- University of Michigan, Health Behavior and Health Education, Faculty MemberUniversity of Michigan, Medical Education, Faculty Memberadd
- Community Engagement & Participation, Medical Education, Cardiovascular, Diabetes, Health Information Systems, Public Health, and 8 moreEpidemiology, Peer Support (Learning and Teaching), Obesity, Primary Health Care, Community, Community Health, Rural Health, and Self Management(Epidemiology, Peer Support (Learning and Teaching), Obesity, Primary Health Care, Community, Community Health, Rural Health, and Self Management)edit
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Purpose The purpose of the study was to evaluate the effectiveness of a peer leader-led (PL) diabetes self-management support (DSMS) group in achieving and maintaining improvements in A1C, self-monitoring of blood glucose (SMBG), and... more
Purpose The purpose of the study was to evaluate the effectiveness of a peer leader-led (PL) diabetes self-management support (DSMS) group in achieving and maintaining improvements in A1C, self-monitoring of blood glucose (SMBG), and diabetes distress in individuals with diabetes. Diabetes self-management support is critical; however, effective, sustainable support models are scarce. Methods The study was a cluster randomized controlled trial of 221 people with diabetes from 6 primary care practices. Practices and eligible participants (mean age: 63.0 years, 63.8% female, 96.8% white, 28.5% at or below poverty level, 32.5% using insulin, A1C ≥7%: 54.2%) were randomized to diabetes self-management education (DSME) + PL DSMS (n = 119) or to enhanced usual care (EUC) (DSME + traditional DSMS with no PL; n = 102). Data were collected at baseline, after DSME (6 weeks), after DSMS (6 months), and after telephonic DSMS (12 months). Results Decreases in A1C occurred between baseline and pos...
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Research Interests: Primary Health Care, Obesity, Self Care, Humans, Blood Pressure, and 15 moreWeight Loss, Female, Male, LDL-cholesterol, Aged, Middle Aged, Adult, Body Weight, Albuminuria, Disease Management, Type 2 Diabetes Mellitus, Case Control Studies, Patient care management, Glycated hemoglobin A, and Antihypertensive agents
Lifestyle interventions targeting weight loss, such as those delivered through the Diabetes Prevention Program, reduce the risk of developing type 2 diabetes. Technology-mediated interventions may be an option to help overcome barriers to... more
Lifestyle interventions targeting weight loss, such as those delivered through the Diabetes Prevention Program, reduce the risk of developing type 2 diabetes. Technology-mediated interventions may be an option to help overcome barriers to program delivery, and to disseminate diabetes prevention programs on a larger scale. We conducted a meta-analysis to evaluate the effect of such technology-mediated interventions on weight loss. In this meta-analysis, six databases were searched to identify studies reporting weight change that used technology to mediate diet and exercise interventions, and targeted individuals at high risk for developing type 2 diabetes. Studies published between January 1, 2002 and August 4, 2016 were included. The search identified 1196 citations. Of those, 15 studies met the inclusion criteria and evaluated 18 technology-mediated intervention arms delivered to a total of 2774 participants. Study duration ranged from 12 weeks to 2 years. A random-effects meta-analysis showed a pooled weight loss effect of 3.76 kilograms (95% CI 2.8-4.7; P<.001) for the interventions. Several studies also reported improved glycemic control following the intervention. The small sample sizes and heterogeneity of the trials precluded an evaluation of which technology-mediated intervention method was most efficacious. Technology-mediated diabetes prevention programs can result in clinically significant amounts of weight loss, as well as improvements in glycaemia in patients with prediabetes. Due to their potential for large-scale implementation, these interventions will play an important role in the dissemination of diabetes prevention programs.
