Felicia Hill-Briggs, PhD - Academia.edu (original) (raw)

Papers by Felicia Hill-Briggs, PhD

Purpose of Review The goal of this review is to describe diabetes within a population health impr... more Purpose of Review The goal of this review is to describe diabetes within a population health improvement framework and to review the evidence for a diabetes population health continuum of intervention approaches, including diabetes prevention and chronic and acute diabetes management, to improve clinical and economic outcomes. Recent Findings Recent studies have shown that compared to usual care, lifestyle interventions in prediabetes lower diabetes risk at the population-level and that group-based programs have low incremental medial cost effectiveness ratio for health systems. Effective outpatient interventions that improve diabetes control and process outcomes are multi-level, targeting the patient, provider, and healthcare system simultaneously and integrate community health workers as a liaison between the patient and community-based healthcare resources. A multi-faceted approach to diabetes management is also effective in the inpatient setting. Interventions shown to promote safe and effective glycemic control and use of evidence-based glucose management practices include provider reminder and clinical decision support systems, automated computer order entry, provider education, and organizational change. Summary Future studies should examine the cost-effectiveness of multi-faceted outpatient and inpatient diabetes management programs to determine the best financial models for incorporating them into diabetes population health strategies.

Disparities in diabetes burden exist in large part because of the social determinants of health (... more Disparities in diabetes burden exist in large part because of the social determinants of health (SDOH). Translation research and practice addressing health equity in diabetes have generally focused on changing individual behavior or providing supportive approaches to compensate for, rather than directly target, SDOH. The purpose of this article is to propose a pathway for addressing SDOH as root causes of diabetes disparities and as an essential target for the next generation of interventions needed to achieve health equity in diabetes prevention and treatment. This review describes (a) the current burden of diabetes disparities, (b) the influence of SDOH on diabetes disparities, (c) gaps in and implications of current translation research, and (d) approaches to achieving health equity in the next generation of diabetes translation. 19.1

Complex environmental, social, behavioral, and emotional factors, known as psy-chosocial factors,... more Complex environmental, social, behavioral, and emotional factors, known as psy-chosocial factors, influence living with diabetes, both type 1 and type 2, and achieving satisfactory medical outcomes and psychological well-being. Thus, individuals with diabetes and their families are challenged with complex, multifaceted issues when integrating diabetes care into daily life. To promote optimal medical outcomes and psychological well-being, patient-centered care is essential, defined as "providing care that is respectful of and responsive to individual patient preferences , needs, and values and ensuring that patient values guide all clinical decisions" (1). Practicing personalized, patient-centered psychosocial care requires that communications and interactions, problem identification, psychosocial screening, diagnostic evaluation, and intervention services take into account the context of the person with diabetes (PWD) and the values and preferences of the PWD. This article provides diabetes care providers with evidence-based guidelines for psychosocial assessment and care of PWD and their families. Recommendations are based on commonly used clinical models, expert consensus, and tested interventions , taking into account available resources, practice patterns, and practitioner burden. Consideration of life span and disease course factors (Fig. 1) is critical in the psychosocial care of PWD. This Position Statement focuses on the most common psychological factors affecting PWD, including diabetes distress and psychological comorbidities, while also considering the needs of special populations and the context of care. GENERAL CONSIDERATIONS IN PSYCHOSOCIAL CARE Recommendations c Psychosocial care should be integrated with collaborative, patient-centered medical care and provided to all people with diabetes, with the goals of optimizing health outcomes and health-related quality of life. A c Providers should consider an assessment of symptoms of diabetes distress, depression, anxiety, and disordered eating and of cognitive capacities using patient-appropriate standardized/validated tools at the initial visit, at periodic intervals, and when there is a change in disease, treatment, or life circumstance. Including caregivers and family members in this assessment is recommended. B c Consider monitoring patient performance of self-management behaviors as well as psychosocial factors impacting the person's self-management. E c Consider assessment of life circumstances that can affect physical and psychological health outcomes and their incorporation into intervention strategies. E c Addressing psychosocial problems upon identification is recommended. If an intervention cannot be initiated during the visit when the problem is identified, a follow-up visit or referral to a qualified behavioral health care provider may be scheduled during that visit. E Practitioners should identify behavioral/mental health providers, ideally those who are knowledgeable about diabetes treatment and the psychosocial aspects of diabetes, with whom they can form alliances and use for referrals (Table 1) in the psychosocial care of PWD. Ideally, psychosocial care providers should be embedded in diabetes care settings. Shared resources such as electronic health records, management data, and patient-reported

