Background: Research focused on disparities related to mental health comorbidities, especially am... more Background: Research focused on disparities related to mental health comorbidities, especially among emerging adults with diabetes, is limited. Identifying associated factors of disparities could inform policy decisions to make diabetes-related interdisciplinary care more accessible for vulnerable groups. Method: Using data from the National Survey on Drug Use and Health (2015-2019), we examined disparities in presence of major depressive episode (MDE) and suicidal ideation among emerging adults with diabetes. Survey designadjusted bivariate and multivariable logistic regression models were used for statistical analyses. Results: The study included 1,125 emerging adults (18-25 years old), with a history of type 1 diabetes (T1D) or type 2 diabetes (T2D). After controlling for sociodemographic and health-related characteristics, we found lower odds of having past-year major MDE for non-Hispanic Black (AOR, 0.42, p=0.032) compared to their non-Hispanic White counterparts. Females were 3.02 times more likely to have past-year MDE than males (AOR, 3.02, p=0.004). The odds of having past-year MDE were 1.96 times higher among individuals who identified as LGB (lesbian, gay, bisexual) (AOR, 1.96, P=0.038). There were no statistically significant disparities in suicidal ideation related to race/ethnicity, sex, education, and family income. However, individuals who identified as LGB had significantly higher likelihood of suicidal ideation than their heterosexual counterparts (AOR, 2.47, P=0.004). Significant disparities related to MDE and suicidal ideation exist based on race/ethnicity, gender, and sexual orientation. Integration of a mental health professional into the multidisciplinary diabetes care team is critical for effective management of comorbid mental health conditions in younger patients with diabetes.
700-P: Outcomes of a Diabetes Support Coach Intervention Implemented during the COVID-19 Pandemic
Diabetes
During the COVID-19 pandemic, people with diabetes reported increased diabetes distress and diffi... more During the COVID-19 pandemic, people with diabetes reported increased diabetes distress and difficulty maintaining glycemic control. These challenges were exacerbated for racial minorities and those with low socioeconomic status. As part of a Project Extension for Community Healthcare Outcomes (ECHO) program, an intervention using 28 diabetes support coaches (DSCs), adults with diabetes who served as peer mentors and healthcare navigators, was implemented with underserved patients with type 1, type 2, and other forms of diabetes at 41 federally qualified health centers in FL and CA (intervention n=74, control n=363). Patients self-enrolled and engaged with DSCs via 1-1 weekly text messages, phone calls, or virtual meetings. Patients’ HbA1c was measured at baseline and 6-month follow-up. The Diabetes Distress Scale (DDS-17), Coronavirus Anxiety Scale (CAS-19), and a survey of diabetes technology use and COVID-19 outcomes were also administered. Descriptive statistics were computed fo...
1410-P: Impacts of COVID-19 on Underserved Communities with Diabetes
Diabetes
People with diabetes have higher COVID-19 morbidity and mortality. These risks are amplified for ... more People with diabetes have higher COVID-19 morbidity and mortality. These risks are amplified for racial minorities and people living in rural areas or with low income, who are more likely to experience severe COVID-19 illness, vaccine hesitancy, and unemployment. A survey of adults with type 1, type 2, and other forms of diabetes (n=450, µ age= 52.7 years) receiving care at 41 federally qualified and community health centers in FL and CA examined COVID-19 illness, prevention, and financial and healthcare impacts. Surveys were completed from fall 2021 to summer 2022; all outcomes were self-reported. Descriptive statistics were computed for key outcomes (n, %). Logistic regression assessed independent associations of COVID-19 vaccine receipt. Between-group comparisons were evaluated via Chi-Squared, Fisher’s Exact, and Cochran-Mantel-Haenszel tests. Overall, 29.7% of participants contracted COVID-19; of those, 45.3% sought medical care or were hospitalized. Most (81.3%) received at le...
The Promising Success of Project ECHO Diabetes: Case Series (Preprint)
BACKGROUND In the U.S., there are over 37 million people with diabetes (PwD), but only 8,000 endo... more BACKGROUND In the U.S., there are over 37 million people with diabetes (PwD), but only 8,000 endocrinologists. Therefore, many PwD receive care exclusively from primary care providers (PCPs). To democratize knowledge regarding insulin-requiring diabetes through tele-education, Stanford University and the University of Florida developed Project Extension for Community Healthcare Outcomes (ECHO) Diabetes. OBJECTIVE ECHO Diabetes uses a Hub and Spoke model connecting specialists (the “Hub”) with PCPs (the “Spokes”). One-hour, weekly sessions include Hub diabetes didactic presentations and Spoke de-identified case presentations. Lessons learned during these sessions target provider knowledge and confidence surrounding diabetes management and patient care. METHODS Spokes were asked to provide short descriptions of PwD whose diabetes management improved directly or indirectly from their providers’ participation and/or their involvement with a Diabetes Support Coach (DSC). We provide a cas...
Introduction: Project ECHO Diabetes is a teleeducation learning model for primary care providers ... more Introduction: Project ECHO Diabetes is a teleeducation learning model for primary care providers (PCPs) seeking to improve care for patients with diabetes from marginalized communities. Project ECHO Diabetes utilized expert ''hub'' teams comprising endocrinologists, dieticians, nurses, psychologists, and social workers and ''spokes'' consisting of PCPs and their patients with diabetes. This Project ECHO Diabetes model provided diabetes support coaches to provide additional support to patients. We sought to estimate the costs of operating a Project ECHO Diabetes hub, inclusive of diabetes support coach costs. Methods: Data from Project ECHO Diabetes from June 2021 to June 2022 and wages from national databases were used to estimate hub and diabetes support coach costs to operate a 6-month, 24-session Project ECHO Diabetes Project ECHO Diabetes Research Team members' names are listed in the ''Acknowledgement'' section.
