In this study, researchers compare and contrast issues regarding diabetes self-management between persons in good versus poor glycemic control. The sample comprises low-income racially diverse adults with diabetes from four mid-western community health centers; 44 patients participated in eight focus groups divided by control status (HbA1c of > 9 [uncontrolled] or < 7 [controlled]). Themes common to both groups included the impact of dietary restrictions on social interactions, food cravings, the impact of mental health on self-management, and the importance of formal and informal (friends and family) support. Those in the uncontrolled groups described fear about being able to control their diabetes, confusion about self-management, and difficulty managing their diabetes while caring for family members. Although those in the controlled groups acknowledged difficulties, they discussed resisting cravings, making improvements with small changes, positive feelings about their ability to control their diabetes, and enjoying new foods and exercise. Interventions should include mental health support, incorporate formal and informal patient support structures, and address literacy issues. Health care providers and intervention personnel should be very concrete about how to do self-management tasks and guide patients on how to alter their diabetes regimens for social and other important life events.

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Background Family support is important in diabetes self-management. However, children as providers of support have received little attention. This study examines the role of children in their parents’ diabetes self-management, diet, and exercise. Methods This research used community-based participatory research principles. Researchers conducted semi-structured parallel interviews of 24 Latino and African-American adults with diabetes and with a child (age 10–17 years) in their home (2004–06). Interviews were transcribed, coded, and analyzed for themes (2004–07). Results Adults and children perceived that children play many roles related to adults’ diabetes self-management. Parents described children as monitoring parents’ dietary intake and reminding them what they should not be eating. Some children helped with shopping and meal preparation. Families described children reminding parents to exercise and exercising with their parent. Children reminded parents about medications and assisted with tasks such as checking blood sugar. Parents and children perceived that children played a role in tempting parents to stray from their diabetes diet, because children's diets included food that parents desired but tried to avoid. Conclusion Children and parents perceived that children have many roles in both supporting and undermining adults’ diabetes self-management. There is more to learn about the bidirectional relationships between adults and children in this setting and the most beneficial roles children can play. Health-care providers should encourage family lifestyle change, strengthen social support for families and direct children toward roles that are beneficial for both parent and child and do not place an unreasonable level of responsibility on the child.

BackgroundSelf-report questionnaires are a valuable method of physical activity measurement in public health research; however, accuracy is often lacking. The purpose of this study is to improve the validity of the Global Physical Activity Questionnaire by calibrating it to 7 days of accelerometer measured physical activity and sedentary behavior.MethodsParticipants (n = 108) wore an ActiGraph GT9X Link on their non-dominant wrist for 7 days. Following the accelerometer wear period, participants completed a telephone Global Physical Activity Questionnaire with a research assistant. Data were split into training and testing samples, and multivariable linear regression models built using functions of the GPAQ self-report data to predict ActiGraph measured physical activity and sedentary behavior. Models were evaluated with the testing sample and an independent validation sample (n = 120) using Mean Squared Prediction Errors.ResultsThe prediction models utilized sedentary behavior, and moderate- and vigorous-intensity physical activity self-reported scores from the questionnaire, and participant age. Transformations of each variable, as well as break point analysis were considered. Prediction errors were reduced by 77.7–80.6% for sedentary behavior and 61.3–98.6% for physical activity by using the multivariable linear regression models over raw questionnaire scores.ConclusionsThis research demonstrates the utility of calibrating self-report questionnaire data to objective measures to improve estimates of physical activity and sedentary behavior. It provides an understanding of the divide between objective and subjective measures, and provides a means to utilize the two methods as a unified measure.