Self-management Education Classes Research Articles

Factors associated with attendance at a pharmacist-led group diabetes self-management education class and impact on health outcomes

BackgroundGroup education has demonstrated benefits among people with diabetes, including reduced A1C and improved self-monitoring practices. Despite this, attendance rates are low for a variety of reasons, including lack of understanding of potential benefits among patients. ObjectivesThe pharmacist-led diabetes self-management education program at a community hospital has low attendance. This project assesses characteristics associated with attendance and compares outcomes among attendees and non-attendees. MethodsRetrospective data was collected between July 2022 and December 2023. Variables included: age, sex, class attendance, pre- and ≥ 90-day post-class A1C, pre- and post-class BMI, attending pharmacist-led clinic prior to scheduled class, social determinants of health screening survey responses, and diagnosis of depression or anxiety. Results103 patients were identified. 53 % attended at least one class out of a series of four. Attendance at the pharmacist-led diabetes clinic (70 % among attendees versus 30 % among non-attendees, p < 0.001) was associated with attendance. Age, gender, concurrent mental health diagnoses (depression and anxiety), and SDOH related needs were not associated with attendance. Baseline A1C was similar for attendees and non-attendees (9.6 vs. 9.7 %, respectively). Post-class A1C was 7.4 % for attendees of at least one class and 8 % for non-attendees. Patients who attended all four classes achieved a mean A1C <7 %. DiscussionThere are many factors that lead to lack of engagement with group education for diabetes. Referral to group education by a pharmacist who has established rapport with the patient and can speak to specific details about benefits of the classes may improve attendance at diabetes group education.

DELIVERING FOOD RESOURCES AND KITCHEN SKILLS TO OLDER ADULTS WITH FOOD INSECURITY AND HYPERTENSION

Abstract Non-Hispanic Black adults experience higher rates of food insecurity, poor diet quality, and hypertension compared with their non-Hispanic White counterparts. Delivering Food Resources and Kitchen Skills (FoRKS) is an integrated intervention that concurrently addresses food insecurity, nutrition literacy, and chronic disease self-management among older patients at a Federally Qualified Health Center. Two clinical dietitians led virtual hypertension self-management, cooking skills, and nutrition education classes twice per week for 16 weeks. Participants registered for classes, ordered free meal ingredients, and received encouragement from the dietitians through the FoRKS mobile technology application. This study presents diet quality descriptive results from the FoRKS pilot intervention conducted at Eskenazi Health from September 2021 to January 2022 in Indianapolis, Indiana. Participants (n=13) with hypertension (systolic blood pressure ≥120 mm Hg) and who identified as food insecure per the 18-item US Household Food Security Survey Module completed the 2018-version of the National Cancer Institute’s Automated Self-Administered 24-hour (ASA24) Dietary Assessment Tool at baseline and post-intervention assessments. Healthy Eating Index (HEI)-2015 scores range from 0-100 and were calculated from ASA24 data. Participants were non-Hispanic Black (n=12) or non-Hispanic White (n=1) with mean age 58 years (range 53-65 years). Mean±SD HEI-2015 scores improved from 51.5±11.9 at baseline to 55.2±12.5 after the intervention. This preliminary data supports further investigation into the efficacy of integrated lifestyle interventions, i.e., FoRKS, using a randomized controlled study design. Addressing food and culinary skills can lead to improvements in diet quality that may translate to improved disease management among diverse older adults.

Participant engagement in a community health worker-delivered intervention and type 2 diabetes clinical outcomes: a quasiexperimental study in MexicanAmericans

ObjectivesThis study helps to fill the existing research gap related to participant engagement in behavioural interventions and diabetes management. We examined type 2 diabetes control over time among Mexican Americans...

Evaluating the efficacy of telephone-based outreach in addressing hypertension control among black men with severe hypertension: An observational study.