BMC health services research, 2015

The republic of Trinidad and Tobago (T&T) is a middle income country with a comparatively high pr... more The republic of Trinidad and Tobago (T&T) is a middle income country with a comparatively high prevalence of diabetes mellitus (DM) compared to others in the Caribbean. To date, there have been no studies on health care professionals' (HCP) perspectives regarding the barriers to achieving optimal care of patients with DM in this country and few previous studies in the Caribbean, yet such perspectives are imperative to develop strategies that reduce the global burden of this disease. An electronic invitation was sent to prospective HCP in T&T inviting them to attend a symposium on DM and cardiovascular disease. A total of 198 HCP participants attended of whom approximately 100 participants completed an Audience Response Survey at the completion of the conference. The Audience Response Survey included questions regarding access to resources, need for prevention and education, and coordination of care for to diabetes care in T&T. Responses were analyzed in aggregate. The 198 HCP pa...

Psychoneuroendocrinology, 2015

Prior studies have shown a bidirectional association between depression and type 2 diabetes melli... more Prior studies have shown a bidirectional association between depression and type 2 diabetes mellitus (T2DM); however, the prospective associations of anger and anxiety with T2DM have not been established. We hypothesized that trait anger and anxiety would predict incident T2DM, independently of depressive symptoms. In the Multi-ethnic Study of Atherosclerosis (MESA), we prospectively examined the association of trait anger and trait anxiety (assessed via the Spielberger Trait Anger and Anxiety Scales, respectively) with incident T2DM over 11.4 years in 5598 White, Black, Hispanic, and Chinese participants (53.2% women, mean age 61.6 years) at baseline without prevalent T2DM or cardiovascular disease. We used Cox proportional hazards models to calculate the hazard ratios (HR) of incident T2DM by previously defined anger category (low, moderate, high), and anxiety quartile, as there were no previously defined categories. High total trait anger was associated with incident T2DM (HR 1.50; 95% CI 1.08-2.07) relative to low total trait anger. The association was attenuated following adjustment for waist circumference (HR 1.32; 95% CI 0.94-1.86). Higher anger reaction was also associated with incident T2DM (HR=1.07; 95% CI 1.03-1.11) that remained significant after adjusting for potential confounders/explanatory factors. In contrast, trait anxiety did not predict incident T2DM. High total trait anger and anger reaction are potential modifiable risk factors for T2DM. Further research is needed to explore the mechanisms of the anger-diabetes relationship and to develop preventive interventions.

The American Journal of Geriatric Psychiatry, 2015

To describe the methodology utilized to evaluate cognitive function in the Multi-Ethnic Study of ... more To describe the methodology utilized to evaluate cognitive function in the Multi-Ethnic Study of Atherosclerosis (MESA) and to present preliminary results by age, sex, and race/ethnicity. Cross-sectional measurements of a prospective observational cohort. Residents of 6 U.S. communities free of cardiovascular disease at baseline (2000-02). 4,591 adults who completed the fifth MESA clinical examination in 2011-12; mean age 70.3 (SD: 9.5) years, 53.1% women, 40.7% non-Hispanic white, 26.4% non-Hispanic black, 21.4% Hispanic, and 11.5% Chinese. The cognitive battery consisted of the Cognitive Abilities Screening Instrument (version 2) to evaluate global cognition, the Digit Symbol Code for processing speed and Digit Spans Forward and Backward to assess memory. Demographic, socioeconomic, and cultural covariates were also collected for descriptive statistics and multivariate modeling. Associations between socioeconomic factors and cognition revealed that age, race/ethnicity, education, occupational status, household income, health insurance type, household size, place of birth, years and generation in U.S., and the presence of the ApoE4 allele were significantly associated with performance on the cognitive tests, although patterns varied by specific test, racial/ethnicity, and sociocultural factors. As many of the influencing cultural and socioeconomic factors measured here are complex, multifactorial, and may not be adequately quantified, caution has been recommended with regard to comparison and interpretation of racial/ethnic group performance differences from these cross-sectional models. These data provide a baseline for future exams and more comprehensive longitudinal analyses of the contributions of subclinical and clinical diseases to cognitive function and decline.

