Challenges and Opportunities of Engaging School Nurses in a Diabetes Care Team in a Culturally Diverse Lowincome Community – a Mixed-methods Feasibility Study

2021 ◽  
Vol 8 (5) ◽  
Author(s):  
Ksenia Tonyushkina ◽  
Victoria Cobb ◽  
Grace Lawson ◽  
Kathleen Dunn ◽  
Jason Pelzek ◽  
...  
Keyword(s):  
Low Income ◽  
Policy Development ◽  
Culturally Diverse ◽  
Insulin Pump ◽  
Diabetes Education ◽  
Insulin Dose ◽  
School Nurses ◽  
Feasibility Trial ◽  
Diabetes Clinic ◽  
Glucose Meter

Objective: In this study, we evaluated the feasibility of monthly insulin dose adjustments for students with type 1 diabetes mellitus (T1DM) through collaboration between pediatric diabetes clinic and school nurses. Methods: We conducted a single-arm adaptive feasibility trial with 30 students from a culturally diverse low-income community. School nurses were trained to download glucose meters and insulin pumps. Outcomes measures included the rate of glucose meter/insulin pump downloads occurred versus planned. We conducted 2 focus groups (N = 23) to seek feedback from school and clinic nurses on the collaboration and used content analysis to identify common themes. Results: The rate of glucose meter/insulin pump downloads was 27%. Feasibility obstacles were grounded in lack of time for nurses and psychosocial stressors in the community. We found a trend toward better diabetes control during the school year versus summer. We identified better communication between the school and clinic nurses and ongoing diabetes education for school nurses as strengths of the pilot. Conclusion: We propose shared clinic visits, care coordination, and behavioral health support as directions for future programs. Our findings provide directions for policy development to strengthen school nurse collaboration with diabetes clinics and improve care of students with T1DM from culturally diverse low-income communities.

scholarly journals Optimizing Glucose Meter Downloads at Parkland Diabetes Clinic

2021 ◽  
Author(s):  
Isabel Wees ◽  
Uma Gunasekaran ◽  
Luigi Meneghini
Keyword(s):  
Best Practices ◽  
American Diabetes Association ◽  
Diabetes Education ◽  
Diabetes Clinic ◽  
Standard Format ◽  
Success Stories ◽  
Number Of Patients ◽  
Diverse Patient Population ◽  
Glucose Meter

Quality Improvement Success Stories are published by the American Diabetes Association in collaboration with the American College of Physicians and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of <em>Clinical Diabetes</em>. The following article describes a project aimed at increasing the number of patients who bring their glucose meters to their appointments for downloading at a diabetes specialty clinic with a diverse patient population in Dallas, TX.

scholarly journals Optimizing Glucose Meter Downloads at Parkland Diabetes Clinic

2021 ◽  
Author(s):  
Isabel Wees ◽  
Uma Gunasekaran ◽  
Luigi Meneghini
Keyword(s):  
Best Practices ◽  
American Diabetes Association ◽  
Diabetes Education ◽  
Diabetes Clinic ◽  
Standard Format ◽  
Success Stories ◽  
Number Of Patients ◽  
Diverse Patient Population ◽  
Glucose Meter

Quality Improvement Success Stories are published by the American Diabetes Association in collaboration with the American College of Physicians and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of <em>Clinical Diabetes</em>. The following article describes a project aimed at increasing the number of patients who bring their glucose meters to their appointments for downloading at a diabetes specialty clinic with a diverse patient population in Dallas, TX.

School Nurses’ Perceptions of Self-Efficacy in Providing Diabetes Care

2006 ◽  
Vol 22 (4) ◽  
pp. 223-228 ◽  
Author(s):  
Kelly L. Fisher
Keyword(s):  
Diabetes Care ◽  
School System ◽  
Self Efficacy ◽  
Diabetes Education ◽  
School Nurses ◽  
School Age ◽  
Glucose Meter ◽  
Nurses Perceptions ◽  
Blood Glucose Meter

The purpose of this study was to measure school nurses’ perceived self-efficacy in providing diabetes care and education to children and to identify factors that correlate with higher self-efficacy levels in the performance of these tasks. The results of this study revealed that the surveyed school nurses perceived a moderate level of self-efficacy in providing diabetes education. Significant findings in this study were positive relationships between self-efficacy and 3 variables: (a) participating in the care of children with diabetes, (b) having type 1 diabetes children in the school system, and (c) supervising children with blood glucose meter testing. There was a significant relationship between higher self-efficacy scores and having a diabetes curriculum. However, only nine school nurses reported having a diabetes curriculum. School nurses can benefit by understanding what factors increase self-efficacy related to diabetes education designed to enhance school-age children’s knowledge of diabetes and its management.