The high prevalence of uncontrolled hypertension (systolic blood pressure [SBP] ≥140mmHg or diastolic blood pressure [DBP] ≥90mmHg) in Black patients represents a significant racial health disparity in the United States. This study evaluated the efficacy of a telephone-based strategy for inviting high-risk patients with severe hypertension to weekly self-management education classes. Further, the study assessed how the outreach intervention correlated with relevant quality improvement outcomes, including improved blood pressure and primary care follow-up among our clinic population of Black men with severe hypertension. A cohort of 265 Black men aged ≥18years with SBP ≥160mmHg or DBP ≥100mmHg at the most recent clinic visit were identified using Epic reports formatted for Federal Uniformed Data Set annual reporting. Telephone outreach was used to invite the cohort to attend weekly in-person classes facilitated by various healthcare professionals. Logistic regression was performed to determine the associations between being reached by phone with (1) class attendance and (2) follow-up appointment attendance. Most of the Black men were single (57.4%, n=152), 49.1% had history of alcohol or substance use (n=130), and 35.8% (n=95) was uninsured. The average age was 55.6years (SD=11.6). After controlling for sociodemographic factors, being reached by phone was significantly associated with an increased likelihood of patient attendance at follow-up appointments (OR=1.91, p=.038) but not with class attendance (OR=2.45, p=.155). Patients who attended a follow-up appointment experienced significant reductions in both SBP and DBP at 9months. Telephone outreach was labor-intensive but effective in keeping under-resourced patient populations engaged in primary care. Future work should aim to develop more efficient strategies for engaging high-risk patients in self-monitoring education to manage hypertension.

Self-Management Education Class Attendance and Health Care Provider Counseling for Physical Activity Among Adults with Arthritis - United States, 2019.

Arthritis is a highly prevalent and disabling condition among U.S. adults (1); arthritis-attributable functional limitations and severe joint pain affect many aspects of health and quality of life (2). Self-management education (self-management) and physical activity can reduce pain and improve the health status and quality of life of adults with arthritis; however, in 2014, only 11.4% and 61.0% of arthritis patients reported engaging in each, respectively. To assess self-reported self-management class attendance and health care provider physical activity counseling among adults with doctor-diagnosed arthritis, CDC analyzed 2019 Behavioral Risk Factor Surveillance System (BRFSS) data. In 2019, an age-standardized state median of one in six (16.2%) adults with arthritis reported ever attending a self-management class, and 69.3% reported ever receiving health care provider counselling to be physically active. Prevalences of both differed by state and sociodemographic characteristics; decreased with lower educational attainment, joint pain severity, and urbanicity; and were lower in men than in women. Health care providers can play an important role in promoting self-management class attendance and physical activity by counseling arthritis patients about their benefits and referring patients to evidence-based programs (3).

Individual and Community Social Determinants of Health Associated With Diabetes Management in a Mexican American Population.

Background: Diabetes is a major health burden in Mexican American populations, especially among those in the Lower Rio Grande Valley (LRGV) in the border region of Texas. Understanding the roles that social determinants of health (SDOH) play in diabetes management programs, both at the individual and community level, may inform future intervention strategies.Methods: This study performed a secondary data analysis on 1,568 individuals who participated in Salud y Vida (SyV), a local diabetes and chronic disease management program, between October 2013 and September 2018 recruited from a local clinic. The primary outcome was the reduction of hemoglobin A1C (HbA1C) at the last follow-up visit compared to the baseline. In addition to age, gender, insurance status, education level and marital status, we also investigated 15 community (census tract) SDOH using the American Community Survey. Because of the high correlation in the community SDOH, we developed the community-level indices representing different domains. Using Bayesian multilevel spatial models that account for the geographic dependency, we were able to simultaneously investigate the individual- and community-level SDOH that may impact HbA1C reduction.Results: After accounting for the diabetes self-management education classes taken by the participants and their length of stay in the program, we found that older age at baseline, being married (compared to being widowed or divorced) and English speaking (compared to Spanish) were significantly associated with greater HbA1C reduction. Moreover, we found that the community level SDOH were also highly associated with HbA1C reduction. With every percentile rank decrease in the socioeconomic advantage index, we estimated an additional 0.018% reduction in HbA1C [95% CI (−0.028, −0.007)]. Besides the socioeconomic advantage index, urban core opportunity and immigrant's cohesion and accessibility indices were also statistically associated with HbA1C reduction.Conclusion: To our knowledge, our study is the first to utilize Bayesian multilevel spatial models and simultaneously investigate both individual- and community-level SDOH in the context of diabetes management. Our findings suggest that community SDOH play an important role in diabetes control and management, and the need to consider community and neighborhood context in future interventions programs to maximize their overall effectiveness.

