Secondary analysis of a randomized trial testing community health educator interventions for diabetes prevention among refugees with depression: effects on nutrition, physical activity and sleep
Abstract Background Refugees have high levels of psychological distress that hamper lifestyle change efforts. We previously reported that community health educator (CHE) diabetes prevention interventions decreased HbA1c and depressive symptoms among Cambodian-American refugees with depression; this...
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| Format: | Article |
| Language: | English |
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BMC
2023-09-01
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| Series: | International Journal of Behavioral Nutrition and Physical Activity |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12966-023-01509-y |
| _version_ | 1797556346783006720 |
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| author | Julie A. Wagner Angela Bermúdez-Millán Thomas E. Buckley Orfeu M. Buxton Richard S. Feinn Sengly Kong Theanvy Kuoch Lindsay Master Mary F. Scully |
| author_facet | Julie A. Wagner Angela Bermúdez-Millán Thomas E. Buckley Orfeu M. Buxton Richard S. Feinn Sengly Kong Theanvy Kuoch Lindsay Master Mary F. Scully |
| author_sort | Julie A. Wagner |
| collection | DOAJ |
| description | Abstract Background Refugees have high levels of psychological distress that hamper lifestyle change efforts. We previously reported that community health educator (CHE) diabetes prevention interventions decreased HbA1c and depressive symptoms among Cambodian-American refugees with depression; this paper reports health behavior outcomes of those interventions. Methods Participants were aged 35–75, Khmer speaking, at risk for diabetes, and met study criteria for likely depression by either a) antidepressant medication and/or b) prolonged elevated depressive symptoms. Participants were randomized to one of three CHE interventions: 1) lifestyle intervention called Eat, Walk, Sleep (EWS), 2) EWS plus medication therapy management with a pharmacist/CHE team (EWS + MTM), or, 3) social services (SS; control). Physical activity and sleep were measured with 7 days of actigraphy. Nutrition was measured as carbohydrates as reported in a culturally tailored food frequency questionnaire. Assessments were at baseline, end point (12 months), and follow-up (15 months). Results The n = 188 participants were 78% female, average age of 55 years, half had a household income < $20,000, and modal education was 7.0 years. Individuals in the two treatment groups that received the EWS intervention significantly increased their brown rice consumption (p < .001, Cohen’s d = 0.76) and their moderate-to-vigorous activity (p = .039, d = 0.32). No intervention changed sleep duration, timing, efficiency or wake after sleep onset. Across groups, individuals who increased brown rice consumption, increased vigorous activity and decreased total sleep time variability showed decreased HbA1c, with small effect sizes. Conclusions CHEs may improve nutrition and physical activity in refugees with depression but more intensive interventions may be required to impact sleep. Improvements in all three behaviors appear to be associated with HbA1c lowering Trial registration ClinicalTrials.gov identifier NCT02502929. |
| first_indexed | 2024-03-10T17:01:31Z |
| format | Article |
| id | doaj.art-05c5bfe0d0a1443bb93c360e862a6633 |
| institution | Directory Open Access Journal |
| issn | 1479-5868 |
| language | English |
| last_indexed | 2024-03-10T17:01:31Z |
| publishDate | 2023-09-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal of Behavioral Nutrition and Physical Activity |
| spelling | doaj.art-05c5bfe0d0a1443bb93c360e862a66332023-11-20T10:57:11ZengBMCInternational Journal of Behavioral Nutrition and Physical Activity1479-58682023-09-0120111110.1186/s12966-023-01509-ySecondary analysis of a randomized trial testing community health educator interventions for diabetes prevention among refugees with depression: effects on nutrition, physical activity and sleepJulie A. Wagner0Angela Bermúdez-Millán1Thomas E. Buckley2Orfeu M. Buxton3Richard S. Feinn4Sengly Kong5Theanvy Kuoch6Lindsay Master7Mary F. Scully8UConn HealthUniversity of Connecticut School of MedicineUniversity of Connecticut School of PharmacyPennsylvania State UniversityQuinnipiac UniversityKhmer Health AdvocatesKhmer Health AdvocatesPennsylvania State UniversityKhmer Health AdvocatesAbstract Background Refugees have high levels of psychological distress that hamper lifestyle change efforts. We previously reported that community health educator (CHE) diabetes prevention interventions decreased HbA1c and depressive symptoms among Cambodian-American refugees with depression; this paper reports health behavior outcomes of those interventions. Methods Participants were aged 35–75, Khmer speaking, at risk for diabetes, and met study criteria for likely depression by either a) antidepressant medication and/or b) prolonged elevated depressive symptoms. Participants were randomized to one of three CHE interventions: 1) lifestyle intervention called Eat, Walk, Sleep (EWS), 2) EWS plus medication therapy management with a pharmacist/CHE team (EWS + MTM), or, 3) social services (SS; control). Physical activity and sleep were measured with 7 days of actigraphy. Nutrition was measured as carbohydrates as reported in a culturally tailored food frequency questionnaire. Assessments were at baseline, end point (12 months), and follow-up (15 months). Results The n = 188 participants were 78% female, average age of 55 years, half had a household income < $20,000, and modal education was 7.0 years. Individuals in the two treatment groups that received the EWS intervention significantly increased their brown rice consumption (p < .001, Cohen’s d = 0.76) and their moderate-to-vigorous activity (p = .039, d = 0.32). No intervention changed sleep duration, timing, efficiency or wake after sleep onset. Across groups, individuals who increased brown rice consumption, increased vigorous activity and decreased total sleep time variability showed decreased HbA1c, with small effect sizes. Conclusions CHEs may improve nutrition and physical activity in refugees with depression but more intensive interventions may be required to impact sleep. Improvements in all three behaviors appear to be associated with HbA1c lowering Trial registration ClinicalTrials.gov identifier NCT02502929.https://doi.org/10.1186/s12966-023-01509-yNutritionPhysical activitySleepDepressionRefugee |
| spellingShingle | Julie A. Wagner Angela Bermúdez-Millán Thomas E. Buckley Orfeu M. Buxton Richard S. Feinn Sengly Kong Theanvy Kuoch Lindsay Master Mary F. Scully Secondary analysis of a randomized trial testing community health educator interventions for diabetes prevention among refugees with depression: effects on nutrition, physical activity and sleep International Journal of Behavioral Nutrition and Physical Activity Nutrition Physical activity Sleep Depression Refugee |
| title | Secondary analysis of a randomized trial testing community health educator interventions for diabetes prevention among refugees with depression: effects on nutrition, physical activity and sleep |
| title_full | Secondary analysis of a randomized trial testing community health educator interventions for diabetes prevention among refugees with depression: effects on nutrition, physical activity and sleep |
| title_fullStr | Secondary analysis of a randomized trial testing community health educator interventions for diabetes prevention among refugees with depression: effects on nutrition, physical activity and sleep |
| title_full_unstemmed | Secondary analysis of a randomized trial testing community health educator interventions for diabetes prevention among refugees with depression: effects on nutrition, physical activity and sleep |
| title_short | Secondary analysis of a randomized trial testing community health educator interventions for diabetes prevention among refugees with depression: effects on nutrition, physical activity and sleep |
| title_sort | secondary analysis of a randomized trial testing community health educator interventions for diabetes prevention among refugees with depression effects on nutrition physical activity and sleep |
| topic | Nutrition Physical activity Sleep Depression Refugee |
| url | https://doi.org/10.1186/s12966-023-01509-y |
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