Effect of Behavioral Intervention on Dilated Fundus Examination Rates in Older African American Individuals With Diabetes Mellitus: A Randomized Clinical Trial. Cultural characteristics of African Americans: implications for the design of trials that target behavior and health promotion programs. Risk Reduction for HIV-Positive African American and Latino Men with Histories of Childhood Sexual Abuse Rationale and design: telephone-delivered behavioral skills interventions for Blacks with type 2 diabetes Impact of Distress Reduction on Behavioral Correlates and A1C in African American Women with Uncontrolled Type 2 Diabetes: Results from EMPOWER. Readiness to Change and Brief Educational Interventions: Successful Strategies to Reduce Stroke Risk Intervening during and after pregnancy to prevent weight retention among African American women
IMPORTANCE African American individuals are at high risk of diabetes mellitus and diabetic retinopathy but have suboptimal rates of dilated fundus examinations ( DFEs ) . Early intervention is crucial for the prevention of diabetic retinopathy in this high-risk population . OBJECTIVE To test the efficacy of behavioral activation for diabetic retinopathy prevention on rates of DFEs in older African American individuals with diabetes mellitus . DESIGN , SETTING , AND PARTICIPANTS Masked r and omized clinical trial at 2 urban medical centers from October 1 , 2010 , to May 31 , 2014 . Participants included 206 African American individuals 65 years and older with diabetes mellitus who had not obtained a DFE in the preceding 12 months . INTERVENTIONS Participants were r and omized to either behavioral activation for diabetic retinopathy prevention , a behavioral intervention design ed to provide education , facilitate identifying and addressing health care barriers , and promote goal setting to improve rates of DFEs , or supportive therapy , a control condition . MAIN OUTCOMES AND MEASURES The primary outcome was medical documentation of a DFE at 6 months ' follow-up . Secondary outcomes included the Risk Perceptions and Risk Knowledge Survey of Diabetes Mellitus , Diabetes Self-Care Inventory , Patient Health Question naire 9 , and National Eye Institute Vision Function Question naire 25 scores and hemoglobin A1c levels . RESULTS More participants in the behavioral activation for diabetic retinopathy prevention group ( 87.9 % ) obtained a DFE compared with those in the supportive therapy group ( 34.1 % ) by the 6-month follow-up assessment ( P < .001 ) . Overall , participants in the behavioral activation for diabetic retinopathy prevention group were 2.5 times more likely to obtain a DFE compared with those in the supportive therapy group ( risk ratio = 2.58 ; 95 % CI , 1.91 - 3.48 ; P < .001 ) . The intervention had no short-term effect on secondary outcomes of hemoglobin A1c levels , depression , or the Risk Perceptions and Risk Knowledge Survey of Diabetes Mellitus or National Eye Institute Vision Function Question naire 25 composite scores ; however , both groups had improved adherence to diabetes mellitus self-care behaviors from baseline to 6-month follow-up . CONCLUSIONS AND RELEVANCE Behavioral activation for diabetic retinopathy prevention significantly increased rates of DFEs in older African American individuals with diabetes mellitus . Behavioral interventions may have the potential to positively affect screening for diabetic retinopathy in at-risk population s. TRIAL REGISTRATION clinical trials.gov Identifier : NCT01179555 OBJECTIVE To identify African American cultural characteristics that may be used to modify clinical trial design s and behavioral programs aim ed at losing weight and maintaining weight loss . DESIGN Focus group discussion s. SETTING University-affiliated biomedical research center . PARTICIPANTS Thirty-one African American men and women who completed the screening process , but were ineligible for the Weight Loss Maintenance ( WLM ) trial , participated in one of five focus group sessions . WLM is a r and omized controlled trial that compares two lifestyle interventions for preventing weight regain in individuals who have successfully lost weight in a group-based behavioral weight loss program .  RESULTS Nine themes emerged as cultural characteristics specific to African Americans seeking participation in a lifestyle change program : ( 1 ) religion is a powerful force ; ( 2 ) family structure ; ( 3 ) integration dismantled the African American family ; ( 4 ) general mistrust of Caucasians ; ( 5 ) African Americans are undervalued and not respected as a people ; ( 6 ) limited re sources equal limited ability to make lifestyle changes ; ( 7 ) preservation of an explicit ethnic identity ; ( 8) education is the key to success as an African American ; and ( 9 ) communication skills are vital . CONCLUSIONS Identifying cultural characteristics specific to African Americans may help investigators design clinical trials that will enhance outcomes and improve the generalizability of results in ethnic minority population While the HIV epidemic has disproportionately affected African American and Latino men who have sex with men ( MSM ) , few HIV prevention interventions