Veteran stroke survivors’ lived experiences after being discharged home: a phenomenological study

Background Stroke is a leading cause of disability in adults and third cause of death in the United States. Survivors face challenges postdischarge, including risks in self-management (SM) following prescribed regimens. Although SM education can help develop skills to control risk factors for stroke recurrence, little is known about lived experiences of patients adopting SM. Aims To examine Veterans’ lived poststroke experiences after discharge and their experiences in SM goal setting/attainment. Methods Patients within one year of discharge from a Veterans Administration Medical Center in the United States with two risk factors for stroke recurrence were enrolled and received an SM workbook. Eight patients were interviewed (six males, two females; mean age 62: range 45–80). Part I concerned lived experience. Part II described experiences with goal setting and attainment. Data were analyzed inductively, identifying common experiences. Deductive analysis described goal setting and attainment. Transcript reviews identified SM themes and strategies. Results Lived experiences included 1) uncertainty about life, 2) anger and frustration, and 3) healthcare system challenges. Coping skills and setting goals to manage risks were critical for physical and emotional functioning. Conclusions SM coping and goal setting aided recovery and improved life quality among Veterans after stroke. SM interventions assisted in regaining physical and emotional function. Findings may help in design of interventions for survivors, using SM and goal setting and attainment. IMPLICATIONS FOR REHABILITATION Several implications for clinical practice were identified: Providers should acknowledge Veterans’ challenges and struggles after their stroke and help Veterans to re-establish social identity, enhance self-esteem and improve mood. More emphasis should be given to the Veterans’ caregivers’ availability and willingness to help with their loved one’s recovery, work reinstatement status and financial struggles. Recognition of the importance of the social context of recovery after a stroke is important, as nonmedical social interaction is often overlooked. Improvements are needed in the area of providers working with social workers and physical, occupational and mental health therapists to arrange more inpatient and outpatient treatments, including more frequent home visits. Veterans should be strongly encouraged to attend self-management diabetes education classes and smoking cessation and weight-loss programs offered for free within the Veterans Health Administration system. Self-management strategies using goal-setting and attainment concepts may assist individuals with stroke to regain physical and emotional functions, subsequently preventing another stroke.

Veterans' Experiences With Diabetes: A Qualitative Analysis.

The purpose of the study was to explore an understanding of the psychosocial-behavioral impact of diabetes self-management among veterans with diabetes. Twenty-six veterans participated in 1 of 9 focus groups that were conducted following a group diabetes self-management education class and prior to a mindfulness intervention as part of a feasibility pilot study. Discussions were guided by open-ended questions that addressed the overarching research question, "How do attitudes and experiences with diabetes inform psychosocial-educational approaches to diabetes self-management education and care for veterans?" Focus groups were audio-recorded and transcribed. The data was then independently coded and thematically analyzed by 2 coders. Five main themes that reflect veterans' perceptions of their experiences with diabetes and diabetes self-management were identified: (1) distress and negative emotions, (2) social isolation, (3) perceived lack of control, (4) attitudes toward diabetes support, and (5) desire for information about stress, diabetes, health, and behavior. Veterans experience emotional distress and have unmet psychosocial needs related to diabetes self-management. Insight gained from these veteran perspectives suggests a framework for integrating psycho-educational interventions like mindfulness into diabetes care that emphasize stress reduction, person-centered communication, and opportunities for peer support.

