Culturally tailored DSMES: A new key for South Asian patients with Type 2 Diabetes Mellitus

South Asians have an exceptionally high risk for developing Type 2 diabetes mellitus. It is very challenging for healthcare providers to successfully manage diabetes and control glucose levels at target due to the unique lifestyle of the South Asian population. Culturally tailored diabetes self-management education and support (DSMES) can be more effective in guiding South Asian patients with Type 2 diabetes. Unique considerations to address lifestyle modification for South Asians include a diet that typically consists of a high carbohydrate to lipids/proteins ratio, preference for high glucose index fruits, regular intake of traditional sweets or desserts, late afternoon tea break followed by late dinner, lack of vigorous exercise (yoga or walking being the preferred activity), lack of DSMES knowledge and skills, and poor access to culturally appropriate resources for diabetes care. We present a 38-year-old male diagnosed with diabetes four years ago who showed poor glucose control before our intervention. Our interventions included education on the importance of blood glucose monitoring, exercise, and diet. Based on our experience with this case, we propose the following recommendations for a tailored approach to DSMES for South Asian patients with Type 2 diabetes: make appropriate dietary changes (decrease total daily caloric intake, decrease the percentage of carbohydrates, addlow glucose index fruits and vegetables, avoid late afternoon tea breaks, eat dinner before 8 PM); incorporate appropriate daily physical activity; and monitor blood glucose daily for prompt feedback.

Diverse, Culturally Rich Approaches to Family Care in the United States

Despite the projected rise in the diversity of caregivers and caregiving in the US, the health system is not prepared to accommodate this growth. Interventions and supports often are not adequately tailored to meet the cultural needs of older adults. Additionally, the limited interventions available for racial/ethnic minority populations frequently fail to capture and report culturally tailored perspectives. Therefore, the purpose of this presentation is to describe how culture influences caregiving in the US. Specifically, it will: (1) provide a contemporary definition of culture; (2) identify cultural domains that impact caregiving; (3) offer examples of how caregiving is influenced by different cultural/demographic backgrounds; (4) provide examples of culturally tailored caregiving programs, and (5) discuss how to approach cultural needs that may not be addressed by current interventions.

Brest Cancer Screening and Mobile Web App Intervention: Perceptions, Knowledge, and Needs among Native Women

American Indian (AI) women have the highest breast cancer mortality and lowest breast cancer screening rates in the U.S. The present study, in collaboration with the Yankton Sioux Tribe (YST) in South Dakota, sought to (1) identify the general public/professionals’ knowledge, attitudes, and needs for a mobile web app for breast cancer screening (wMammogram) intervention, and (2) inform development of the wMammogram intervention to improve Breast Cancer screening among YST women. Following a community-based participatory research approach, two focus groups were conducted in October 2020 with a total of 22 YST women aged 40-70 years, including 17 elderly women. Each group consisted of 11 community leaders, members, healthcare professionals. Qualitative analysis was conducted using grounded theory. Participants in both groups were generally favorable toward the wMammogram intervention, and noted a potential health benefit, particularly for women in their 50s to 60s. Key areas identified by participants for intervention include: (1) needs for better knowledge of breast cancer, screening, and prevention/early detection, (2) culturally tailored educational materials rooted in AI cultural values and beliefs (e.g., holistic wellness approach, Native lifestyles), (3) barriers (e.g., fear), (4) motivators (e.g., reminders), and (5) suggestions for acceptability (e.g., content and structure of messages). These results suggest that the wMammogram intervention, which is culturally tailored and addresses the community’s concerns, can be a feasible, acceptable, and effective tool to promote breast cancer screening among YST women. The results informed the development of an innovative health intervention to help reduce health disparities experienced in Indian Country.

A technology-based intervention to improve safety, mental health and empowerment outcomes for immigrant women with intimate partner violence experiences: it’s weWomen plus sequential multiple assignment randomized trial (SMART) protocol

