Cross-Validating a Structural Model of Factors Influencing Diabetes Self-Management in Chinese Americans with Type 2 Diabetes.

Introduction: The purpose of this study was to cross-validate a structural model depicting the effects of individual and environmental factors on diabetes self-management in Chinese Americans with type 2 diabetes.

Methodology: A cross-sectional survey was administered to a convenience sample of 209 Chinese Americans with type 2 diabetes in the Midwest of the United States. Structural equation modeling was used to cross-validate the model fit.

Minimal intervention needed for change: definition, use, and value for improving health and health research.

Much research focuses on producing maximal intervention effects. This has generally not resulted in interventions being rapidly or widely adopted or seen as feasible given resources, time, and expertise constraints in the majority of real-world settings. We present a definition and key characteristics of a minimum intervention needed to produce change (MINC).

Understanding who benefits at each step in an internet-based diabetes self-management program: application of a recursive partitioning approach.

Background: Efforts to predict success in chronic disease management programs have been generally unsuccessful.

Objective: To identify patient subgroups associated with success at each of 6 steps in a diabetes self-management (DSM) program.

Design: Using data from a randomized trial, recursive partitioning with signal detection analysis was used to identify subgroups associated with 6 sequential steps of program success: agreement to participate, completion of baseline, initial website engagement, 4-month behavior change, later engagement, and longer-term maintenance.

Relative contributions of naturalistic and constructed support: two studies of women with type 2 diabetes.

Do distinct sources of social support have differential effects on health? Although previous research has contrasted family and friend support (naturalistic support), research on the relative effects of naturalistic support and constructed support (e.g., support groups) is extremely rare.

Adapting and RE-AIMing a heart disease prevention program for older women with diabetes.

Coronary heart disease is a pervasive public health problem with a heavy burden among older women. There is a need for developing effective interventions for addressing this problem and for evaluating the dissemination potential of such interventions. A multiple-behavior-change program originally designed for men with heart disease was adapted for women at high risk of heart disease in two randomized clinical trials-the Mediterranean Lifestyle Program and ¡Viva Bien!.

Cultural adaptations of behavioral health interventions: a progress report.

Objective: To reduce health disparities, behavioral health interventions must reach subcultural groups and demonstrate effectiveness in improving their health behaviors and outcomes. One approach to developing such health interventions is to culturally adapt original evidence-based interventions. The goals of the article are to (a) describe consensus on the stages involved in developing cultural adaptations, (b) identify common elements in cultural adaptations, (c) examine evidence on the effectiveness of culturally enhanced interventions for various health conditions, and (d) pose questions for future research.

Intervention costs and cost-effectiveness for a multiple-risk-factor diabetes self-management trial for Latinas: economic analysis of ¡Viva Bien!

Information on cost-effectiveness of multiple-risk-factor lifestyle interventions for Latinas with diabetes is lacking. The aim of this paper is to evaluate costs and cost-effectiveness for ¡Viva Bien!, a randomized trial targeting Latinas with type 2 diabetes. We estimated 6-month costs; calculated incremental costs per behavioral, biologic, and quality-of-life change; and performed sensitivity analyses from health plan and participant perspectives.

Long-term outcomes from a multiple-risk-factor diabetes trial for Latinas: ¡Viva Bien!

Latinas with type 2 diabetes are in need of culturally sensitive interventions to make recommended longterm lifestyle changes and reduce heart disease risk. To test the longer-term (24-month) effects of a previously successful, culturally adapted, multiple-healthbehavior- change program, ¡Viva Bien!, 280 Latinas were randomly assigned to usual care or ¡Viva Bien!. Treatment included group meetings to promote a culturally adapted Mediterranean diet, physical activity, supportive resources, problem solving, stress-management practices, and smoking cessation.

Use of RE-AIM to develop a multi-media facilitation tool for the patient-centered medical home.

Background: Much has been written about how the medical home model can enhance patient-centeredness, care continuity, and follow-up, but few comprehensive aids or resources exist to help practices accomplish these aims. The complexity of primary care can overwhelm those concerned with quality improvement.

Methods: The RE-AIM planning and evaluation model was used to develop a multimedia, multiple-health behavior tool with psychosocial assessment and feedback features to facilitate and guide patient-centered communication, care, and follow-up related to prevention and self-management of the most common adult chronic illnesses seen in primary care.

Computerized portion-size estimation compared to multiple 24-hour dietary recalls for measurement of fat, fruit, and vegetable intake in overweight adults.

Validated self-report methods of dietary assessment exist and might be improved in terms of both accuracy and cost-efficiency with computer technology. The objectives of this preliminary study were to develop an initial version of an interactive CD-ROM program to estimate fruit, vegetable, and fat intake, and to compare it to multiple 24-hour dietary recalls (averaged over 3 days). In 2009, overweight male and female adults (n=205) from Lane County, OR, completed computerized and paper versions of fruit, vegetable, and fat screening instruments, and multiple 24-hour dietary recalls.

Effects of acculturation on a culturally adapted diabetes intervention for Latinas.

Objective: To inform the refinement of a culturally adapted diabetes intervention, we evaluated acculturation's association with variables at several sequential steps: baseline measures of diet and physical activity, intervention engagement, putative mediators (problem solving and social resources), and outcomes (fat consumption and physical activity).

Method: Latina women (N = 280) recruited from health organizations were randomly assigned to a culturally adapted lifestyle intervention (¡Viva Bien!) or usual care. A brief version of the Acculturation Rating Scale for Mexican Americans-II (ARSMA-II) acculturation scales (Anglo and Latina orientations) was administered at baseline.

Engagement in a diabetes self-management website: usage patterns and generalizability of program use.