Pilot Cluster Randomized Controlled Trial of Integrative Nutritional Counseling Versus Standard Diabetes Self-Management Education for Chinese Americans with Type 2 Diabetes.

Purpose: Chinese Americans (CAs) with diabetes and limited English proficiency often struggle to adhere to standard diabetes diets focused on food measurement/restriction. Chinese medicine principles commonly inform food choices among CAs but are rarely acknowledged in nutritional interventions. We developed and tested feasibility of a theoretically informed integrative nutritional counseling (INC) program that combines Chinese medicine principles with biomedical nutrition standards.Methods: We randomized diabetes self-management education (DSME) classes to include either: (1) usual nutrition curriculum based on American Diabetes Association (ADA) recommendations delivered by a diabetes educator (control) or (2) INC curriculum based on a combination of ADA recommendations and Chinese medicine principles delivered by a diabetes educator and a licensed acupuncturist (intervention). All DSME enrollees were invited to participate in research entailing data collection at three time points: baseline, after the DSME nutrition class, and at 6-month follow-up. Using validated measures, we collected dietary self-efficacy, diabetes distress, diet satisfaction, and dietary adherence. We also measured weight and glycemic control.Results: Study participants were 18 Cantonese-speaking patients with diabetes who were predominantly female and older, with low levels of income and acculturation. Intervention and control groups were similar at baseline. INC performed similarly to usual DSME with 100% of participants reporting the INC booklet helped their learning. Dietary adherence significantly improved in participants who received the INC curriculum.Conclusion: INC is feasible to implement as part of DSME classes and shows promise as a complementary culturally sensitive addition to usual diabetes nutrition education for CA patients.

Wellness project implementation within Houston\u2019s Faith and Diabetes initiative: a mixed methods study

BackgroundFaith-based health promotion has shown promise for supporting healthy lifestyles, but has limited evidence of reaching scale or sustainability. In one recent such effort, volunteers from a diverse range of faith organizations were trained as peer educators to implement diabetes self-management education (DSME) classes within their communities. The purpose of this study was to identify factors associated with provision of these classes within six months of peer-educator training.MethodsThis study used the Consolidated Framework for Implementation Research (CFIR) to identify patterns from interviews, observations, attendance records, and organizational background information. Two research team members thematically coded interview transcripts and observation memos to identify patterns distinguishing faith organizations that did, versus did not, conduct DSME classes within six months of peer-educator training. Bivariate statistics were also used to identify faith organizational characteristics associated with DSME class completion within this time frame.ResultsVolunteers from 24 faith organizations received peer-educator training. Of these, 15 led a DSME class within six months, graduating a total of 132 participants. Thematic analyses yielded two challenges experienced disproportionately by organizations unable to complete DSME within six months: [1] Their peer educators experienced DSME as complex, despite substantial planning efforts at simplification, and [2] the process of engaging peer educators and leadership within their organizations was often more difficult than anticipated, despite initial communication by Faith and Diabetes organizers intended to secure informed commitments by both groups. Many peer educators were overwhelmed by training content, the responsibility required to start and sustain DSME classes, and other time commitments. Other priorities competed for time in participants’ lives and on organizational calendars, and scheduling processes could be slow. In an apparent dynamic of “crowding out,” coordination was particularly difficult in larger organizations, which were less likely than smaller organizations to complete DSME classes despite their more substantial resources.ConclusionsInitial commitment from faith organizations’ leadership and volunteers may not suffice to implement even relatively short and low cost health promotion programs. Faith organizations might benefit from realistic previews about just how challenging it is to make these programs a sufficiently high organizational and individual priority.

