Lucy M. Candib Copyright (c) 2011 All rights reserved. http://works.bepress.com/lucy_candib Recent documents in Lucy M. Candib en-us Sat, 15 Oct 2011 02:19:04 PDT 3600 Randomized trial of a literacy-sensitive, culturally tailored diabetes self-management intervention for low-income latinos: latinos en control http://works.bepress.com/lucy_candib/82 http://works.bepress.com/lucy_candib/82 Thu, 13 Oct 2011 07:33:50 PDT OBJECTIVE:

To test whether a theory-based, literacy, and culturally tailored self-management intervention, Latinos en Control, improves glycemic control among low-income Latinos with type 2 diabetes.

RESEARCH DESIGN AND METHODS:

A total of 252 patients recruited from community health centers were randomized to the Latinos en Control intervention or to usual care. The primarily group-based intervention consisted of 12 weekly and 8 monthly sessions and targeted knowledge, attitudes, and self-management behaviors. The primary outcome was HbA(1c). Secondary outcomes included diet, physical activity, blood glucose self-monitoring, diabetes knowledge and self-efficacy, and other physiological factors (e.g., lipids, blood pressure, and weight). Measures were collected at baseline and at 4- and 12-month follow-up. Change in outcomes over time between the groups and the association between HbA(1c) and possible mediators were estimated using mixed-effects models and an intention-to-treat approach.

RESULTS:

A significant difference in HbA(1c) change between the groups was observed at 4 months (intervention -0.88 [-1.15 to -0.60] versus control -0.35 [-0.62 to 0.07], P < 0.01), although this difference decreased and lost statistical significance at 12 months (intervention -0.46 [-0.77 to -0.13] versus control -0.20 [-0.53 to 0.13], P = 0.293). The intervention resulted in significant change differences in diabetes knowledge at 12 months (P = 0.001), self-efficacy (P = 0.001), blood glucose self-monitoring (P = 0.02), and diet, including dietary quality (P = 0.01), kilocalories consumed (P < 0.001), percentage of fat (P = 0.003), and percentage of saturated fat (P = 0.04). These changes were in turn significantly associated with HbA(1c) change at 12 months.

CONCLUSIONS:

Literacy-sensitive, culturally tailored interventions can improve diabetes control among low-income Latinos; however, strategies to sustain improvements are needed.

]]> Milagros C. Rosal et al. Diabetes Mellitus, Type 2 Health Literacy Poverty Self Care Hispanic Americans Screening for Childhood Trauma in Adult Primary Care Patients: A Cross-Sectional Survey http://works.bepress.com/lucy_candib/81 http://works.bepress.com/lucy_candib/81 Wed, 09 Mar 2011 08:59:26 PST Objective: Compared to screening for partner violence, screening for childhood physical and sexual abuse among adult patients has received little attention, despite associated adverse health consequences. The objective of this exploratory study was to describe the practices, skills, attitudes, and perceived barriers of a large sample of family physicians in screening adult patients for childhood sexual or physical abuse.

Method: Surveys were mailed to the 833 members of the Massachusetts Academy of Family Physicians in 2007 eliciting information about screening practices. Factors associated with routine or targeted screening among adult primary care patients were evaluated.

Results: Less than one-third of providers reported usually or always screening for childhood trauma and correctly estimated childhood abuse prevalence rates; 25% of providers reported that they rarely or never screen patients. Confidence in screening, perceived role, and knowledge of trauma prevalence were associated with routine and targeted screening. Women and physicians reporting fewer barriers were more likely to routinely screen adult patients.

Conclusions: Despite the 20%–50% prevalence of child abuse exposure among adult primary care patients, screening for childhood abuse is not routine practice for most physicians surveyed; a large subgroup of physicians never screen patients. Study findings draw attention to a largely unexplored experience associated with considerable health care costs and morbidity. Results highlight the need to develop training programs about when to suspect trauma histories and how to approach adult patients.