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This study explores gender values and beliefs among Latino and African American men with diabetes and examines how these values and beliefs may influence their health behaviors. Participants were recruited from individuals who... more
This study explores gender values and beliefs among Latino and African American men with diabetes and examines how these values and beliefs may influence their health behaviors. Participants were recruited from individuals who participated in one of three Racial and Ethnic Approaches to Community Health Detroit Partnership diabetes self-management interventions. One focus group was conducted with African American men (n = 10) and two focus groups were conducted with Latino men (n = 12) over a 3-month period. Sessions lasted 90 minutes, were audiotaped, and analyzed using thematic content analysis techniques. Two themes emerged that characterize gender identity and its relationship to health behavior in men: (a) men's beliefs about being men (i.e., key aspects of being a man including having respect for themselves, authority figures, and peers; fulfilling the role as breadwinner; being responsible for serving as the leader of the family; and maintaining a sense of chivalry) and (...
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ABSTRACT Objective: To determine participant satisfaction with two lay health coaches (LHC) who provided support in a modified diabetes prevention program (mDPP) conducted in six high-crime neighborhoods near Pittsburgh, PA. Methods:... more
ABSTRACT Objective: To determine participant satisfaction with two lay health coaches (LHC) who provided support in a modified diabetes prevention program (mDPP) conducted in six high-crime neighborhoods near Pittsburgh, PA. Methods: Participants were screened for BMI ≥ 25 kg/m2 and waist circumference > 88 cm in females and > 102 cm in males to determine eligibility for a 12-week group lifestyle balance (GLB) program. Participants with these criteria were considered at risk for diabetes and/or cardiovascular disease. Program staff consisted of a dietitian, exercise specialist, and two LHC. Satisfaction with LHC was determined with an 11-item questionnaire. Results: 114 participants were enrolled in the program (87.1% female, 60% non-white, 93% with BMI ≥ 30 kg/m2). Of those enrolled, 74.5% (n=85) completed the LHC questionnaire. All participants strongly agreed (82.3%) or agreed (17.7%) that LHC were helpful during class sessions; however, only 36.5% (31) sought LHC advice outside of class. Nearly ¾ of participants (70.6%) sought support from LHC at least once during the program. Of those, 78.3% (47) reported being helped by the LHC emotionally; 90% (54) reported being helped with general food/nutrition information; and 80.3% (50) with exercise information. 1/3 of participants (33.8%) felt “much more comfortable” asking the LHC questions compared to the dietitian or exercise specialist, while 60% (51) reported feeling equally as comfortable. Conclusion: Participants in an mDPP were satisfied with the use of LHC and found them to play an important role in the program. Using LHC in primary prevention is feasible and valuable to participants.
The purpose of this study was to determine whether weight loss and cardiovascular disease risk factor reduction was maintained following a lifestyle intervention. Five hundred fifty-five individuals without diabetes from 8 rural... more
The purpose of this study was to determine whether weight loss and cardiovascular disease risk factor reduction was maintained following a lifestyle intervention. Five hundred fifty-five individuals without diabetes from 8 rural communities were screened for BMI ≥25 kg/m(2) and abdominal obesity (86.1% female, 95.1% white, 55.8% obese). Communities and eligible participants (n = 493; mean age, 51 years, 87.6% female, 94.1% Caucasian) were assigned to 4 study groups: face-to-face, DVD, Internet, and self-selection (SS) (n = 101). Self-selection participants chose the intervention modality (60% face-to-face, 40% Internet, 0% DVD). Outcomes included weight change and risk factor reduction at 18 months. All groups achieved maintenance of 5% weight loss in over half of participants. Self-selection participants had the largest proportion maintain (89.5%). Similarly, nearly 75% of participants sustained risk factor reduction. After multivariate adjustment, participants in SS were 2.3 times...
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UMI, ProQuest ® Dissertations & Theses. The world's most comprehensive collection of dissertations and theses. Learn more... ProQuest, Implementing the chronic care model to improve diabetes care in the community:... more
UMI, ProQuest ® Dissertations & Theses. The world's most comprehensive collection of dissertations and theses. Learn more... ProQuest, Implementing the chronic care model to improve diabetes care in the community: Translating theory to practice. ...