Background Intimate partner violence (IPV) disproportionately affects immigrant women, an understudied and underserved population in need for evidence-based rigorously evaluated culturally competent interventions that can effectively address their health and safety needs. Methods This study uses a sequential, multiple assignment, randomized trial (SMART) design to rigorously evaluate an adaptive, trauma-informed, culturally tailored technology-delivered intervention tailored to the needs of immigrant women who have experienced IPV. In the first stage randomization, participants are randomly assigned to an online safety decision and planning or a usual care control arm and safety, mental health and empowerment outcomes are assessed at 3-, 6- and 12-months post-baseline. For the second stage randomization, women who do not report significant improvements in safety (i.e., reduction in IPV) and empowerment from baseline to 3 months follow up (i.e., non-responders) are re- randomized to safety and empowerment strategies delivered via text only or a combination of text and phone calls with trained advocates. Data on outcomes (safety, mental health, and empowerment) for early non-responders is assessed at 6 and 12 months post re-randomization. Discussion The study’s SMART design provides an opportunity to implement and evaluate an individualized intervention protocol for immigrant women based on their response to type or intensity of intervention. The findings will be useful for identifying what works for whom and characteristics of participants needing a particular type or intensity level of intervention for improved outcomes. If found to be effective, the study will result in an evidence-based trauma-informed culturally tailored technology-based safety decision and planning intervention for immigrant survivors of IPV that can be implemented by practitioners serving immigrant women in diverse settings. Trial registration This trial was registered with ClinicalTrials.gov as NCT04098276 on September 13, 2019.

Community-based Culturally Tailored Education Programs for Black Adults With Cardiovascular Disease, Diabetes, Hypertension, and Stroke: a Systematic Review Protocol

Background: Chronic conditions and stroke disproportionately affect Black adults in communities all around the world due patterns of systemic racism, disparities in care, and lack of resources. Culturally-tailored programs can meet the needs of the communities they serve, including Black adults who tend to have reduced access to postacute services. To address unequal care received by Black communities, a shift to community-based programs that deliver culturally-tailored programs may give an alternative to a healthcare model which reinforces health inequities. However, community-based culturally-tailored programs (CBCT) are relatively understudied but show promise to improve the delivery of services to marginalized communities. The objectives of this review are to: (i) synthesize key program characteristics and outcomes of CBCT programs that are designed to improve health outcomes in Black adults with cardiovascular disease, hypertension, diabetes, or stroke and (ii) identify which of the five categories of culturally appropriate programs from Kreuter and colleagues have been used to implement CBCT programs.Methods: This is a protocol for a systematic review that will search MEDLINE, EMBASE and CINAHL databases to identify CBCT programs for Black adults with cardiovascular disease, hypertension, diabetes, or stroke.Discussion: Health inequities have disproportionately impacted Black communities and will continue to persist if adjustments are not prioritized within healthcare to provide services, care, and programs meant to address the specific barriers to better health. Many interventions meant to improve the health outcomes of marginalized groups are created using an outsider's perspective, with little input from target communities, leading to interventions that may not address the specific barriers contributing to poor health outcomes. The inclusion of community members in the design of CBCT programs allows for a deeper understanding of the issues facing the community and provides an opportunity to incorporate cultural values that may enhance the efficacy, relevance and appropriateness of programs to the target communities. Trial registration: PROSPERO CRD42021245772

Delay Early CKD with Lifestyle Intervention in African Americans with Diabetic Kidney Disease: A Pre-Post Pilot Study (Preprint)

BACKGROUND Behavioral factors such as lifestyle have been shown to explain approximately 24% of the excess risk of chronic kidney disease among African Americans. OBJECTIVE The main objective of this study was to examine the feasibility and preliminary efficacy of a culturally tailored lifestyle intervention in African Americans with type 2 diabetes mellitus and chronic kidney disease (CKD). METHODS A pre-post design was used to test the feasibility of a lifestyle intervention in African American adults recruited from Medical University of South Carolina. Clinical outcomes (hemoglobin A1c, blood pressure and estimated glomerular filtration rate (eGFR)) were measured at baseline and post-intervention. Disease knowledge, self-care and behavior outcomes were also measured using validated structured questionnaires at baseline and post-intervention. Descriptive statistics and effect sizes were calculated to determine clinically important changes from baseline. RESULTS Significant pre-post mean differences and decreases were observed for HbA1c (mean 0.75, p=0.01), total cholesterol (mean 16.38, p<0.01), low density lipoprotein (mean 13.73, p<0.01) and eGFR (mean 6.73, p=0.02). Significant pre-post mean differences and increases were observed for CKD self-efficacy (mean -11.15, p=0.03), CKD knowledge (mean -2.62, p<0.01), exercise behavior (mean -1.21, p<0.01) and blood sugar testing (mean -2.15, p<0.01). CONCLUSIONS This study provides preliminary data for a large-scale appropriately powered, randomized control trial to examine a culturally tailored lifestyle intervention in African Americans to improve clinical, knowledge and self-care behavior outcomes in this population.