]]> Linda F. Weinreb et al. Child Abuse Child Abuse, Sexual Adult Survivors of Child Abuse Primary Health Care Physicians, Family Physician's Practice Patterns Mass Screening Cross-Sectional Studies Translational Research at Community Health Centers: Challenges and Successes in Recruiting and Retaining Low-Income Latino Patients With Type 2 Diabetes Into a Randomized Clinical Trial http://works.bepress.com/lucy_candib/80 http://works.bepress.com/lucy_candib/80 Mon, 06 Dec 2010 07:36:36 PST PURPOSE: To describe methods used to recruit and retain low-income Latinos in a randomized clinical trial (RCT) of a diabetes self-management intervention at 5 community health centers (CHCs) in Massachusetts.

METHODS: Consent from primary care providers (PCPs) was obtained to screen their patients. Trained site research coordinators (SRCs) screened, recruited, and enrolled participants following a multistep process (medical record reviews, PCP approval, a patient eligibility interview) and provided support for retention efforts. Assessment staff were trained in motivational strategies to facilitate retention and received ongoing support from a retention coordinator. Electronic tracking systems facilitated recruitment and retention activities.

RESULTS: Of an initial pool of 1176 patients, 1034 were active at the time of screening, 592 (57%) were eligible by medical record review, and 487 received PCP approval (92% of reviewed patients). Of these, 293 patients completed the patient screening interview (60% of patients with PCP approval, and 76% of those reached), and 276 were eligible. Sixteen percent of all active patients refused participation, and 8% of contacted patients were unreachable. Two hundred fifty-two patients were randomized after completion of baseline assessments. Clinical, behavioral, and psychosocial assessment completion rates were 92%, 77%, and 86% at 12-month follow-up, respectively, and 93% of patients completed at least one study assessment at 12 months.

CONCLUSIONS: CHCs are a prime setting for translation research aimed to eliminate diabetes health disparities. Successful recruitment and retention efforts must address institutional/organizational, research team, and patient-related challenges.

]]> Milagros C. Rosal et al. Community Health Centers Randomized Controlled Trials as Topic Patient Selection Hispanic Americans Diabetes Mellitus, Type 2 Translational Research Design and methods for a randomized clinical trial of a diabetes self-management intervention for low-income Latinos: Latinos en Control http://works.bepress.com/lucy_candib/79 http://works.bepress.com/lucy_candib/79 Mon, 15 Mar 2010 08:20:17 PDT BACKGROUND: US Latinos have greater prevalence of type 2 diabetes (diabetes), uncontrolled diabetes and diabetes co-morbidities compared to non-Latino Whites. They also have lower literacy levels and are more likely to live in poverty. Interventions are needed to improve diabetes control among low-income Latinos.

METHODS AND DESIGN: This randomized clinical trial tested the efficacy of a culturally- and literacy-tailored diabetes self-management intervention (Latinos en Control) on glycemic control among low-income Latinos with diabetes, compared to usual care (control). Participants were recruited from five community health centers (CHCs) in Massachusetts. The theory-based intervention included an intensive phase of 12 weekly sessions and a follow-up maintenance phase of 8 monthly sessions. Assessments occurred at baseline, and at 4 and 12 months. The primary outcome was glycosylated hemoglobin (HbA1c). Secondary outcomes were self-management behaviors, weight, lipids and blood pressure. Additional outcomes included diabetes knowledge, self-efficacy, depression and quality of life. The study was designed for recruitment of 250 participants (estimated 20% dropout rate) to provide 90% power for detecting a 7% or greater change in HbA1c between the intervention and control groups. This is a difference in change of HbA1c of 0.5 to 0.6%.

DISCUSSION: Low-income Latinos bear a great burden of uncontrolled diabetes and are an understudied population. Theory-based interventions that are tailored to the needs of this high-risk population have potential for improving diabetes self-management and reduce health disparities. This article describes the design and methods of a theory driven intervention aimed at addressing this need.