Journal of Rehabilitation Medicine, 2008

To examine effectiveness of standardized occupational therapy and physical therapy assessments in... more To examine effectiveness of standardized occupational therapy and physical therapy assessments in detecting functional changes and predicting clinical improvement in patients with suspected normal pressure hydrocephalus undergoing cerebrospinal fluid drainage. Cohort study. Eighty-seven patients admitted to an inpatient neurology unit for elective cerebrospinal fluid drainage for suspected normal pressure hydrocephalus. Before and after a protocol of continuous cerebrospinal fluid drainage via spinal catheter, patients were administered the Functional Independence Measure (FIMTM), Timed Up and Go (TUG), Tinetti Assessment Tool of Gait and Balance, 9-hole peg test, and Cognitive Assessment of Minnesota (CAM). Following cerebrospinal fluid drainage, changes in functional performance were compared for responders to cerebrospinal fluid drainage and non-responders to cerebrospinal fluid drainage. At baseline, CAM was more sensitive than the Mini Mental State Exam in predicting responders. Post-drainage: responders improved on 52% of tests while non-responders improved on only 11%. Assessments that differentiated magnitude of improvement in responders vs non-responders were: TUG (p<0.05), Tinetti total (p<0.001), Tinetti balance (p<0.001), Tinetti gait…

BMC nephrology, 2015

Live donor kidney transplantation (LDKT), an optimal therapy for many patients with end-stage kid... more Live donor kidney transplantation (LDKT), an optimal therapy for many patients with end-stage kidney disease, is underutilized, particularly by African Americans. Potential recipient difficulties initiating and sustaining conversations about LDKT, identifying willing and medically eligible donors, and potential donors' logistical and financial hurdles have been cited as potential contributors to race disparities in LDKT. Few interventions specifically targeting these factors have been tested. We report the protocol of the Talking about Living Kidney Donation Support (TALKS) study, a study designed to evaluate the effectiveness of behavioral, educational and financial assistance interventions to improve access to LDKT among African Americans on the deceased donor kidney transplant recipient waiting list. We adapted a previously tested educational and social worker intervention shown to improve consideration and pursuit of LDKT among patients and their family members for its use a...

Background: African Americans (AA) have higher rates of diabetes-related complications compared t... more Background: African Americans (AA) have higher rates of diabetes-related complications compared to their white counterparts, and poorer medication adherence may contribute to this disparity. To design more effective interventions and improve health outcomes, there is a need to better understand behaviors associated with medication non-adherence in this population. Research Design and Methods: We conducted a cross-sectional study among 488 AA adults with type 2 diabetes who were participants in Project Sugar 2, a clinic and primary-care based intervention study in an urban managed care organization. Medication adherence was assessed using a measure designed for urban populations of low socioeconomic status (Hill-Bone Compliance scale). The scale consisted of 9 questions evaluating how often participants forgot to take their medication, get prescriptions filled, and how often they missed taking them when they, for example, were being careless, felt better, or sick. A higher score indi...

Background: While African Americans suffer disproportionately from complications of diabetes, few... more Background: While African Americans suffer disproportionately from complications of diabetes, few studies have tested culturally appropriate and comprehensive interventions to improve diabetes care and reduce ER visits. Methods: Therefore, we conducted a randomized controlled trial among 542 African Americans with type 2 diabetes enrolled in an urban managed care organization. Participants were randomized to either an Intensive Intervention Group (INT) or Minimal Intervention Group (MIN). The INT consisted of individualized, culturally-tailored care provided by a nurse-case manager (who assessed and reinforced medication adherence and medical issues in the clinic) and a community health worker (who provided health education and mobilized social support in the home), using evidence-based clinical algorithms with feedback to primary care providers. The MIN consisted of mailings and phone calls every 6 mo to remind participants about preventive screenings. Participants made data collec...