have focused on African American and Latino men who have sex with both men and women ( MSMW ) . Even fewer interventions target HIV-positive African American and Latino MSM and MSMW with histories of childhood sexual abuse ( CSA ) , a population that may be vulnerable to high-risk sexual behaviors , having multiple sexual partners , and depression . The Men ’s Health Project , a small r and omized clinical trial , compared the effects of two 6-session interventions , the Sexual Health Intervention for Men ( S-HIM ) , guided by social learning theory and aim ed at decreasing high-risk sexual behaviors , number of sexual partners , and depressive symptoms , and a st and ard health promotion control ( SHP ) . A community sample of 137 HIV-positive gay and non-gay identifying African American and Latino MSM and MSMW with histories of CSA was recruited . Results were based on an “ intent to treat ” analyses of baseline to post , 3 and 6 month follow-ups . The sample as a whole reported reductions in sexual risk behaviors and number of sexual partners from baseline to post-test , and from the 3 to 6 month follow-ups , although the decrease in sexual risk behavior from baseline to post-test was significant only for S-HIM participants . No significant differences between conditions were reported for depressive symptoms , but the total sample reported a significant decrease at 6 months . These findings highlight the importance of addressing sexual decision-making and psychological adjustment for ethnic men , while being sensitive to CSA histories and sexual minority status , and suggest the need to develop additional strategies to heighten HIV risk reduction over time Background African Americans with Type 2 diabetes ( T2DM ) have higher prevalence of diabetes , poorer metabolic control , and greater risk for complications and death compared to American Whites . Poor outcomes in African Americans with T2DM can be attributed to patient , provider , and health systems level factors . Provider and health system factors account for < 10 % of variance in major diabetes outcomes including hemoglobin A1c ( HbA1c ) , lipid control , and re source use . Key differences appear to be at the patient level . Of the patient level factors , consistent differences between African Americans and American Whites with T2DM have been found in diabetes knowledge , self-management skills , empowerment , and perceived control . A variety of interventions to improve diabetes self-management have been tested including : 1 ) knowledge interventions ; 2 ) lifestyle interventions ; 3 ) skills training interventions ; and 4 ) patient activation and empowerment interventions . Most of these interventions have been tested individually , but rarely have they been tested in combination , especially among African Americans who have the greatest burden of diabetes related complications . This study provides a unique opportunity to address this gap in the literature . Methods / Design We describe an ongoing four-year r and omized clinical trial , using a 2 × 2 factorial design , which will test the efficacy of separate and combined telephone-delivered , diabetes knowledge/information and motivation/behavioral skills training interventions in high risk African Americans with poorly controlled T2DM ( HbA1c ≥ 9 % ) . Two-hundred thirty-two ( 232 ) male and female African-American participants , 18 years of age or older and with an HbA1c ≥ 9 % , will be r and omized into one of four groups for 12-weeks of phone interventions : ( 1 ) an education group , ( 2 ) a motivation/skills group , ( 3 ) a combined group or ( 4 ) a usual care/general health education group . Participants will be followed for 12-months to ascertain the effect of the interventions on glycemic control . Our primary hypothesis is that among African Americans with poorly controlled T2DM , patients r and omized to the combined diabetes knowledge/information and motivation/behavioral skills training intervention will have significantly greater reduction in HbA1c at 12 months of follow-up compared to the usual care/general health education group . Discussion Results from this study will provide important insight into how best to deliver diabetes education and skills training in ethnic minorities and whether combined knowledge/information and motivation/behavioral skills training is superior to the usual method of delivering diabetes education for African Americans with poorly controlled T2DM.Trial registration National Institutes of Health Clinical Trials Registry ( Clinical Trials.gov identifier # NCT00929838 ) OBJECTIVE Symptoms of emotional distress related to diabetes have been associated with inadequate self-care behaviors , medication non-adherence , and poor glycemic control that may predispose patients to premature death . African American women , in whom diabetes is more common and social support is often insufficient , may be at particularly high risk . The objective of this study was to examine the impact of lowering diabetes-related emotional distress on glycemic control and associated behavioral correlates in rural African American women with uncontrolled type 2 diabetes ( T2D ) . DESIGN