Purpose The purpose of the study was to explore the influences of the neighborhood environment on physical activity (PA) among people living with type 2 diabetes mellitus (T2DM) in a community with limited resources. Methods Participants were adults with T2DM and their family members or friends who help in the management of T2DM and who were living in a low-income African American (AA) community. Health care providers working in the neighborhood were also included. Using an emergent design, qualitative data were collected through 7 focus group discussions (N = 63) and 13 in-depth interviews. Verbatim transcriptions were analyzed via thematic coding to explore contextual factors that limit PA and meaning around neighborhood features that promote or discourage PA. Results Levels of PA were strongly limited by neighborhood insecurity and a lack of recreational facilities in the neighborhood. People with T2DM and physical/mobility disabilities were more affected by the neighborhood environment than those without disabilities, particularly due to perceived safety concerns and social stigma. Despite socioeconomic inequalities within neighborhoods, participants showed resilience and made efforts to overcome social-environmental barriers to PA, applied various coping strategies, and received social support. Conclusions Results suggested that in an underserved neighborhood, individual barriers to physical activity were amplified by neighborhood-level factors such as crime, especially among individuals who have T2DM and disabilities. Socioeconomic inequalities should be addressed further to improve management of T2DM and its complications.
Purpose The purpose of this study was to understand barriers and facilitators to engagement in a diabetes prevention program for young women at an urban safety-net health care system. Methods Individual semistructured interviews (N = 29) explored motivations, challenges, and successes regarding participation and suggestions for improvement among women aged 18 to 39 years who enrolled in the National Diabetes Prevention Program in the past 2 years. Participants were classified as nonattendees (n = 10), early-withdrawers (n = 9), or completers (n = 10). Interview transcriptions were analyzed using a grounded hermeneutic editing approach. Results Qualitative analysis revealed 4 main themes (enrollment, attendance, experience, and suggestions) with multiple subthemes. Most women were motivated to enroll for health and family concerns. Early-withdrawers and nonattendees reported confusion about the program’s aim and relevancy, logistical barriers, and lack of connection with fellow participants/coaches. Highly engaged women noted persistent motivation, perceived weight loss, and supportive program relationships. Conclusions Multiple barriers/facilitators for young women appear addressable in future adaptations. Additional research is needed to confirm these findings in other settings and explore implementation and effectiveness of adaptations, with a goal of reducing risks prior to conception.
Purpose The purpose of this study is to examine diabetes standard of care among individuals who have diabetes with and without cognitive limitation disabilities (CLDs). Individuals with CLDs are more likely to develop diabetes and less likely to participate in diabetes standard of care services compared to those without CLDs. Methods We used pooled cross-sectional data (2011-2016) from the Household Component of the Medical Expenditure Panel Survey (HC-MEPS). Dependent variables were utilization of dilated eye exams, foot checks, A1C blood tests, and engagement in moderate or vigorous physical exercise 5 times per week. Our independent variable was diabetes with CLDs vs diabetes without CLDs. We controlled for predisposing, enabling, and need factors. Results Findings suggest that individuals with diabetes and CLDs were less likely to engage in moderate or vigorous physical exercise 5 times per week compared to individuals without CLDs. For other diabetes care services, individuals with CLDs are as likely to participate in health services utilization as those without CLDs. Conclusions Our study supports research that indicates individuals with diabetes and CLDs were less likely to participate in physical exercise compared to individuals without CLDs. Conversely, individuals with diabetes and CLDs were just as likely to receive a dilated eye exam, have their feet checked, and have their A1C checked as individuals without CLDs, which is a very encouraging finding.
Purpose The purpose of the study was to evaluate the effectiveness of ALDEA (Latinos con Diabetes en Acción), a Shared Medical Appointment (SMA) intervention, compared to usual primary care (UPC) for the treatment of adults with type 2 diabetes over a 6-month period. It was hypothesized that participants in the SMA will have greater reductions in A1C at 6 months post-intervention compared to the control group. Methods This study was a quasi-experimental design with a non-randomized matched control group that followed participants prospectively for 6 months. All adults living with type-2 diabetes receiving primary care at a 2 FQHC clinics were eligible for inclusion. Participants in the control group were matched retrospectively on baseline A1C and age. Results The reductions in A1C were greater in the ALDEA SMA intervention group relative to the UPC control group at 6 months in both of the FQHC centers and in the combined sample. Conclusions This study demonstrated that patients in the ALDEA program had a significantly greater reduction in A1C at 6 months compared to the control group. Despite its limitations, the ALDEA SMA program was successful in empowering patients and improving glycemic control.