Journal of Epidemiology and Global Health, 2015

The present study aims to determine the prevalence of self-reported sleep duration and sleep habi... more The present study aims to determine the prevalence of self-reported sleep duration and sleep habits and their associated factors in patients with type 2 diabetes in Trinidad. This was a cross-sectional multicenter study. There were 291 patients with type 2 diabetes studied. Sleep habits were assessed using the Epworth Sleepiness Scale (ESS) and the National Health and Nutrition Examination Survey sleep disorder questionnaire. Demographic, anthropometric and biochemical data were also collected. The sample had a mean age of 58.8years; 66.7% were female. The mean BMI was 28.9kg/m(2). The prevalence of Excessive Daytime Sleepiness (EDS) was 11.3%. The prevalence of patients with short sleep (⩽6h) was 28.5%. The prevalence of patients with poor sleep was 63.9%. Poor sleep was associated with age, intensive anti-diabetic treatment and longer duration of diabetes. Short sleep was associated with intensive anti-diabetic treatment and BMI, while EDS was associated with increased BMI. In a sample of patients with type 2 diabetes, a high prevalence of self-reported sleep duration and unhealthy sleep habits was found. There needs to be an increased awareness of sleep conditions in adults with type 2 diabetes by doctors caring for these patients.

Progress in transplantation (Aliso Viejo, Calif.), 2011

Ethnic/racial minority and nonminority families' perceived barriers to discussing preemptive ... more Ethnic/racial minority and nonminority families' perceived barriers to discussing preemptive living related kidney transplantation (LRKT) and their views on the potential value of health care professionals trained to address barriers are unknown. OBJECTIVE, SETTING, AND PARTICIPANTS: To collect pilot data for evaluating perceived barriers to preemptive LRKT and to inform the development of a culturally sensitive intervention to improve families' consideration of LRKT. In 4 structured group interviews of African American and non-African American patients (2 groups) with progressing chronic kidney disease and their family members (2 groups), participants' perceived barriers to initiating LRKT discussions and their views regarding the value of social workers to support discussions were explored. Patients' barriers included concerns about their (1) ability to initiate discussions, (2) discussions being misinterpreted as donation requests, (3) potential burdening of famil...

International Journal of Behavioral Medicine, 2014

The Nursing clinics of North America, 2006

Evidence exists that lifestyle interventions in the prevention and treatment of type 2 diabetes a... more Evidence exists that lifestyle interventions in the prevention and treatment of type 2 diabetes are effective. The present challenge is to translate the evidence into policies and practices that maximize the potential health benefits for the largest number of individuals. Translational efforts are urgently needed to identify how best to identify individuals for lifestyle prevention efforts, prepare health care systems for treatment delivery, and design public health policies that support healthy weight through healthy opportunities for eating and physical activity.

Purpose of Review The goal of this review is to describe diabetes within a population health impr... more Purpose of Review The goal of this review is to describe diabetes within a population health improvement framework and to review the evidence for a diabetes population health continuum of intervention approaches, including diabetes prevention and chronic and acute diabetes management, to improve clinical and economic outcomes. Recent Findings Recent studies have shown that compared to usual care, lifestyle interventions in prediabetes lower diabetes risk at the population-level and that group-based programs have low incremental medial cost effectiveness ratio for health systems. Effective outpatient interventions that improve diabetes control and process outcomes are multi-level, targeting the patient, provider, and healthcare system simultaneously and integrate community health workers as a liaison between the patient and community-based healthcare resources. A multi-faceted approach to diabetes management is also effective in the inpatient setting. Interventions shown to promote safe and effective glycemic control and use of evidence-based glucose management practices include provider reminder and clinical decision support systems, automated computer order entry, provider education, and organizational change. Summary Future studies should examine the cost-effectiveness of multi-faceted outpatient and inpatient diabetes management programs to determine the best financial models for incorporating them into diabetes population health strategies.

Disparities in diabetes burden exist in large part because of the social determinants of health (... more Disparities in diabetes burden exist in large part because of the social determinants of health (SDOH). Translation research and practice addressing health equity in diabetes have generally focused on changing individual behavior or providing supportive approaches to compensate for, rather than directly target, SDOH. The purpose of this article is to propose a pathway for addressing SDOH as root causes of diabetes disparities and as an essential target for the next generation of interventions needed to achieve health equity in diabetes prevention and treatment. This review describes (a) the current burden of diabetes disparities, (b) the influence of SDOH on diabetes disparities, (c) gaps in and implications of current translation research, and (d) approaches to achieving health equity in the next generation of diabetes translation. 19.1

