Adequate health literacy is associated with better health outcomes in people with type 2 diabetes in Mexico

BACKGROUND People from Black, Asian and Minority Ethnic (BAME) groups are known to have an increased risk of developing type 2 diabetes and face greater barriers to accessing healthcare resources compared to their “white British” counterparts. The main mediators of lifestyle behavioural change are gender, generation, geography, genes, God/religion, and gaps in knowledge and economic resources. Dietary and cultural practices of these individuals significantly vary according to gender, generation, geographical origin and religion. Recognition of these factors and implementing culturally sensitive interventions for type 2 diabetes prevention and management is essential in increasing knowledge of healthy eating, engagement in physical activity and improving health outcomes in BAME communities. Few health apps are tailored for BAME populations, and BAME communities are considered hard-to-reach. OBJECTIVE Our objective was to establish whether the Low Carb Program is a viable scalable solution that can be used as an effective tailored type 2 diabetes intervention for BAME communities. We hypothesized that by taking into account cultural sensitivities, providing the platform in native languages and personalising the platform in accordance with known barriers to health disparities including gender, generation, dietary preferences and religion, the app would engage BAME communities and improve type 2 diabetes related health outcomes. METHODS The study used a quasi-experimental research design comprised of an open-label, single-arm, pre-post intervention using a sample of convenience. All 705 adults with type 2 diabetes who had activated their referral to the Low Carb Program as a result of an NHS consultation between September 2018 and March 2019 were followed for a period of 12 months; mean age 54.61 (SD 16.69) years; 58.2% (410/705) women; 45.1% (318/705) white, 28.5% (201/705) Indian/Pakistani/Bangladeshi/Other Central Asian, 10.8% (76/705) Arab, 6.2% (44/705) Mixed/Multiple ethnic groups, 6% (43/705) black, 1.8% (13/705) other, (7/705) 1% Chinese/Japanese/Other East Asian. Mean starting glycated haemoglobin A1c (HbA1c) 7.99% (SD 2.05%); mean body weight 88.96kg (SD 23.25kg). RESULTS Of the 705 study participants, 513 (72.76%) had completed the Low Carb Program at 12 months. There were statistically significant reductions in body weight and HbA1c in white, Indian/Pakistani/Bangladeshi/Other Central Asian, Arabic and black participants with the most significant differences in the Indian/Pakistani/Bangladeshi/Other Central Asian population HbA1c -1.18% (SD 1.49%) and weight 8.03kg (SD 10.65kg). 82.9% of all participants (419/705) of all participants lost at least 5% of their body weight. CONCLUSIONS Offering the culturally tailored Low Carb Program that empowers members to make dietary and lifestyle changes to different BAME groups is an effective and engaging tool in the management of type 2 diabetes. Most importantly, BAME populations in particular people from Indian/Pakistani/Bangladeshi and Arabic groups who achieve better health outcomes than their white counterparts.

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Mobile Virtual reality vs. Mobile 360 Video to Promote Enrollment in the Diabetes Prevention Program Amongst Hispanic Adults (Preprint)

10.2196/preprints.26013 ◽

2020 ◽

Author(s):

Bryan Gibson ◽

Sara Simonsen ◽

Jakob Jensen ◽

Leah Yingling ◽

Julia Schaeffer ◽

...

Keyword(s):