960-P: Multisite Quality Improvement Initiative within the Project ECHO Diabetes Virtual Network
Diabetes
Poor outcomes for people with diabetes have necessitated targeted quality improvement (QI) projec... more Poor outcomes for people with diabetes have necessitated targeted quality improvement (QI) projects to affect change. Project ECHO Diabetes is a tele-education and tele-mentoring program for community health clinics in California and Florida serving under-resourced patients with diabetes who lack routine access to specialty care. The model provided a unique opportunity to undertake a multi-site QI initiative, where 12 community clinics participated in measuring and improving quality of care. Using a modified-Delphi approach, clinic providers rated various QI measures on their validity and feasibility. A total of 18 measures were selected, and each clinic chose its own measures to track throughout the one-year initiative. The number of measures each clinic focused on ranged from 1 to 9, with a median of 3. Quarterly, clinics met remotely to report performance based on selected measures and discuss their efforts, successes, and setbacks. At the end of the QI year, clinics reported wid...
Background Little is known about the coronavirus disease 2019 (COVID-19) pandemic’s psychological... more Background Little is known about the coronavirus disease 2019 (COVID-19) pandemic’s psychological effects on caregivers of children with type 1 diabetes. Objective This study aimed to investigate the experience of caregivers of youth with type 1 diabetes during the COVID-19 pandemic. Methods A 49-item questionnaire using a 5-point Likert scale and open-response questions was distributed via e-mail and type 1 diabetes–related social media platforms from 4 May to 22 June 2020. Quantitative data were analyzed using SPSS v.25 statistical software. Descriptive statistics were used. Relationships were compared using Pearson correlation. Qualitative data were coded and categorized. Results A total of 272 caregivers participated (mean ± SD respondent age 42.1 ± 7.8 years; 94.5% females; 81.3% with college degree or higher; 52.6% with annual income >$99,000; 80.1% with private insurance). The mean ± SD age of caregivers’ children with type 1 diabetes was 11.0 ± 4.1 years, and their mean ±...
IntroductionProject ECHO (Extension for Community Healthcare Outcomes) is a tele-education outrea... more IntroductionProject ECHO (Extension for Community Healthcare Outcomes) is a tele-education outreach model that seeks to democratize specialty knowledge to reduce disparities and improve health outcomes. Limited utilization of endocrinologists forces many primary care providers (PCPs) to care for patients with type 1 diabetes (T1D) without specialty support. Accordingly, an ECHO T1D program was developed and piloted in Florida and California. Our goal was to demonstrate the feasibility of an ECHO program focused on T1D and improve PCPs’ abilities to manage patients with T1D.Research design and methodsHealth centers (ie, spokes) were recruited into the ECHO T1D pilot through an innovative approach, focusing on Federally Qualified Health Centers and through identification of high-need catchment areas using the Neighborhood Deprivation Index and provider geocoding. Participating spokes received weekly tele-education provided by the University of Florida and Stanford University hub speci...
Type 1 diabetes (T1D) is a lifelong and chronic condition that can cause severely compromised hea... more Type 1 diabetes (T1D) is a lifelong and chronic condition that can cause severely compromised health. The T1D treatment regimen is complex, and is a particular challenge for adolescents, who frequently experience a number of treatment adherence barriers (e.g., forgetfulness, planning and organizational challenges, stress). Diabetes Journey is a gamified mHealth program designed to improve T1D self-management through a specific focus on decreasing adherence barriers and improving executive functioning skills for adolescents. Grounded in situativity theory and guided by a sociotechnical-pedagogical usability framework, Diabetes Journey was designed, developed, and evaluated using a learning experience design approach. This approach applied design thinking methods within a Successive Approximation Model design process. Iterative design and formative evaluation were conducted across three design phases, and improvements were implemented following each phase. Findings from the user testing phase indicate Diabetes Journey is a user-friendly mHealth program with high usability that holds promise for enhancing adolescents' T1D self-management. Implications for future designers and researchers are discussed regarding the social dimension of the sociotechnical-pedagogical usability framework. An extension to the framework is proposed to extend the social dimension to include socio-cultural and contextual considerations when designing mHealth applications. Consideration of the pedagogical and sociocultural dimensions of learning is imperative when developing psychoeducational interventions.
Objective Mealtime family functioning is important in shaping health behaviors associated with ov... more Objective Mealtime family functioning is important in shaping health behaviors associated with overweight/obesity, particularly for preschool-aged children. Parental controlling feeding behaviors (i.e., restriction and pressure to eat), may impact mealtime family functioning and thus be targets of prevention and intervention efforts. The current study aimed to address literature gaps by examining both mother and father self-reports of controlling feeding behaviors, and the discrepancies between parents’ reports. Further, the study examined the associations among controlling feeding behaviors and objective mealtime family functioning in a community sample of preschool-aged children. Methods The sample included 27 children between 2 and 6 years of age and their immediate family members. Two mealtimes were videotaped for each family and coded for family functioning using the Mealtime Interaction Coding System, and self-reports of feeding practices were collected using the Child Feeding...
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Papers by Sarah Westen