1213-P: Utilizing Lean Six Sigma and Quality Improvement (QI) Tools to Improve Hemoglobin A1c Control in Persons with Diabetes

Aim: Using lean six sigma QI tools, Define-Measure-Analyze-Improve-Control (DMAIC), design and implement best practices to reduce percentage of patients with hgbA1c &amp;gt;9.0% from baseline of 26% in May 2018 to 21% by July 2019 in our endocrinology clinic. Methods: We used institution’s diabetes registry to capture hgbA1c values and patient visits to endocrinology clinic. DMAIC data driven improvement cycle was used for identifying care gaps, problem solving and interventions to improve workflow processes. At the end of the DMAIC implementation, Plan-Do-Study-Act (PDSA) cycles were implemented for 6 months for control of the new processes. During Analyze phase, main care gaps identified were missing hgbA1c values, appointment cancellations and low participation in self-management diabetes education. We implemented pre visit planning, standardization of hgbA1c ordering process, standing medical orders for both hgbA1c testing and self-management diabetes education classes. DMAIC phases were completed over five months, and the process was monitored for next six months. Results: 3016 persons were seen for diabetes management during the measurement period. Percent in poor control improved from 26% in May 2018 to 18% by July 2019. Conclusion: Quality improvement tools can be successfully applied to improve and sustain clinical outcomes such as hgbA1c control in persons with diabetes. Disclosure S. Ali: None. U. Kollipara: None.

Impact of Student Pharmacists Teaching a Diabetes Self-Management Education and Support Class

Objective. To evaluate student pharmacists' knowledge of diabetes and self-perceptions of aptitude and confidence before and after teaching a diabetes self-management education and support (DSMES) class. Methods. Students enrolled in an advanced pharmacy practice experience (APPE) in ambulatory care were randomly assigned to the intervention group (taught a DSMES class) or control group (did not teach a DSMES class) between June 2016 to April 2018. Students self-assessed their aptitude and confidence using a 14-item pre- and post-intervention survey instrument. Additionally, participants completed a 10-item diabetes knowledge evaluation at baseline and during week three or four of the APPE. Results. Forty-six students participated in the study (26 students in the intervention group and 20 in the control group). Students in the intervention cohort demonstrated a significant improvement in their knowledge score (81.8% post-intervention vs 68.4% pre-intervention). Students in the control cohort did not experience a significant change in knowledge scores from pre- to post-intervention evaluation (70.0% vs 74.1%). The intervention cohort achieved a significantly greater improvement in confidence scores compared to the control group (11.8 vs 6.7 increase in scores, respectively). Conclusion. A student pharmacist team-taught DSMES class resulted in significant improvement in diabetes knowledge, aptitude, and confidence. Student pharmacist participation in a DSMES class may improve knowledge and enhance confidence, while offering an opportunity to advance the pharmacy practice model in ambulatory care.

Supporting self-management education for arthritis: Evidence from the Arthritis Conditions and Health Effects Survey on the influential role of health care providers.

Self-management education programs are recommended for many chronic conditions. We studied which adults with arthritis received a health care provider's recommendation to take a self-management education class and who attended. We analyzed data from a 2005--2006 national telephone survey of US adults with arthritis ≥45 years (n = 1793). We used multivariable-adjusted prevalence ratios (PR) from logistic regression models to estimate associations with: (1) receiving a health care provider recommendation to take a self-management education class; and (2) attending a self-management education class. Among all adults with arthritis: 9.9% received a health care provider recommendation to take an self-management education class; 9.7% attended a self-management education class. Of those receiving a recommendation, 52.0% attended a self-management education class. The strongest association with self-management education class attendance was an health care provider recommendation to take one (PR = 8.9; 95% CI = 6.6-12.1). For adults with arthritis, a health care provider recommendation to take a self-management education class was strongly associated with self-management education class attendance. Approximately 50% of adults with arthritis have ≥1 other chronic conditions; by recommending self-management education program attendance, health care providers may activate patients' self-management behaviors. If generalizable to other chronic conditions, this health care provider recommendation could be a key influencer in improving outcomes for a range of chronic conditions and patients' quality of life.

