OBJECTIVEThis study evaluated the effect of cognitive behavioral therapy (CBT) plus lifestyle counseling in primary care on hemoglobin A 1c (HbA 1c ) in rural adult patients with type 2 diabetes (T2D) and comorbid depressive or regimen-related distress (RRD) symptoms.
RESEARCH DESIGN AND METHODSThis study was a randomized controlled trial of a 16-session severity-tailored CBT plus lifestyle counseling intervention compared with usual care. Outcomes included changes in HbA 1c , RRD, depressive symptoms, self-care behaviors, and medication adherence across 12 months.
RESULTSPatients included 139 diverse, rural adults (mean age 52.6 6 9.5 years; 72% black; BMI 37.0 6 9.0 kg/m 2 ) with T2D (mean HbA 1c 9.6% [81 mmol/mol] 6 2.0%) and comorbid depressive or distress symptoms. Using intent-to-treat analyses, patients in the intervention experienced marginally significant improvements in HbA 1c (20.92 6 1.81 vs. 20.31 6 2.04; P = 0.06) compared with usual care. However, intervention patients experienced significantly greater improvements in RRD (21.12 6 1.05 vs. 20.31 6 1.22; P = 0.001), depressive symptoms (23.39 6 5.00 vs. 20.90 6 6.17; P = 0.01), self-care behaviors (1.10 6 1.30 vs. 0.58 6 1.45; P = 0.03), and medication adherence (1.00 6 2.0 vs. 0.17 6 1.0; P = 0.02) versus usual care. Improvement in HbA 1c correlated with improvement in RRD (r = 0.3; P = 0.0001) and adherence (r = 20.23; P = 0.007).
CONCLUSIONSTailored CBT with lifestyle counseling improves behavioral outcomes and may improve HbA 1c in rural patients with T2D and comorbid depressive and/or RRD symptoms.
Complementary and integrative health (CIH) services are being used more widely across the nation, including in both military and veteran hospital settings. Literature suggests that a variety of CIH services show promise in treating a wide range of physical and mental health disorders. Notably, the Department of Veterans Affairs is implementing CIH services within the context of a health care transformation, changing from disease based health care to a personalized, proactive, patient-centered approach where the veteran, not the disease, is at the center of care. This study examines self-reported physical and mental health outcomes associated with participation in the Integrative Health and Wellness Program, a comprehensive CIH program at the Washington DC VA Medical Center and one of the first wellbeing programs of its kind within the VA system. Using a prospective cohort design, veterans enrolled in the Integrative Health and Wellness Program filled out self-report measures of physical and mental health throughout program participation, including at enrollment, 12 weeks, and 6 months. Analyses revealed that veterans reported significant improvements in their most salient symptoms of concern (primarily pain or mental health symptoms), physical quality of life, wellbeing, and ability to participate in valued activities at follow-up assessments. These results illustrate the potential of CIH services, provided within a comprehensive clinic focused on wellbeing not disease, to improve self-reported health, wellbeing, and quality of life in a veteran population. Additionally, data support recent VA initiatives to increase the range of CIH services available and the continued growth of wellbeing programs within VA settings. (PsycINFO Database Record
Purpose:
This study evaluated a novel composite measure of health literacy and numeracy by assessing its predictive validity for diabetes self-care activities and glycemic control.
Methods:
Patients (N = 102) with type 2 diabetes were recruited from a family medicine clinic at an academic medical center. Combined health literacy was assessed by combining the results of the Health Literacy Scale and the Subjective Numeracy Scale. Self-management activities were assessed by the Summary of Diabetes Self-Care Activities scale. Hemoglobin A1c (A1c) values were extracted from patients' medical records to assess glycemic control. Path models were used to test the predicted pathways linking health literacy and numeracy, independently and together, to self-management activities and glycemic control.
Results:
The mean combined literacy score was 72.0 (range, 33-104); the mean health literacy score alone was 43.9 (range, 14-56); and the mean numeracy score alone was 28.1 (range, 8-48). The direct effects results showed that the combined health literacy score (B = 0.107, P < .05) and the health literacy score alone (B = 0.234, P < .05) were significantly associated with self-care activities. The health literacy score alone also had a significant direct effect on A1c (B = −0.081, P < .05). The indirect effects of the combined health literacy on glycemic control through self-care activities were not statistically significant.
Conclusions:
Findings from this study suggest that the combined health literacy has predictive validity for self-care activities whereas the health literacy alone has predictive validity for glycemic control. More research is needed to validate these findings. Higher patient health literacy skills were not consistently associated with higher perceived numeracy skills. Additional attention and efforts should be made to make sure patients understand medical instructions involving numerical calculations.
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