Type 2 Diabetes ◽

Virtual Reality ◽

Health Literacy ◽

Mobile Phone ◽

Prevention Program ◽

Diabetes Prevention ◽

Risk Perceptions ◽

Diabetes Prevention Program ◽

Pilot Test

BACKGROUND The Diabetes Prevention Program (DPP) reduces the risk of developing Type 2 Diabetes, however enrollment is very low. OBJECTIVE The goal of this project was to pilot test the efficacy of two brief, immersive mobile phone videos (presented either in virtual reality or 360 video) on risk perceptions and enrollment in the DPP. METHODS Adults with prediabetes were recruited at a clinic serving a low income Hispanic community. After consenting, participants completed a baseline survey that collected demographics and risk perceptions based on the tripartite model of risk perceptions.. They were then informed that they had prediabetes and provided with a link to an educational website that explains: what prediabetes and Type 2 Diabetes (T2DM) are, how lifestyle affects risk of T2DM, what the DPP is, and where to enroll. Participants then viewed two videos using their smartphone ; either with a cardboard VR headset (VR) or their smartphone alone (360 video), per random assignment. Two weeks later a follow-up survey collected measures of: enrollment in the DPP, risk perceptions, health literacy, the importance of contextual factors related to the DPP in their decision of whether or not to enroll in the DPP (e.g. distance to the class ), and qualitative feedback on the interventions. We used logistic regression to determine whether enrollment in the DPP differed by intervention mode, while accounting for heath literacy and contextual factors related to the DPP. We used unpaired t-tests to examine differences in change in risk perceptions between groups. We used paired t-tests to examine within-subject changes in risk perceptions. RESULTS 116 participants provided complete data. Most participants were middle-aged (mean age= 44.6 yrs.; SD= 11.9) Hispanic (114/116), female (79/116), with low health literacy (mean score =12.3/20; SD=3.4). Enrollment in the DPP was 44/116 overall (37.9% ) but did not differ by group ( OR for enrolling in VR group= 1.78 ; 95% CI: 0.75-4.3, p=0.19) . Individuals who rated t the distance needed to travel to attend the DPP as more important were less likely to enroll in the DPP (OR = 0.56, 95% CI:0.33-0.92; p=0.03) Risk perceptions did not differ by group ( mean change in 360 video group = -0.07, mean change in VR group = 0.03, t==0.6, p= 0.54) and did not change within subjects ( mean 0.02, t=0.21, p=0.83). Participants feedback suggested that the videos are emotionally engaging and educational. CONCLUSIONS We present a pilot test of immersive mobile phone videos which appear to be efficacious in promoting enrollment in the DPP. Further work to determine the replicability of these findings, the mechanism of action of the videos, and potential moderators of the efficacy of these videos is discussed.

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Examining the impact of mental disease on type 2 diabetes outcomes: results from the EpiChron Cohort

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.819 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

I Guerrero Fernández de Alba ◽

A Gimeno-Miguel ◽

B Poblador Plou ◽

K Bliek Bueno ◽

J Carmona Pirez ◽

...

Keyword(s):

Type 2 Diabetes ◽

Substance Abuse ◽

Early Detection ◽

Health Outcomes ◽

Emergency Room ◽

Mental Disease ◽

Emergency Room Visits ◽

Mental Diseases ◽

The Impact

Abstract Background Type 2 diabetes mellitus (T2D) is often accompanied by other chronic diseases, including mental diseases (MD). This work aimed at studying MD prevalence in T2D patients and analyse its impact on T2D health outcomes. Methods Retrospective, observational study of individuals of the EpiChron Cohort aged 18 and over with prevalent T2D at baseline (2011) in Aragón, Spain (n = 63,365). Participants were categorized by the existence or absence of MD, defined as the presence of depression, anxiety, schizophrenia or substance abuse. MD prevalence was calculated, and a logistic regression model was performed to analyse the likelihood of the four studied health outcomes (4-year all-cause mortality, all-cause hospitalization, T2D-hospitalization, and emergency room visits) based on the presence of each type of MD, after adjusting by age, sex and number of comorbidities. Results Mental diseases were observed in 19% of T2D patients, with depression being the most frequent condition, especially in women (20.7% vs. 7.57%). Mortality risk was significantly higher in patients with MD (odds ratio -OR- 1.24; 95% confidence interval -CI- 1.16-1.31), especially in those with substance abuse (OR 2.18; 95% CI 1.84-2.57) and schizophrenia (OR 1.82; 95% CI 1.50-2.21). The presence of MD also increased the risk of T2D-hospitalization (OR 1.51; 95% CI 1.18-1.93), emergency room visits (OR 1.26; 95% CI 1.21-1.32) and all-cause hospitalization (OR 1.16; 95% CI 1.10-1.23). Conclusions The high prevalence of MD among T2D patients, and its association with health outcomes, underscores the importance of providing integrated, person-centred care and early detection of comorbid mental diseases in T2D patients to improve disease management and health outcomes. Key messages Comprehensive care of T2D should include specific strategies for prevention, early detection, and management of comorbidities, especially mental disorders, in order to reduce their impact on health. Substance abuse was the mental disease with the highest risk of T2D-hospitalization, emergency room visits and all-cause hospitalization.