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Diabetes management for older Latino adults is complex, given a higher incidence of multiple coexisting medical conditions and psychosocial barriers to self-management. Community health workers (CHWs) may be effective in reducing these... more
Diabetes management for older Latino adults is complex, given a higher incidence of multiple coexisting medical conditions and psychosocial barriers to self-management. Community health workers (CHWs) may be effective in reducing these barriers. The REACH Detroit CHW randomized controlled intervention studies with Latino/as with diabetes found improvements in self-management behaviors and glucose control after participating in a CHW-led intervention. Using data from the REACH Detroit Partnership's cohort 3, this study used descriptive statistics and multiple linear regression analyses to evaluate whether the six-month CHW intervention had a greater effect on older Latino/as (ages 55 and older) than younger participants between baseline and post-intervention follow-up at six months. There were significant intervention effects by age group that varied by outcome. Compared to a control group that received enhanced usual care, there were statistically significant intervention effect...
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Objective: To determine participant satisfaction with two lay health coaches (LHC) who provided support in a modified diabetes prevention program (mDPP) conducted in six high-crime neighborhoods near Pittsburgh, PA. Methods: Participants... more
Objective: To determine participant satisfaction with two lay health coaches (LHC) who provided support in a modified diabetes prevention program (mDPP) conducted in six high-crime neighborhoods near Pittsburgh, PA. Methods: Participants were screened for BMI ≥ 25 kg/m2 and waist circumference > 88 cm in females and > 102 cm in males to determine eligibility for a 12-week group lifestyle balance (GLB) program. Participants with these criteria were considered at risk for diabetes and/or cardiovascular disease. Program staff consisted of a dietitian, exercise specialist, and two LHC. Satisfaction with LHC was determined with an 11-item questionnaire. Results: 114 participants were enrolled in the program (87.1% female, 60% non-white, 93% with BMI ≥ 30 kg/m2). Of those enrolled, 74.5% (n=85) completed the LHC questionnaire. All participants strongly agreed (82.3%) or agreed (17.7%) that LHC were helpful during class sessions; however, only 36.5% (31) sought LHC advice outside of ...
A wayfinding service for empowering physical activity is presented. The service finds routes that involve multi-modal transportation where walking is always one mode. The service is based on the new concept of multi-modal transportation... more
A wayfinding service for empowering physical activity is presented. The service finds routes that involve multi-modal transportation where walking is always one mode. The service is based on the new concept of multi-modal transportation with multi-criteria walking. A prototype of the service is developed and a new empowerment approach for it is discussed.
To determine the levels of functional health literacy (FHL) among insulin-taking African Americans with diabetes from an urban medical practice and to determine if associations exist between FHL levels and glycemic control. Seventy... more
To determine the levels of functional health literacy (FHL) among insulin-taking African Americans with diabetes from an urban medical practice and to determine if associations exist between FHL levels and glycemic control. Seventy insulin-taking African Americans seen for diabetes management comprised the analysis cohort. Patients were 18 years or older, African American, had diabetes, and currently using insulin via syringe, pen, or insulin pump. All participants completed a one-time assessment of FHL levels, using the Newest Vital Sign (NVS). Scores ranged from 0 to 6 (0-1 = high likelihood of limited FHL; 2-3 = possibility of limited FHL; 4-6 = adequate FHL). A combination of t tests, Pearson's chi-square tests, and multivariate logistic regression models were used to determine associations between glycemic control and FHL. Average age was 58.7, 59.1% were female, 90.8% with type 2 diabetes, and 15.1% using an insulin pump. Glycemic control was: A1C < 7%: 22.9%, A1C < 8%: 47.1%. Of participants, 47.1% had adequate FHL, 31.4% had possible limited FHL, and 21.4% had a high likelihood of limited FHL. Also, 67.7% of participants with A1C ≥ 8% had a high likelihood of limited FHL. After adjusting for age and gender, participants with a high likelihood of limited FHL were 6.2 times (95% confidence interval [CI], 1.4-28.3) more likely to have A1C ≥ 8%. Insulin-taking African Americans with a high likelihood of limited FHL are approximately 6 times more likely to have an A1C ≥ 8% compared to patients with a possibility of limited FHL, or adequate FHL, demonstrating the need for focused interventions tailored to FHL needs.