Background: Increased access to the Internet and the availability of efficacious eHealth interventions offer great promise for assisting adults with diabetes to change and maintain health behaviors. A key concern is whether levels of engagement in Internet programs are sufficient to promote and sustain behavior change.

Objective: This paper used automated data from an ongoing Internet-based diabetes self-management intervention study to calculate various indices of website engagement.

Use of voter registration records to recruit a representative sample.

Research samples are not often compared to broader community samples to evaluate their representativeness, a critical factor in determining the generalizability of study findings. This study evaluated the use of voter-registration records for recruiting a representative sample of community-dwelling, older, and overweight participants for research on improving measures of diet and physical activity. County voter-registration records were used to identify individuals between 45 and 75 years of age and living in the two cities closest to the research lab.

Outcomes from a multiple risk factor diabetes self-management trial for Latinas: ¡Viva Bien!

Background: Culturally appropriate interventions are needed to assist Latinas in making multiple healthful lifestyle changes.

Purpose: The purpose of this study was to test a cultural adaptation of a successful multiple health behavior change program, ¡Viva Bien!

Methods: Random assignment of 280 Latinas with type 2 diabetes to usual care only or to usual care + ¡Viva Bien!, which included group meetings for building skills to promote the Mediterranean diet, physical activity, stress management, supportive resources, and smoking cessation.

Results: ¡Viva Bien! participants compared to usual care significantly improved psychosocial and behavioral outcomes (fat intake, stress management practice, physical activity, and social-environmental support) at 6 months, and some improvements were maintained at 12 months.

Starting the conversation performance of a brief dietary assessment and intervention tool for health professionals.

Introduction: For chronic disease prevention and management, brief but valid dietary assessment tools are needed to determine risk, guide counseling, and monitor progress in a variety of settings. Starting The Conversation (STC) is an eight-item simplified food frequency instrument designed for use in primary care and health-promotion settings.

Purpose: This report investigates the feasibility, validity, and sensitivity to change of the STC tool, a simplified screener instrument for assessment and counseling.

Psychometric properties of a Korean version of the summary of diabetes self-care activities measure.

Background: The summary of diabetes self-care activities (SDSCA) questionnaire is one of the most widely used self-report instruments for measuring diabetes self-management in adults.

Objectives: This study aimed to examine the psychometric properties of a Korean version of the SDSCA questionnaire.

Methods: The 11-item English version of the SDSCA was translated into Korean following the standard translation methodology.

Outcomes of minimal and moderate support versions of an internet-based diabetes self-management support program.

Objective: Internet and other interactive technology-based programs offer great potential for practical, effective, and cost-efficient diabetes self-management (DSM) programs capable of reaching large numbers of patients. This study evaluated minimal and moderate support versions of an Internet-based diabetes self-management program, compared to an enhanced usual care condition.

Research Design And Methods: A three-arm practical randomized trial was conducted to evaluate minimal contact and moderate contact versions of an Internet-based diabetes self-management program, offered in English and Spanish, compared to enhanced usual care.

A qualitative case study examining intervention tailoring for minorities.

Objectives: To explore issues of intervention tailoring for ethnic minorities based on information and experiences shared by researchers affiliated with the Health Maintenance Consortium (HMC).

Methods: A qualitative case study methodology was used with the administration of a survey (n = 17 principal investigators) and follow-up telephone interviews. Descriptive and content analyses were conducted, and a synthesis of the findings was developed.

Seven-year follow-up of a multiple-health-behavior diabetes intervention.

Objective: To examine the long-term effects of multiple health-behavior changes from the Mediterranean Lifestyle Program.

Methods: The randomized trial targeted postmenopausal women with type 2 diabetes (N = 279) at high risk for heart disease. The intervention featured a weekend retreat followed by regular meetings over 24 months to enhance healthful eating, physical activity (PA), stress management, and support behaviors.

Mediation analyses: applications in nutrition research and reading the literature.

Mediation analysis is a newer statistical tool that is becoming more prominent in nutrition research. Its use provides insight into the relationship among variables in a potential causal chain. For intervention studies, it can define the influence of different programmatic components and, in doing so, allows investigators to identify and refine a program's critical aspects.

Viva bien!: Overcoming recruitment challenges in a multiple-risk-factor diabetes trial.

Objectives: To describe recruitment of Latinas in a randomized clinical trial conducted within 2 health care organizations.

Methods: The study relied on project-initiated telephone calls as part of a multifaceted recruitment approach. Chi-square and t tests were conducted to compare participants and nonparticipants on a number of variables.

Self-efficacy, problem solving, and social-environmental support are associated with diabetes self-management behaviors.

Objective: To evaluate associations between psychosocial and social-environmental variables and diabetes self-management, and diabetes control.

Research Design And Methods: Baseline data from a type 2 diabetes self-management randomized trial with 463 adults having elevated BMI (M = 34.8 kg/m(2)) were used to investigate relations among demographic, psychosocial, and social-environmental variables; dietary, exercise, and medication-taking behaviors; and biologic outcomes.

Methods for the cultural adaptation of a diabetes lifestyle intervention for Latinas: an illustrative project.

Because Latinas experience a high prevalence of type 2 diabetes and its complications, there is an urgent need to reach them with interventions that promote healthful lifestyles. This article illustrates a sequential approach that took an effective multiple-risk-factor behavior-change program and adapted it for Latinas with type 2 diabetes. Adaptation stages include (a) information gathering from literature and focus groups, (b) preliminary adaptation design, and (c) preliminary adaptation test.

A brief intervention designed to increase breast cancer self-screening.

Purpose: To assess the efficacy of an intervention designed to increase appropriate use of breast self-examination (BSE).

Methods: Two-armed randomized clinical trial of cancer-control interventions in women that compared a BSE intervention program to a dietary intervention, which served as the control group. The study was conducted at a large health maintenance organization in Portland, Oregon.