scholarly journals A Pharmacist-Led Medication Coaching Program Serving Senior Residents of Low-Income Housing

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 761-762
Author(s):  
Jennifer Bacci ◽  
Joshua Akers ◽  
Katie Mahan ◽  
Geoffrey Meer ◽  
Jeffrey Kinter ◽  
...  
Keyword(s):  
Older Adults ◽  
Community Pharmacy ◽  
Affordable Housing ◽  
Low Income ◽  
Culturally Diverse ◽  
Organization Structure ◽  
Local Area ◽  
Fiscal Year ◽  
Service Process ◽  
Process Outcomes

Abstract In 2015, one independent community pharmacy partnered with the local Area Agency on Aging to provide medication coaching to low-income, culturally diverse, older adults living in 6 affordable housing buildings in the Seattle area. A pilot was conducted during the 2015-2016 fiscal year to determine the need for and feasibility of the service. Process outcomes, including patient and service demographics, medication-related problems, and pharmacist interventions, were captured via the pharmacists’ patient care documentation. Pharmacists had 34 total visits with 17 unique residents who were taking an average of 8.1 medications. Pharmacists identified 97 medication-related problems, averaging 5.7 problems per resident, and performed 88 interventions, averaging 5.2 interventions per resident. The findings of this pilot demonstrated the needs and feasibility of implementing pharmacists’ services within a housing organization structure and has resulted in the continuation and growth of the program.

scholarly journals How to evaluate the implementation of complex health programmes in low-income settings: the approach of the Gavi Full Country Evaluations

2020 ◽  
Vol 35 (Supplement_2) ◽  
pp. ii35-ii46 ◽  
Author(s):  
Caroline Soi ◽  
Jessica C Shearer ◽  
Ashwin Budden ◽  
Emily Carnahan ◽  
Nicole Salisbury ◽  
...  
Keyword(s):  
Low Income ◽  
Policy Development ◽  
Complex Interventions ◽  
Immunization Coverage ◽  
Health Systems Strengthening ◽  
Public Health Services ◽  
Programme Implementation ◽  
Over Time ◽  
Health Programmes ◽  
Immunization Programmes

Abstract Vaccination, like most other public health services, relies on a complex package of intervention components, functioning systems and committed actors to achieve universal coverage. Despite significant investment in immunization programmes, national coverage trends have slowed and equity gaps have grown. This paper describes the design and implementation of the Gavi Full Country Evaluations, a multi-country, prospective, mixed-methods approach whose goal was to monitor and evaluate processes, inputs, outputs and outcomes of immunization programmes in Bangladesh, Mozambique, Uganda and Zambia. We implemented the Full Country Evaluations from 2013 to 2018 with the goal of identifying the drivers of immunization programme improvement to support programme implementation and increase equitable immunization coverage. The framework supported methodological and paradigmatic flexibility to respond to a broad range of evaluation and implementation research questions at global, national and cross-country levels, but was primarily underpinned by a focus on evaluating processes and identifying the root causes of implementation breakdowns. Process evaluation was driven by theories of change for each Gavi funding stream (e.g. Health Systems Strengthening) or activity, ranging from global policy development to district-level programme implementation. Mixing of methods increased in relevance and rigour over time as we learned to build multiple methods into increasingly tailored evaluation questions. Evaluation teams in country-based research institutes increasingly strengthened their level of embeddedness with immunization programmes as the emphasis shifted over time to focus more heavily on the use of findings for programme learning and adaptation. Based on our experiences implementing this approach, we recommend it for the evaluation of other complex interventions, health programmes or development assistance.

Parent-Reported Medication Use in a Head Start Population

2008 ◽  
Vol 24 (5) ◽  
pp. 319-325
Author(s):  
Tara M. Brinkman ◽  
John S. Carlson
Keyword(s):  
Head Start ◽  
Low Income ◽  
Medication Use ◽  
School Nurses ◽  
Psychotropic Medications ◽  
Hispanic Children ◽  
Raising Awareness ◽  
Head Start Children ◽  
Different Types ◽  
Reported Data

This study investigates the prevalence of medication use within a Head Start population. Parent-reported data ( N = 1,397) from initial enrollment information indicated 6.8% of children were taking 34 different types of medication. More than two thirds (69%) of those on medication were prescribed more than one medication, and more than one third (37%) were taking three or more medications. The majority of children were reported to be taking medications that were asthma (88%) or allergy (17%) related. Psychotropic medications accounted for 4% of the medications, indicating a prevalence of less than 0.3%. African American and Hispanic children were overrepresented in those taking medicines. School nurses can work with parents and caregivers of Head Start children by raising awareness of (1) the benefits and side effects of medications commonly taken within this population, (2) the significant role that asthma medications play in low-income areas, and (3) the issues and challenges associated with polypharmacy practices.

