Factors Influencing Strength of Commitment to Recommended Lifestyle Selfmanagement among Black Group

1
Factors Influencing Strength of Commitment to
Recommended Lifestyle Self-management among Black
Groups with Diabetes

• Virginie Zoumenou, PhD, CNS, LDN
• Susan P Himburg, PhD, RD, FADA
• Marcia Magnus, PhD
• Valerien Adoueni , MD
• CDC Diabetes Translation Conference
• 04/24/09

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Objectives

• Describe and compare
• Participants strength of commitment to following
  dietary and weight control recommendations by
• Ethnicity
• Social demographic factors
• Daily Self-management Habits

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Study Design

• DESIGN Cross- sectional
• Framework Dahlgren
  Whitehead
• (ecological health
  approach theory)
• SUBJECTS Aged 20 years and older
• 180 Black Americans in Miami Florida
• (Caribbean-, Haitian- , and African-Americans)
• 180 Black Africans in Abidjan Côte dIvoire
• (Akan, Krou, and Malinke)

4
Recruitment

• self-selected convenience sample
• outpatients recruited from
• four public clinics in Miami and
• one public clinic in Abidjan.

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Participants Characteristics

• Participants
• age range 22 -78 years
• mean age of 55.9 years
• 63 females 37 males
• average educational level less than high school
  diploma.
• The length of time since diagnosis ranged from 6
  - 15 years. Few participants were diagnosed
  recently (lt 1 year).

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Tools and Analysis

• A survey adapted from Diabetes Care Profile
  Questionnaire (Michigan Diabetes Research and
  Training Center) was used to collect data on
• Ethnicity The Medical Effectiveness Research
  Center (MERC) Self-Identity Screening tool
• The Commitment to Lifestyle Self-Management Tool
  (CLSM)
• One-way ANOVA, Crosstabulations, Chi square
  statistics, Pearson and Canonical correlations
  were computed for differences among groups.

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The Commitment to Lifestyle Self-Management Tool
Scales and Number of Items
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The Commitment to Lifestyle Self-Management
ToolVisual Scale

• Dedication to Diabetic Diet

• Dedication to Exercise and Weight Control

• How strongly committed are you
• to stay away from sweet foods?
• Visual Scale
• 1 2 3 4 5

• How strongly committed are you
• to do some exercise?
• Visual Scale
• 1 2 3 4 5

High score indicates high strength of commitment
Reference Zoumenou V et al. Measure of Strength
of Commitment to Successful Diabetes
Self-Management Among Blacks Reliability and
Validity European Journal of Scientific Research
(EJSR) Vol.26 No.2 (2009), pp.176-188.
www.eurojournals.com
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Strength of Commitment Assessment

• RESULTS

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Strength of Commitment and Ethnicity (N360)
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Ethnicity and Dedication to Diabetic Diet

• The ANOVA was significant with F (5,354) 92.95,
  p lt0.001.
• A high score indicates higher dedication to
  adhering to diabetic diet. (stay away from fried
  foods, stay away from sweet foods, eat less at a
  social event, eat small portions etc)
• All three Black African groups had significantly
  more strength of commitment to adhering to a
  diabetic diet than the three Black American
  groups.
• No significant differences within the Black
  American groups or within the Black African
  groups

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Strength of Commitment and Ethnicity (N360)
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Ethnicity and Dedication to Weight Control
Attitudes

• The ANOVA was significant with F (5,354) 17.76,
  plt0.05 .
• A high score indicates strongly committed to
  controlling attitudes regarding exercise and diet
  for weight control.
• (exercise to lose weight, eat less to lose
  weight, watch my diet, etc)
• Malinke were more committed to controlling
  attitudes regarding exercise and diet for weight
  control than all the other ethnic groups.
• Haitian Americans were even less committed to
  controlling their weight in terms of exercise and
  diet than Caribbean Americans.