]]> Milagros C. Rosal et al. Adolescent Adult Attitude to Health Community Health Services Counseling Diabetes Mellitus, Type 2 Follow-Up Studies Health Behavior Hemoglobin A, Glycosylated *Hispanic Americans Humans Massachusetts Poverty Randomized Controlled Trials as Topic Research Design Self Care Urban Population Young Adult Women-Centered Care in Pregnancy and Childbirth http://works.bepress.com/lucy_candib/78 http://works.bepress.com/lucy_candib/78 Mon, 15 Mar 2010 08:18:46 PDT A woman-centered approach to pregnancy must be flexible enough to address the variety of women's experiences around the world, encompassing medical conditions, cultures and family structures. It must also include women who choose not to carry a pregnancy or experience a miscarriage. This unique woman-centered text explores all these issues and more, providing a vital resource for primary care maternity clinicians and trainees including family physicians, nurse practitioners, women's health clinicians, midwives, obstetrical nurses and obstetricians. It applies the powerful, proven model of patient-centered care to pregnancy and birth - an expansion beyond previous applications to various chronic illnesses. Woman-Centered Care in Pregnancy and Childbirth incorporates dozens of vignettes describing clinicians' approaches to woman-centered maternity care with women and families from a variety of social, cultural, and economic situations facing common or problematic challenges over the course of prenatal care, birth and the postpartum period.

Citation: Sara G. Shields and Lucy M. Candib (editors), Women-Centered Care in Pregnancy and Childbirth. Radcliffe Publishing, 2010. ISBN 1846191610, 9781846191619.

]]> Sara G. Shields et al. Women's Health Obstetrics Pregnancy Gynecology Patient-Centered Care Parturition Book Review of <em>Women, Health and Healing: Toward a New Perspective</em> http://works.bepress.com/lucy_candib/77 http://works.bepress.com/lucy_candib/77 Fri, 04 Sep 2009 05:59:47 PDT Book Review of Women, Health and Healing: Toward a New Perspective, Eds. Ellen Lewin and Virginia Olesen, Published by Tavistock Publications, 1985.

]]> Lucy M. Candib Moving on to strengths http://works.bepress.com/lucy_candib/76 http://works.bepress.com/lucy_candib/76 Fri, 04 Sep 2009 05:59:46 PDT Lucy M. Candib Adult Battered Women Borderline Personality Disorder Child Child Abuse, Sexual Domestic Violence Family Practice Female Humans Incest Rape Self-Injurious Behavior The family approach at each moment http://works.bepress.com/lucy_candib/75 http://works.bepress.com/lucy_candib/75 Fri, 04 Sep 2009 05:59:44 PDT In this paper I have demonstrated some of the skills involved in an approach to the entire family at each moment. I have focused on a family approach in well child care, episodic care for children, and adolescent pregnancy and have demonstrated how such an approach is essentially preventive. The traditional relationship of the family physician with individuals, usually women and mothers, creates an implicit alliance with the symptom bearer which may work contrary to the goals of treatment. Avoidance of hidden alliances and open communication with all members of the family permit the doctor to engage with families in a relationship which is both preventive and therapeutic.

]]> Lucy M. Candib Adolescent Child *Delivery of Health Care *Family Practice Female Humans *Physician-Patient Relations Pregnancy Pregnancy in Adolescence Prenatal Care Family Medicine in Ecuador: At Risk in a Developing Nation http://works.bepress.com/lucy_candib/74 http://works.bepress.com/lucy_candib/74 Fri, 04 Sep 2009 05:59:43 PDT There is an overwhelming need for primary care in Ecuador, with many obstacles. Family medicine will require creative strategies and strong support in order to begin to address the country's needs for primary care.