Complex environmental, social, behavioral, and emotional factors, known as psy-chosocial factors,... more Complex environmental, social, behavioral, and emotional factors, known as psy-chosocial factors, influence living with diabetes, both type 1 and type 2, and achieving satisfactory medical outcomes and psychological well-being. Thus, individuals with diabetes and their families are challenged with complex, multifaceted issues when integrating diabetes care into daily life. To promote optimal medical outcomes and psychological well-being, patient-centered care is essential, defined as "providing care that is respectful of and responsive to individual patient preferences , needs, and values and ensuring that patient values guide all clinical decisions" (1). Practicing personalized, patient-centered psychosocial care requires that communications and interactions, problem identification, psychosocial screening, diagnostic evaluation, and intervention services take into account the context of the person with diabetes (PWD) and the values and preferences of the PWD. This article provides diabetes care providers with evidence-based guidelines for psychosocial assessment and care of PWD and their families. Recommendations are based on commonly used clinical models, expert consensus, and tested interventions , taking into account available resources, practice patterns, and practitioner burden. Consideration of life span and disease course factors (Fig. 1) is critical in the psychosocial care of PWD. This Position Statement focuses on the most common psychological factors affecting PWD, including diabetes distress and psychological comorbidities, while also considering the needs of special populations and the context of care. GENERAL CONSIDERATIONS IN PSYCHOSOCIAL CARE Recommendations c Psychosocial care should be integrated with collaborative, patient-centered medical care and provided to all people with diabetes, with the goals of optimizing health outcomes and health-related quality of life. A c Providers should consider an assessment of symptoms of diabetes distress, depression, anxiety, and disordered eating and of cognitive capacities using patient-appropriate standardized/validated tools at the initial visit, at periodic intervals, and when there is a change in disease, treatment, or life circumstance. Including caregivers and family members in this assessment is recommended. B c Consider monitoring patient performance of self-management behaviors as well as psychosocial factors impacting the person's self-management. E c Consider assessment of life circumstances that can affect physical and psychological health outcomes and their incorporation into intervention strategies. E c Addressing psychosocial problems upon identification is recommended. If an intervention cannot be initiated during the visit when the problem is identified, a follow-up visit or referral to a qualified behavioral health care provider may be scheduled during that visit. E Practitioners should identify behavioral/mental health providers, ideally those who are knowledgeable about diabetes treatment and the psychosocial aspects of diabetes, with whom they can form alliances and use for referrals (Table 1) in the psychosocial care of PWD. Ideally, psychosocial care providers should be embedded in diabetes care settings. Shared resources such as electronic health records, management data, and patient-reported

BMC health services research, 2015

The republic of Trinidad and Tobago (T&T) is a middle income country with a comparatively high pr... more The republic of Trinidad and Tobago (T&T) is a middle income country with a comparatively high prevalence of diabetes mellitus (DM) compared to others in the Caribbean. To date, there have been no studies on health care professionals' (HCP) perspectives regarding the barriers to achieving optimal care of patients with DM in this country and few previous studies in the Caribbean, yet such perspectives are imperative to develop strategies that reduce the global burden of this disease. An electronic invitation was sent to prospective HCP in T&T inviting them to attend a symposium on DM and cardiovascular disease. A total of 198 HCP participants attended of whom approximately 100 participants completed an Audience Response Survey at the completion of the conference. The Audience Response Survey included questions regarding access to resources, need for prevention and education, and coordination of care for to diabetes care in T&T. Responses were analyzed in aggregate. The 198 HCP pa...

Psychoneuroendocrinology, 2015

Prior studies have shown a bidirectional association between depression and type 2 diabetes melli... more Prior studies have shown a bidirectional association between depression and type 2 diabetes mellitus (T2DM); however, the prospective associations of anger and anxiety with T2DM have not been established. We hypothesized that trait anger and anxiety would predict incident T2DM, independently of depressive symptoms. In the Multi-ethnic Study of Atherosclerosis (MESA), we prospectively examined the association of trait anger and trait anxiety (assessed via the Spielberger Trait Anger and Anxiety Scales, respectively) with incident T2DM over 11.4 years in 5598 White, Black, Hispanic, and Chinese participants (53.2% women, mean age 61.6 years) at baseline without prevalent T2DM or cardiovascular disease. We used Cox proportional hazards models to calculate the hazard ratios (HR) of incident T2DM by previously defined anger category (low, moderate, high), and anxiety quartile, as there were no previously defined categories. High total trait anger was associated with incident T2DM (HR 1.50; 95% CI 1.08-2.07) relative to low total trait anger. The association was attenuated following adjustment for waist circumference (HR 1.32; 95% CI 0.94-1.86). Higher anger reaction was also associated with incident T2DM (HR=1.07; 95% CI 1.03-1.11) that remained significant after adjusting for potential confounders/explanatory factors. In contrast, trait anxiety did not predict incident T2DM. High total trait anger and anger reaction are potential modifiable risk factors for T2DM. Further research is needed to explore the mechanisms of the anger-diabetes relationship and to develop preventive interventions.