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Strength of Commitment and Ethnicity (N360)
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Ethnicity and Dedication to Using Social Support
for Weight Control

• The ANOVA was significant with F (5,354) 58.50,
  plt0.001.
• High score indicates strongly committed to using
  social and community support for weight control.
  (exercise with a friend or family member, or a
  neighbor, get support from professional
  personnel etc)
• All three groups of Black Africans significantly
  were less committed to using social and community
  support for weight control than the three groups
  of Black Americans.
• No significant differences among the three Black
  African groups or among the three Black American
  groups

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Strength of Commitment and Socio-demographic
Factors

• Using canonical correlation
• Being African (from Côte dIvoire), r.99
• Number of people living in the house, r.62
• Being married. r.36
• were associated with
• Higher strength of commitment to diabetic diet
  r0.87
• Higher strength of commitment to weight control
  attitudes, r0.45
• (With canonical correlation of r.88)
• Participant age, year of diagnosis, education
  were not associated with high strength of
  commitment

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Strength of Commitment and Daily
Self-management Habits

• Using canonical correlation
• Checking blood glucose sugar every four weeks or
  more r.95
• Scheduling meals and snacks sometimes or often,
  r.52
• Following the schedule sometimes or often, r.48
• Walking to the clinic, r.50
• Having more than 2 hours exercise, r.47
• were associated with
• Higher strength of commitment to diabetic diet,
  r0.87
• Higher strength of commitment to weight control
  attitudes, r0.43
• High attendance to diabetes classes and access to
  diabetes management equipment were not associated
  with high strength of commitment

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Strength of Commitment and Clinical Outcomes
(N360)
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Significant Factors and Dahlgren and Whitehead
Ecological Model

• Country of origin
• Ethnicity
• Marital status

MACROLEVEL General Socio-economic,
cultural, and environmental conditions
MIDLEVEL Living and working conditions

• Number of people in the house
• Type of transportation
• Family support, friend help

MIDLEVEL Social and community network

• Family support
• Friend help

MICROLEVEL Individual lifestyle factors

• Daily dietary and
• Weight control self-management factors

MICROLEVEL People, age, sex, constitutional or
biological factors
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Conclusion

• Adherence to diabetes self-management is a
  multi-factorial phenomenon
• Cultural background, living conditions,
  community and social network may have an
  influence on patients strength of commitment to
  diet and weight control self-management.

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Conclusion

• Black groups cannot be considered as a homogenous
  group
• Participants willingness and beliefs were found
  as the key factors to following the
  recommendations

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Recommendations

• Emphasize individualized assessment
• What are their beliefs?
• What are their goals ?
• How they want to achieve them?
• Implement appropriate culturally sensitive
  education strategies
• How to modify a strategy and make it appropriate
  to the clients cultural background?

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Recommendations

• Conduct summative and formative evaluation of
  diabetes education program
• Involve healthcare professionals teamwork
  (Dietitian, Certified Diabetes Educator,
  Nutritionist Health Educator, Social Worker,
  Endocrinologist, Primary Care Physician,
  Exercise Physiologist).
• Diabetes is a lifetime disease.
• A comprehensive and an on-going self management
  education
• associated with patients willingness to follow
  the diet and weight
• control regimen may increase the strength of
  commitment among
• persons with type 2 diabetes.

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Acknowledgments

• Florida International University Miami, FL
• Paulette Johnson, PhD. Statistical consulting
• Sandra Lobar, PhD. College of Nursing and Health
  Sciences
• Zisca Dixon PhD, RD. Dietetics and Nutrition
• Carol deLong Pyles PhD. College of Nursing and
  Health Sciences
• National Institute of Public Health Abidjan, Côte
  dIvoire (INSP)
• Valerien Adoueni, MD
• Assistant Researchers in Miami and Abidjan

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THANK YOU

• Contact
• Virginie Zoumenou, PhD, CNS, LDN
• University of Maryland Eastern Shore/ Maryland
  Cooperative Extension
• vmzoumenou_at_umes.edu
• [phone]