Which patients do not seek additional medical care after a self-management class for low back pain? An observational cohort

Objectives: (1) To identify baseline variables associated with patients that sought no additional care during the 12 months following a single self-management education session for low back pain (LBP), and (2) in those who sought care, to determine whether the same variables were associated with low versus high downstream LBP-related healthcare utilization. Design: An observational cohort. Setting: Single large military hospital. Participants: A total of 733 patients with LBP. Intervention: Single self-management education session. Main outcomes: Eleven variables were explored in two distinct logistic regression models: (1) no additional care versus additional care, and (2) low versus high number of additional visits in the additional care group. Results: In the first model, not being on active duty service (odds ratio (OR) = 1.98, 95% confidence interval (CI) = 1.37–2.86), low baseline disability (OR = 1.02, 95% CI = 1.00–1.04), low baseline fear-avoidance related to work (OR = 1.02, 95% CI = 1.00–1.03), and, in the last year, no opioid prescriptions (OR = 1.44, 95% CI = 1.00–2.07), physical therapy (OR = 1.63, 95% CI = 1.00–2.65), or sleep disorder diagnosis (OR = 1.62, 95% CI = 1.05–2.51) significantly increased the odds that patients would not seek any additional care. In the second model, not being on active duty service (OR = 2.18, 95% CI = 1.38–3.46), low baseline disability (OR = 1.04, 95% CI = 1.02–1.06), and no opioid prescriptions in the prior year (OR = 2.19, 95% CI = 1.42–3.37) increased the odds that patients would have less visits (⩽2 visits). Conclusion: Our study found several variables that helped determine whether patients would seek little or no additional care during the 12 months following a self-management education class for LBP.

669-P: Factors to Improve Attendance at Diabetes Self-Management Education Classes

Formal diabetes self-management education (DSME) improves glycemic control. Yet, many patients referred to DSME do not attend. This study examined differences between patients referred to DSME who attended class (PA) and those who did not (PN) to assess factors that might be associated with attendance. Methods: The study was conducted at an urban safety net hospital over two months. Phone interviews (128) were conducted with a convenience sample of patients after the scheduled DSME class (43 PA and 85 PN) to assess reason for attendance or not. Medical records supplied data on demographics, insurance status, and co-morbidities. Results: DSME overall attendance was 32% of 197. While obesity was associated with increased likelihood of attendance (OR 2.67, P &amp;lt; .05), overall disease burden was not. Attendance did not differ by age, sex, diabetes duration, insurance status, or A1c. PA and PN reported similar reasons for planning to attend (general knowledge, 36%; “told to”, 32%; dietary information, 24%). Primary reasons for not attending were time conflicts (31%), poor health (24%), lack of perceived need (24%), and transportation (22%). Excluding those PN who denied perceived need for DSME, 64% of PN wanted to reschedule. Thus, lack of attendance may be related more to barriers than lack of interest. PN wanting knowledge were more likely (OR 6.7 p&amp;lt; 0.001) to want to reschedule and those just “told to” go (OR 0.24 p&amp;lt; 0.05) or felt no need (OR 0.15 p&amp;lt; 0.05) were less likely to reschedule. Conclusions: Addressing both external and internal factors should improve DSME attendance. Flexible/negotiated scheduling, greater variety of class times/locations, ease of rescheduling, and access to alternative transportation options may address external barriers. To address perception of a lack of need for DSME, additional strategies such as clear communication of DSME benefits by clinical providers are needed to enhance attendance. Disclosure R. Wolf: None. C.S. Barnes: None. J. Caudle: None. S.G. Krishnapura: None. J.L. Dupont: None. R.J. Crawford: None. P.L. Dickerson: None. D.C. Ziemer: None.

