Translation of research advances into clinical practice for at-risk communities is important to eliminate disease disparities. Adult type 2 diabetes prevalence in the US territory of American Samoa is 21.5%, but little intervention research has been carried out there. We discuss our experience with cultural translation, drawing on an emerging implementation science, which aims to build a knowledge base on adapting interventions to real-world settings. We offer examples from our behavioral intervention study, Diabetes Care in American Samoa, which was adapted from Project Sugar 2, a nurse and community health worker intervention to support diabetes self-management among urban African Americans. The challenges we experienced and solutions we used may inform adaptations of interventions in other settings.Translating efficacious health treatments into routine clinical and public health practice to eliminate health disparities for communities at risk is an increasing public health priority. Recent significant advances in diabetes care have the potential to prevent complications from diabetes and improve quality of life, yet these evidence-based practices are not being used in real-world settings. 1,2 Innovations from other cultures or from efficacy studies in academic settings may be ineffective in low-income, minority, or ethnic communities. This is attributable Correspondence should be sent to Judith DePue, EdD, MPH, Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro Bldg 5W, One Hoppin St, Providence, RI 02903 (jdepue@lifespan.org). Reprints can be ordered at http://www.ajph.org by clicking the "Reprints/Eprints" link. ContributorsJ. D. DePue originated the overall translation model and intervention and led the writing team. R. K. Rosen originated the qualitative design phases of the study, contributed to writing the sections of the article describing these steps, and contributed to editing throughout. M. Batts-Turner was involved with an earlier study (Project Sugar), advised on translation of protocols and staff training for the current study, and contributed to writing those sections of the article and to editing. N. Bereolos assisted with implementing several phases of the study and contributed to writing lessons learned on study implementation, Step 7 section, and to editing. M.
High type 2 diabetes prevalence, associated with recent cultural changes in diet and physical activity, characterizes the U.S. territory of American Samoa. Comorbid diabetes and depression rates are high worldwide and contribute to negative diabetes outcomes; these rates have not been assessed in American Samoa. In this study, six focus groups (FGs) were conducted with 39 American Samoan adults with diabetes; questions on perceptions of diabetes and depressive symptoms were included. Thirteen healthcare staff interviews were conducted to gain further insight into diabetes care in American Samoa. FGs and healthcare staff interviews were translated, transcribed, and entered into NVivo 8 to facilitate analysis. Thematic analysis showed that diabetes patients saw depressive symptoms as directly contributing to high blood sugar. However, these symptoms were rarely mentioned spontaneously, and providers reported they seldom assess them in patients. Many patients and healthcare staff believed the best ways to respond to feelings of depression involved relaxing, leaving difficult situations, or eating. Staff also discussed cultural
BackgroundWe developed and disseminated an educational DVD to introduce U.S. Veterans to independently-practiced complementary and alternative medicine (CAM) techniques and encourage CAM experimentation. The project’s goal was to determine optimal dissemination methods to facilitate implementation within the Veteran’s Health Administration.MethodsIn the first phase, the DVD was disseminated using four methods: passive, provider-mediated, active, and peer-mediated. In the second, implementation phase, “champion” providers who supported CAM integrated dissemination into clinical practice. Qualitative data came from Veteran focus groups and semi-structured provider interviews. Data from both phases was triangulated to identify common themes.ResultsEffective dissemination requires engaging patients. Providers who most successfully integrated the DVD into practice already had CAM knowledge, and worked in settings where CAM was accepted clinical practice, or with leadership or infrastructure that supported a culture of CAM use. Institutional buy-in allowed for provider networking and effective implementation of the tool. Providers were given autonomy to determine the most appropriate dissemination strategies, which increased enthusiasm and use.ConclusionsMany of the lessons learned from this project can be applied to dissemination of any new educational tool within a healthcare setting. Results reiterate the importance of utilizing best practices for introducing educational tools within the healthcare context and the need for thoughtful, multi-faceted dissemination strategies.
Objective The presence of multiple comorbid conditions is common after combat deployment and complicates treatment. A potential treatment approach is to target shared mechanisms across conditions that maintain poorer health-related quality of life (HRQOL). One such mechanism may be decrements in pleasurable activities. Impairment in pleasurable activities frequently occurs after deployment and may be associated with poorer HRQOL. Method In this brief report, we surveyed 126 Veterans who had previously sought an assessment at a Veterans Affairs post-deployment health clinic and assessed pleasurable activities, HRQOL, and post-deployment health symptoms. Results Forty-three percent of Veterans met our criteria for all three post-deployment conditions (PTSD, depression and chronic wide-spread physical symptoms). Greater engagement in pleasurable activities was associated with better HRQOL for all Veterans regardless of type or level of post-deployment health symptoms. Conclusion Future research should study if interventions that encourage Veterans with post-deployment health conditions to engage in pleasurable activities are effective rehabilitation strategies.
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