcomes in black women with type 2 diabetes.

An 11-week culturally relevant group diabetes self-management training (DSMT), coping skills training (CST), and diabetes care intervention was compared to a 10-week usual diabetes education and diabetes care intervention on physiological and psychosocial outcomes in 109 Black women (aged 48 +/- 10 years) with type 2 diabetes in primary care (PC). Strong time effects for hemoglobin A1c improvement were seen in both groups from baseline to 3 months and remained similar at 12 and 24 months (p < .0001). Systolic blood pressure (p =.01) and low-density lipoprotein cholesterol levels (p = .05) improved in both groups from baseline to 24 months. Baseline quality of life ([QOL]; Medical Outcome Study Short Form-36) was low. Social function, role-emotional, and mental health domains increased initially in both groups then declined slightly, with less decline for the experimental group at 12 months. At 24 months, experimental group scores increased. General health (p = .002), vitality (p = .01), role-physical, and bodily pain (p = .02) domains increased in both groups over time. Perceived provider support for diet (p = .0001) and exercise (p = .0001) increased in both groups over time. Diabetes-related emotional distress decreased in the experimental compared to the control group (group x time, p = .01). Findings suggest that both methods of diabetes education combined with care can improve metabolic control, QOL, and perceptions of provider care. CST may further assist in long-term improvements in health outcomes. Behavioral interventions are needed in addition to routine diabetes care, particularly in PC.

Incretin-based therapies: therapeutic rationale and pharmacological promise for type 2 diabetes.

PURPOSE: To highlight the therapeutic promise of the incretin hormone glucagon-like peptide-1 (GLP-1), the consequent rationale for therapies acting through GLP-1-mediated pathways in type 2 diabetes mellitus (T2DM), and the emerging clinical role of the dipeptidyl peptidase-4 (DPP-4) inhibitors and GLP-1 receptor agonists. DATA SOURCES: The PubMed database was searched (using terms including incretins, GLP-1, GIP, DPP-4), along with recent ADA and EASD abstracts. CONCLUSIONS: Many traditional drugs used for T2DM fail to achieve and maintain glycemic control, and possess limitations such as risk for hypoglycemia and weight gain. GLP-1 is a gut-derived hormone that glucose-dependently stimulates insulin secretion while simultaneously reducing gastric emptying and appetite. Other physiological actions of GLP-1 may benefit the cardiovascular system and beta-cell function. Recently developed drug therapies that mimic or prolong the action of this hormone, therefore, have great promise in the treatment of T2DM. IMPLICATIONS FOR PRACTICE: The GLP-1 receptor agonists and DPP-4 inhibitors are incretin-based therapies that are now becoming established as effective therapies for T2DM to be used either as monotherapy or added to other antidiabetes drugs. They enable improvements to be made in glycemic control without weight gain, with a low risk for hypoglycemia, and with potential additional clinical benefits.

Coronary heart disease prevention and lifestyle interventions: cultural influences.

Unless action is directed to address the multiple influences on coronary heart disease (CHD) risk reduction behaviors, across all population groups, the aims of Healthy People 2010 with regard to CHD will not be realized. Health-promotion and disease-prevention models, including a framework for primordial, primary, and secondary prevention provided by an American Heart Association task force, and a model for interventions to eliminate health disparities are reviewed. The role of culture, ethnicity, race, and socioeconomic status and how these concepts have been studied in recent lifestyle interventions aimed at CHD risk reduction is explored. Finally, these findings are synthesized to provide suggestions for nursing care delivery in primary and tertiary care settings.