Virtual Education for Older Adults with Type 2 Diabetes during Transitions

Compared to older adults without type 2 diabetes (T2D) older adults with T2D have higher rates of hospital admission and readmission. Despite having a diagnosis of T2D, attendance of diabetes self-management education (DSME) classes by older adults is low. Hospitalizations are an opportune time to engage older adults with T2D, currently no interventions exist utilizing telehealth and DSME for this population during transitions. The purpose of this study is to demonstrate the feasibility of providing DSME through telehealth to older patients with T2D following a hospital admission. We conducted a qualitative study using semi-structured, face-to-face interviews with older adults with T2D engaged in a post-discharge DSME telehealth transitions intervention. Hospitalized older adults (≥ 55 years of age) with T2D were recruited. An advanced practice nurse certified diabetes educator provided one in-person home visit within 48 hours of discharge and weekly DSME sessions via electronic tablet for four additional weeks. After completion of the program, eight patients were asked to describe their experience using the tablet to receive DSME, describe any behavior changes, and if they would accept future education virtual visits. Interviews were audio-recorded, transcribed verbatim and content analyzed thematically. Participants (50% male, aged 57-73 years, 75% African American), cited inconvenience and lack of availability as the leading cause for prior DSME non-attendance. Participants described an increased awareness of dietary habits and more frequent monitoring of glucose. Seven out of 8 participants indicated they would participate in future virtual DSME sessions. Every participant indicated the technology was easy to use and would recommend sessions to others. Our findings support ADA recommendations to improve transitions and to evaluate DSME need at this critical time. Technology use is feasible to enhance availability and convenience for continued DSME in the home after a hospital admission. Disclosure C.R. Whitehouse: None. J.A. Long: None. L. McLeer Maloney: None. D.A. Horowitz: None. K. Bowles: None.

Poorly Controlled Diabetes in New York City: Mapping High-Density Neighborhoods.

To identify geographic areas in New York City (NYC) for implementing programming focused on reducing the burden attributed to poor glycemic control and improving the health of New Yorkers. We geocoded addresses of NYC residents in the NYC Hemoglobin A1c (HbA1C) Registry with high (>9%) HbA1c test values from 2011 to 2013 on an NYC base map. The ArcGIS point density spatial analysis tool was applied to create a map of NYC residents with diabetes in poor glycemic control. The setting for HbA1c testing was medical facilities within NYC. The study population included NYC residents (excluding undomiciled persons and addresses corresponding to prisons, hospitals, or nursing homes) 18 years or older who underwent HbA1c testing from 2011 to 2013. A map depicting point density of NYC residents with poor glycemic control was developed each year from 2011 to 2013 (2011: n = 70 359; 2012: n = 75 643; 2013: n = 78 694). Particularly, high densities of persons in poor glycemic control were identified in Flatbush, East Harlem, Washington Heights/Inwood, and the South Bronx. The 2 highest-density gradients (out of 9) covered approximately 1.7% of the total habitable area in NYC, while accounting for more than 1 in 10 (10.5%) persons in poor glycemic control. The 3 highest-density gradients covered 4.1% of NYC's habitable area and accounted for more than 1 in 5 (21.9%) persons in poor glycemic control. The point density analysis highlighted several defined geographic areas representing a meaningful proportion of the population in poor glycemic control. This analysis could be used to raise community awareness and guide potential programming focused on reducing the burden of poor glycemic control such as the placement of diabetes self-management education classes, community health workers, and farmers' markets. Given the geographic breadth of NYC and limited resources, focused efforts on these defined areas would reach a sizeable number of the at-risk population.

A Mindful Approach to Diabetes Self-Management Education and Support for Veterans.