Research Interests: Nursing, Health Literacy, Self Care, Humans, Needs Assessment, and 15 moreBlood Glucose, Insulin, Female, Male, Risk factors, African Americans, Middle Aged, Adult, Oral Hypoglycemic Agents, Curriculum and Pedagogy, Urban Population, Risk Factors, Type 2 Diabetes Mellitus, Pilot Projects, and Socioeconomic Factors
Research Interests: Nursing, Photography, Quality of life, Diet, Adolescent, and 15 moreHumans, Blood Glucose, Female, Male, Patient Compliance, Patient Satisfaction, Aged, Middle Aged, Adult, Curriculum and Pedagogy, Reproducibility of Results, Type 2 Diabetes Mellitus, Pilot Projects, Cross-Over Studies, and Energy Intake
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Research Interests: Nutrition and Dietetics, Risk, Treatment Outcome, Decision Trees, Humans, and 15 moreMarkov chains, Diabetes mellitus, Chronic Disease, United States, Female, Male, Intervention Studies, Middle Aged, Quality adjusted life years, Adult, Cost Benefit Analysis, Disease Progression, Sensitivity and Specificity, Military Personnel, and Cohort Studies
Research Interests: Primary Health Care, Community-Based Mental Health Services, Diabetes, Self Care, Treatment Outcome, and 17 moreCommunity, Humans, Insulin, Diabetes mellitus, Cholesterol, Chronic Disease, Female, Male, Aged, Chronic Care Model, Randomized Controlled Trial, Oral Hypoglycemic Agents, Urban Population, Disease Management, Self monitoring of blood glucose, Community Based Mental Health Services, and Diabetes Care(Community, Humans, Insulin, Diabetes mellitus, Cholesterol, Chronic Disease, Female, Male, Aged, Chronic Care Model, Randomized Controlled Trial, Oral Hypoglycemic Agents, Urban Population, Disease Management, Self monitoring of blood glucose, Community Based Mental Health Services, and Diabetes Care)
(Community, Humans, Insulin, Diabetes mellitus, Cholesterol, Chronic Disease, Female, Male, Aged, Chronic Care Model, Randomized Controlled Trial, Oral Hypoglycemic Agents, Urban Population, Disease Management, Self monitoring of blood glucose, Community Based Mental Health Services, and Diabetes Care)
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Research Interests: Program Evaluation, Nursing, Primary Care, Primary Health Care, Educational Measurement, and 16 moreFamily Practice, Humans, Program Development, Chronic Disease, Female, Male, Total Quality Management, Pennsylvania, Clinical Sciences, Aged, Middle Aged, Chronic Care Model, Curriculum and Pedagogy, Type 2 Diabetes Mellitus, Pilot Projects, and Rural Health Services
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A Complex Chronic Disease (CCD) is a condition involving multiple morbidities that requires the attention of multiple health care providers or facilities and possibly community (home)-based care. A patient with CCD presents to the health... more
A Complex Chronic Disease (CCD) is a condition involving multiple morbidities that requires the attention of multiple health care providers or facilities and possibly community (home)-based care. A patient with CCD presents to the health care system with unique needs, disabilities, or functional limitations. The literature on how to best support self-management efforts in those with CCD is lacking. With this paper, the authors present the case of an individual with diabetes and end-stage renal disease who is having difficulty with self-management. The case is discussed in terms of intervention effectiveness in the areas of prevention, addiction, and self-management of single diseases. Implications for research are discussed.