The American Journal of Geriatric Psychiatry, 2015

To describe the methodology utilized to evaluate cognitive function in the Multi-Ethnic Study of ... more To describe the methodology utilized to evaluate cognitive function in the Multi-Ethnic Study of Atherosclerosis (MESA) and to present preliminary results by age, sex, and race/ethnicity. Cross-sectional measurements of a prospective observational cohort. Residents of 6 U.S. communities free of cardiovascular disease at baseline (2000-02). 4,591 adults who completed the fifth MESA clinical examination in 2011-12; mean age 70.3 (SD: 9.5) years, 53.1% women, 40.7% non-Hispanic white, 26.4% non-Hispanic black, 21.4% Hispanic, and 11.5% Chinese. The cognitive battery consisted of the Cognitive Abilities Screening Instrument (version 2) to evaluate global cognition, the Digit Symbol Code for processing speed and Digit Spans Forward and Backward to assess memory. Demographic, socioeconomic, and cultural covariates were also collected for descriptive statistics and multivariate modeling. Associations between socioeconomic factors and cognition revealed that age, race/ethnicity, education, occupational status, household income, health insurance type, household size, place of birth, years and generation in U.S., and the presence of the ApoE4 allele were significantly associated with performance on the cognitive tests, although patterns varied by specific test, racial/ethnicity, and sociocultural factors. As many of the influencing cultural and socioeconomic factors measured here are complex, multifactorial, and may not be adequately quantified, caution has been recommended with regard to comparison and interpretation of racial/ethnic group performance differences from these cross-sectional models. These data provide a baseline for future exams and more comprehensive longitudinal analyses of the contributions of subclinical and clinical diseases to cognitive function and decline.

Journal of Rehabilitation Medicine, 2008

To examine effectiveness of standardized occupational therapy and physical therapy assessments in... more To examine effectiveness of standardized occupational therapy and physical therapy assessments in detecting functional changes and predicting clinical improvement in patients with suspected normal pressure hydrocephalus undergoing cerebrospinal fluid drainage. Cohort study. Eighty-seven patients admitted to an inpatient neurology unit for elective cerebrospinal fluid drainage for suspected normal pressure hydrocephalus. Before and after a protocol of continuous cerebrospinal fluid drainage via spinal catheter, patients were administered the Functional Independence Measure (FIMTM), Timed Up and Go (TUG), Tinetti Assessment Tool of Gait and Balance, 9-hole peg test, and Cognitive Assessment of Minnesota (CAM). Following cerebrospinal fluid drainage, changes in functional performance were compared for responders to cerebrospinal fluid drainage and non-responders to cerebrospinal fluid drainage. At baseline, CAM was more sensitive than the Mini Mental State Exam in predicting responders. Post-drainage: responders improved on 52% of tests while non-responders improved on only 11%. Assessments that differentiated magnitude of improvement in responders vs non-responders were: TUG (p<0.05), Tinetti total (p<0.001), Tinetti balance (p<0.001), Tinetti gait…

BMC nephrology, 2015

Live donor kidney transplantation (LDKT), an optimal therapy for many patients with end-stage kid... more Live donor kidney transplantation (LDKT), an optimal therapy for many patients with end-stage kidney disease, is underutilized, particularly by African Americans. Potential recipient difficulties initiating and sustaining conversations about LDKT, identifying willing and medically eligible donors, and potential donors' logistical and financial hurdles have been cited as potential contributors to race disparities in LDKT. Few interventions specifically targeting these factors have been tested. We report the protocol of the Talking about Living Kidney Donation Support (TALKS) study, a study designed to evaluate the effectiveness of behavioral, educational and financial assistance interventions to improve access to LDKT among African Americans on the deceased donor kidney transplant recipient waiting list. We adapted a previously tested educational and social worker intervention shown to improve consideration and pursuit of LDKT among patients and their family members for its use a...