scholarly journals Recruitment of low-income pregnant women into a dietary and dental care intervention: lessons from a feasibility trial

2020 ◽  
Author(s):  
Amanda Rodrigues Amorim Adegboye ◽  
Paula G Cocate ◽  
Camila Benaim ◽  
Maria Claudia da Veiga Carvalho ◽  
Michael M Schlüssel ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Pregnant Women ◽  
Low Income ◽  
Quantitative Data ◽  
Health Centre ◽  
Feasibility Trial ◽  
Random Allocation ◽  
Eligibility Criteria ◽  
Related Factors ◽  
Phone Calls

Abstract Background: There are difficulties in carrying out research in low-income urban communities, but the methodological challenges and suggestions on how to deal with them are often undocumented. The aim of this study is to describe the challenges of recruiting and enrolling low-income pregnant women with periodontitis to a clinical trial on vitamin D/calcium milk fortification and periodontal therapy (PT) and describe the patient-, study protocol- and setting-related factors related to women’s ineligibility and refusal to participate in the study. Methods: A mixed-method sequential exploratory design was applied. Qualitative and quantitative data on recruitment to a 2x2 factorial feasibility clinical trial were used. 18 women attending the health centre in a low-income area in Duque de Caxias (Rio de Janeiro, Brazil) took part in focus group discussions and data were thematically analysed. Quantitative data were analysed using appropriate descriptive statistics, including absolute and relative frequencies. Results: Of all referrals (767), 548 (78.5%) did not meet the initial eligibility criteria. The main reason for exclusion (58%) was advanced gestational age (>20 weeks) at first prenatal appointment. In the periodontal examination (dental screen), the main reason for exclusion was the presence of extensive caries (64 out of 127 exclusions). Non-participation of those eligible after the periodontal examination was approximately 24% (22 out 92 eligible women) and predominantly associated with patient-related barriers (e.g. transportation barriers, family obligations, unresponsive to phone calls, and disconnected telephones). The study recruited 70 women with periodontitis in 53 weeks and did not reach the benchmark of 120 women in 36 weeks (58.3% of the original target). Recruitment was severely hindered by health centre closures due to general strikes. The recruitment yields were 9.1% (70/767) of all women contacted at first prenatal visit and 76.1% (70/92) of those screened eligible and enrolled in the trial. Women did not report concerns regarding random allocation and considered fortified milk as a healthy and safe food for pregnant women. Some women reported that financial constraints (e.g. transportation cost) could hinder participation in the study. Conclusion: Engagement between the research team and health centre staff (e.g. nurses) facilitated referral and recruitment, yet some pregnant women failed to participate in the study largely due to significant patient-related socio-demographic barriers and setting-related factors. Our data illustrate the complexity of overcoming recruitment and enrolment challenges for clinical trials in resource-limited settings.

scholarly journals Challenges of Diabetes Self-Management in Adults Affected by Food Insecurity in a Large Urban Centre of Ontario, Canada

2021 ◽  
Author(s):  
Justine Chan ◽  
Margaret De Melo ◽  
Jacqui Gingras ◽  
Enza Gucciardi
Keyword(s):  
Food Insecurity ◽  
Low Income ◽  
Local Community ◽  
Diabetes Education ◽  
Self Management ◽  
Semistructured Interview ◽  
Management Support ◽  
Urban Centre ◽  
Education Centre ◽  
Screening Questions

Objective. To explore how food insecurity affects individuals’ ability to manage their diabetes, as narrated by participants living in a large, culturally diverse urban centre. Design. Qualitative study comprising of in-depth interviews, using a semistructured interview guide. Setting. Participants were recruited from the local community, three community health centres, and a community-based diabetes education centre servicing a low-income population in Toronto, Ontario, Canada. Participants. Twenty-one English-speaking adults with a diagnosis of diabetes and having experienced food insecurity in the past year (based on three screening questions). Method. Using six phases of analysis, we used qualitative, deductive thematic analysis to transcribe, code, and analyze participant interviews. Main Findings. Three themes emerged from our analysis of participants’ experiences of living with food insecurity and diabetes: (1) barriers to accessing and preparing food, (2) social isolation, and (3) enhancing agency and resilience. Conclusion. Food insecurity appears to negatively impact diabetes self-management. Healthcare professionals need to be cognizant of resources, skills, and supports appropriate for people with diabetes affected by food insecurity. Study findings suggest foci for enhancing diabetes self-management support.

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