Purpose The purpose of this study is to determine feasibility, satisfaction, and preliminary effects of Mindful Stress Reduction in Diabetes Education (Mind-STRIDE), a mindfulness-based intervention for veterans. Methods The study used a single-group pretest-posttest repeated-measures design. The 90-minute Mind-STRIDE training, adapted from Mindfulness Based Stress Reduction (MBSR), was provided as the final component of a half-day diabetes self-management education class at a Veterans Affairs (VA) outpatient diabetes clinic. Following initial training, participants were asked to practice mindfulness at home for 10 minutes each day during the 3-month study. Study recruitment and retention were calculated as rates. Veteran and diabetes educator satisfaction were assessed by rating scales and open-ended comments. Psychosocial-behavioral and metabolic outcomes were assessed at baseline and 3 months after initial training. Bivariate correlations were performed to describe relationships between mindfulness and other outcome variables. Gain scores and Wilcoxon matched-pair signed rank tests were used to assess pre to post changes; Cohen's d was applied to estimate the magnitude of effects. Results Twenty-eight of 49 eligible veterans (57%) enrolled in the study. Of those, 11 veterans (39%) demonstrated participation in home practice, and 20 veterans (71%) completed the study. Overall, participants and diabetes educators were highly satisfied with the Mind-STRIDE intervention. Significant improvements were found in diabetes distress, diabetes self-efficacy, diabetes self-management behaviors, mindful-describing, and A1C. Conclusion Results suggest feasibility, satisfaction, and positive preliminary effects. Efficacy testing by randomized controlled trial with analysis of covariance structures is warranted.

Influences on Diabetes Self-Management Education Participation in a Low-Income, Spanish-Speaking, Latino Population.

Objective.To investigate influences on participation in diabetes self-management education (DSME) classes in a low-income, Spanish-speaking, Latino population.Methods.Fifteen patients from an Oregon clinic participated in semi-structured interviews designed to understand influences on their participation in DSME classes, and the authors conducted a thematic analysis.Results.Four themes characterized the data: 1) limited resources, 2) culture, 3) relationship with diabetes, and 4) relationship with clinic. Barriers to class attendance included lack of time, childcare, and transportation; male participants’ shame of illness and lack of interest in health; and difficulty contacting participants by telephone. Motivators of class attendance included interest in being healthy for the sake of family; interest in nutrition; knowledge of the effects of diabetes on self, friends, and family; and positive experiences with group support and self-efficacy in class.Practice implications and conclusion.Participation in DSME classes in this low-income, Spanish-speaking, Latino population was influenced by many factors. Understanding these factors is an important step toward creating classes that are successful in increasing attendance rates for this and similar populations. Creative, targeted approaches to designing DSME classes for low-income, Spanish-speaking, Latino patients and similar populations are needed. These may include classes that remove the barriers of shame and lack of interest for male participants; focus on family involvement, celebration of culturally appropriate foods, group support, and self-efficacy; are accessible to resource-limited participants; and use alternative methods to recruit hard-to-reach participants.

Peer-led, transformative learning approaches increase classroom engagement in care self-management classes during inpatient rehabilitation of individuals with spinal cord injury

Objective: Evaluate effects of revised education classes on classroom engagement during inpatient rehabilitation for individuals with spinal cord injury/disease (SCI/D).Design: Multiple-baseline, quasi-experimental design with video recorded engagement observations during conventional and revised education classes; visual and statistical analysis of difference in positive engagement responses observed in classes using each approach.Participants/Setting: 81 patients (72% male, 73% white, mean age 36 SD 15.6) admitted for SCI/D inpatient rehabilitation in a non-profit rehabilitation hospital, who attended one or more of 33 care self-management education classes that were video recorded. All study activities were approved by the host facility institutional review board.Intervention: Conventional nurse-led self-management classes were replaced with revised peer-led classes incorporating approaches to promote transformative learning. Revised classes were introduced across three subject areas in a step-wise fashion over 15 weeks.Outcome Measure: Positive engagement responses (asking questions, participating in discussion, gesturing, raising hand, or otherwise noting approval) were documented from video recordings of 14 conventional and 19 revised education classes.Results: Significantly higher average (per patient per class) positive engagement responses were observed in the revised compared to conventional classes (p=0.008).Conclusion: Redesigning SCI inpatient rehabilitation care self-management classes to promote transformative learning increased patient engagement. Additional research is needed to examine longer term outcomes and replicability in other settings.