Background: African Americans (AA) have higher rates of diabetes-related complications compared t... more Background: African Americans (AA) have higher rates of diabetes-related complications compared to their white counterparts, and poorer medication adherence may contribute to this disparity. To design more effective interventions and improve health outcomes, there is a need to better understand behaviors associated with medication non-adherence in this population. Research Design and Methods: We conducted a cross-sectional study among 488 AA adults with type 2 diabetes who were participants in Project Sugar 2, a clinic and primary-care based intervention study in an urban managed care organization. Medication adherence was assessed using a measure designed for urban populations of low socioeconomic status (Hill-Bone Compliance scale). The scale consisted of 9 questions evaluating how often participants forgot to take their medication, get prescriptions filled, and how often they missed taking them when they, for example, were being careless, felt better, or sick. A higher score indi...

Background: While African Americans suffer disproportionately from complications of diabetes, few... more Background: While African Americans suffer disproportionately from complications of diabetes, few studies have tested culturally appropriate and comprehensive interventions to improve diabetes care and reduce ER visits. Methods: Therefore, we conducted a randomized controlled trial among 542 African Americans with type 2 diabetes enrolled in an urban managed care organization. Participants were randomized to either an Intensive Intervention Group (INT) or Minimal Intervention Group (MIN). The INT consisted of individualized, culturally-tailored care provided by a nurse-case manager (who assessed and reinforced medication adherence and medical issues in the clinic) and a community health worker (who provided health education and mobilized social support in the home), using evidence-based clinical algorithms with feedback to primary care providers. The MIN consisted of mailings and phone calls every 6 mo to remind participants about preventive screenings. Participants made data collec...

Journal of Epidemiology and Global Health, 2015

The present study aims to determine the prevalence of self-reported sleep duration and sleep habi... more The present study aims to determine the prevalence of self-reported sleep duration and sleep habits and their associated factors in patients with type 2 diabetes in Trinidad. This was a cross-sectional multicenter study. There were 291 patients with type 2 diabetes studied. Sleep habits were assessed using the Epworth Sleepiness Scale (ESS) and the National Health and Nutrition Examination Survey sleep disorder questionnaire. Demographic, anthropometric and biochemical data were also collected. The sample had a mean age of 58.8years; 66.7% were female. The mean BMI was 28.9kg/m(2). The prevalence of Excessive Daytime Sleepiness (EDS) was 11.3%. The prevalence of patients with short sleep (⩽6h) was 28.5%. The prevalence of patients with poor sleep was 63.9%. Poor sleep was associated with age, intensive anti-diabetic treatment and longer duration of diabetes. Short sleep was associated with intensive anti-diabetic treatment and BMI, while EDS was associated with increased BMI. In a sample of patients with type 2 diabetes, a high prevalence of self-reported sleep duration and unhealthy sleep habits was found. There needs to be an increased awareness of sleep conditions in adults with type 2 diabetes by doctors caring for these patients.

Progress in transplantation (Aliso Viejo, Calif.), 2011

Ethnic/racial minority and nonminority families' perceived barriers to discussing preemptive ... more Ethnic/racial minority and nonminority families' perceived barriers to discussing preemptive living related kidney transplantation (LRKT) and their views on the potential value of health care professionals trained to address barriers are unknown. OBJECTIVE, SETTING, AND PARTICIPANTS: To collect pilot data for evaluating perceived barriers to preemptive LRKT and to inform the development of a culturally sensitive intervention to improve families' consideration of LRKT. In 4 structured group interviews of African American and non-African American patients (2 groups) with progressing chronic kidney disease and their family members (2 groups), participants' perceived barriers to initiating LRKT discussions and their views regarding the value of social workers to support discussions were explored. Patients' barriers included concerns about their (1) ability to initiate discussions, (2) discussions being misinterpreted as donation requests, (3) potential burdening of famil...

International Journal of Behavioral Medicine, 2014

The Nursing clinics of North America, 2006

Evidence exists that lifestyle interventions in the prevention and treatment of type 2 diabetes a... more Evidence exists that lifestyle interventions in the prevention and treatment of type 2 diabetes are effective. The present challenge is to translate the evidence into policies and practices that maximize the potential health benefits for the largest number of individuals. Translational efforts are urgently needed to identify how best to identify individuals for lifestyle prevention efforts, prepare health care systems for treatment delivery, and design public health policies that support healthy weight through healthy opportunities for eating and physical activity.