]]> Lucy M. Candib Primary Health Care Ecuador Ways of knowing in family medicine: contributions from a feminist perspective http://works.bepress.com/lucy_candib/73 http://works.bepress.com/lucy_candib/73 Fri, 04 Sep 2009 05:59:42 PDT Feminist psychologists have recently drawn a distinction between separate and connected knowing, two different ways of finding out about the world. Family medicine practice uses connected knowing to discover, through empathy, what another person may be experiencing; in contrast, family medicine research, in order to gain academic credibility, relies on separate knowing, typical of scientific thinking. These two ways of knowing have been variously described by Bruner as paradigmatic vs. narrative, by Kuzel as rationalistic vs. naturalistic, and by Stephens as seeing vs. hearing. The two ways of knowing vary in their use of context, time span, believability, and empathy. Family medicine, in a parallel with women who are finding their voice in a world which has not respected them, must come to blend the two ways of knowing. We can begin reframing our research questions by drawing on knowledge of our intimate, long-term connections with patients, thus underscoring the importance of the knower and the relationship with the known.

]]> Lucy M. Candib *Family Practice Female Humans Learning Research Thinking Women A New View of Women’s Sexual Problems—A Family Physician’s Response http://works.bepress.com/lucy_candib/72 http://works.bepress.com/lucy_candib/72 Fri, 04 Sep 2009 05:59:41 PDT Lucy M. Candib Physicians, Family Women's Health Crossdisciplinary approaches and physiotherapy http://works.bepress.com/lucy_candib/71 http://works.bepress.com/lucy_candib/71 Fri, 04 Sep 2009 05:59:40 PDT Alice Kvale et al. Book Review: <em>Women Physicians: Careers, Status and Power</em> http://works.bepress.com/lucy_candib/69 http://works.bepress.com/lucy_candib/69 Fri, 04 Sep 2009 05:59:39 PDT Book review of of Women Physicians: Careers, Status and Power, by Judith Lorber, Published by Tavistock Publications, 1984.

]]> Lucy M. Candib Margaret Plauthier: A Clinical Diary http://works.bepress.com/lucy_candib/70 http://works.bepress.com/lucy_candib/70 Fri, 04 Sep 2009 05:59:39 PDT Lucy M. Candib The neighborhood health center--reform ideas of yesterday and today http://works.bepress.com/lucy_candib/68 http://works.bepress.com/lucy_candib/68 Fri, 04 Sep 2009 05:59:38 PDT John D. Stoeckle et al. *Community Health Services History of Medicine Organization and Administration Poverty Preventive Health Services Social Work United States Voluntary Health Agencies Qualitative Research: Perspectives on the Future http://works.bepress.com/lucy_candib/67 http://works.bepress.com/lucy_candib/67 Fri, 04 Sep 2009 05:59:37 PDT Lucy M. Candib et al. Qualitative Research Family Life Cycle Theory--A Feminist Critique http://works.bepress.com/lucy_candib/66 http://works.bepress.com/lucy_candib/66 Fri, 04 Sep 2009 05:59:36 PDT Lucy M. Candib Primary Health Care Physicians, Family Feminism Emergency Contraception: A Potential Solution http://works.bepress.com/lucy_candib/65 http://works.bepress.com/lucy_candib/65 Fri, 04 Sep 2009 05:59:35 PDT Sara Shields et al. Contraception, Postcoital Screening for type 2 diabetes: Why patients who self monitor glucose might be more depressed http://works.bepress.com/lucy_candib/64 http://works.bepress.com/lucy_candib/64 Fri, 04 Sep 2009 05:59:34 PDT Lucy M. Candib Blood Glucose Blood Glucose Self-Monitoring Depressive Disorder Diabetes Mellitus Humans Reconsidering Power in the Clinical Relationship http://works.bepress.com/lucy_candib/63 http://works.bepress.com/lucy_candib/63 Fri, 04 Sep 2009 05:59:33 PDT Lucy M. Candib Physician-Patient Relations Power (Psychology)