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Type 2 diabetes self-management schemas across diverse health literacy levels: a qualitative investigation

Psychology and Health ◽

10.1080/08870446.2021.1909023 ◽

2021 ◽

pp. 1-21

Author(s):

Julie Ayre ◽

Carissa Bonner ◽

Danielle M. Muscat ◽

Sian Bramwell ◽

Sharon McClelland ◽

...

Keyword(s):

Type 2 Diabetes ◽

Health Literacy ◽

Self Management ◽

Qualitative Investigation

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Low health literacy is associated with higher risk of type 2 diabetes: a cross-sectional study in Germany

BMC Public Health ◽

10.1186/s12889-021-10508-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Daniel Tajdar ◽

Dagmar Lühmann ◽

Regina Fertmann ◽

Tim Steinberg ◽

Hendrik van den Bussche ◽

...

Keyword(s):

Type 2 Diabetes ◽

Health Literacy ◽

Statistical Models ◽

Cross Sectional Study ◽

Diabetes Risk ◽

Sectional Study ◽

Cross Sectional ◽

Low Health Literacy ◽

The Individual

Abstract Background Low health literacy is believed to be associated with behaviours that increase the risk of type 2 diabetes. But there is limited knowledge on the relation between health literacy (HL) and diabetes risk, and whether improving HL could be a potential prevention strategy. Therefore, the main purpose of this study was to examine the link between HL and diabetes risk among non-diabetic adults. Methods We used data from the Hamburg Diabetes Prevention Survey, a population-based cross-sectional study in Germany. One thousand, two hundred and fifty-five non-diabetic subjects aged 18–60 years were eligible. The German Diabetes Risk Score (GDRS, ranging 0 to 123 points) was used to determine the individual risk of type 2 diabetes. The short version of the European Health Literacy Questionnaire (HLS-EU-Q16, ranging 0 to 16 points) was applied to assess the individual self-reported HL. Subjects were asked to self-estimate their diabetes risk, which was then compared with the calculated GDRS. Descriptive statistics were calculated to investigate group differences in the GDRS and self-estimated diabetes risk. Linear as well as logistic regression models were performed to analyse potential influencing variables of the GDRS as well as incorrect self-estimated diabetes risk. In three nested statistical models for each outcome, these analyses were adjusted for age, gender, educational level and the presence of chronic conditions. Results According to the criteria of the GDRS, 996 (79.4%) subjects showed “low risk”, 176 (14.0%) “still low risk”, 53 (4.2%) “elevated risk”, and 30 (2.4%) “high to very high risk” to develop type 2 diabetes within the next 5 years. In the statistical models including all control variables, subjects with “inadequate HL” scored 2.38 points higher on the GDRS (95% CI 0.378 to 4.336; P = 0.020) and had a 2.04 greater chance to estimate their diabetes risk incorrectly (OR 2.04; 95% CI 1.33 to 3.14; P = 0.001) compared to those with “sufficient HL”. Conclusion The risk of type 2 diabetes is increased in people with inadequate self-reported HL. People with high diabetes risk and inadequate HL might be provided with educational programs to improve diabetes knowledge and reduce behavioural risk factors.

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