Post-hoc analysis of prospect i ve , r and omized , controlled trial . SETTING Rural communities in the southeastern United States . PATIENTS 129 rural middle-aged African American women with uncontrolled type 2 diabetes (T2D)(A1C ≥ 7.0 ) . PRIMARY INDEPENDENT VARIABLE Diabetes-related distress . MAIN OUTCOME MEASURES Changes from baseline to 12-month follow-up in diabetes-related distress , and associated changes in medication adherence , self-care activities , self-efficacy , and glycemic control ( A1C ) . RESULTS Patients with a reduction in diabetes-related distress ( n=79 ) had significantly greater improvement in A1C , medication adherence , self-care activities , and self-efficacy compared with those in whom diabetes distress worsened or was unchanged ( n=50 ) . Changes in distress were also significantly and inversely correlated with improvements in medication adherence , self-care activities , and self-efficacy . CONCLUSIONS Among rural African American women , reductions in diabetes-related distress may be associated with lower A1C and improvements in self-efficacy , self-care behaviors , and medication adherence & NA ; Despite recent advances in stroke treatment and prevention , identifying effective educational interventions for “ at‐risk ” groups that will help reduce their stroke risk and improve the speed of seeking treatment remains of paramount importance . The purpose of this pilot study was to determine whether a brief educational intervention , tailored to the patient 's stage of readiness to change , could affect the initiation and achievement of stroke risk‐reducing behaviors for this at‐risk population . The study also explored potential demographic and medical confounders that could influence behavioral and knowledge goal achievement . Three groups of 20 participants , each with multiple risk factors for stroke , from a family practice clinic were r and omly assigned to a control , simple‐advice , or brief intervention group .  The majority of the participants were African American with a mean age of 68 years . Selected findings showed ( a ) significant differences in the number of newly initiated stroke‐risk‐reduction behaviors and stroke knowledge among the three groups and ( b ) significant positive correlations between the action stage of readiness to change and the initiation and achievement of the new stroke‐risk‐reduction behaviors . Although results supported the usefulness of the brief intervention model to reduce modifiable stroke‐risk factors and increase stroke knowledge , the necessity of additional longitudinal research that refines the targeting of interventions for diverse racial , cultural , and age groups was acknowledged Efforts to prevent postpartum weight retention in extant clinical trials of African American women have proven exceedingly challenging . The primary purpose of this pilot study was to determine whether a behavioral intervention implemented in early pregnancy through 6 months postpartum could increase the proportion of African American women who were at or below their early pregnancy weights by 6 months postpartum . We additionally evaluated whether mothers ' postpartum weight loss could be maintained at 12 months postpartum . Participants were 66 socioeconomically disadvantaged African American women ( 36 % overweight , 64 % obese ) r and omly assigned to a behavioral intervention or usual care group . The intervention , implemented from early pregnancy to 6 months postpartum , promoted weight control through : ( 1 ) empirically supported behavior change goals ; ( 2 ) interactive self-monitoring text messages ; ( 3 ) weekly to monthly health coach calls ; and ( 4 ) skills training and support through Facebook . In modified intent-to-treat analyses , participants assigned to the intervention were significantly more likely to be at or below their early pregnancy weights by 6 months postpartum compared to usual care ( 56 % vs. 29 % , p = 0.04 ) . At 12 months postpartum , the maternal weight difference between intervention and usual care groups was not maintained ( 41 % vs. 38 % respectively at or below early pregnancy weights , p = 0.83 ) . Findings suggest that a combined pregnancy and postpartum weight control intervention improves 6 month weight outcomes in socioeconomically disadvantaged African American women with obesity . Longer interventions may be needed to overcome late postpartum weight gain among this high risk group . Clinical trial registration number : Clinical Trials.gov identifier
Characteristics of successful interventions included using problem solving with the patient , culturally tailoring the intervention , and using a nurse educator .
OBJECTIVE The use of behavioral interventions has been shown to improve glycemic control , however , the effectiveness of different behavioral interventions in one of the most high risk population s , African Americans , remains unclear .
Our systematic review identified and examined findings of published behavioral interventions targeted at African Americans to improve glycemic control .
The goal of our study was to distinguish which interventions were effective and identify areas for future research .