Purpose:  The Integrative medicine group visits program (IMGV) is a 9-week intensive outpatient medical group visit program for chronic pain patients combining principles of mind-body techniques with group discussions on wellness topics.

Methods:  We conducted three focus groups (N=20) with participants with chronic pain and depression who had participated in an IMGV program in order to better understand the participants’ experiences and interpretations of the program and its effects. An unaffiliated facilitator asked participants about their perceptions of the program and motivation for attending; lessons learned or lifestyle changes made; physical, mental, or behavioral effects attributed to the program; and opinions about group versus individual care. The focus groups were audiotaped, transcribed, and analyzed preliminarily. Transcripts will be further analyzed using grounded thematic analysis techniques.

Results: The focus group participants (N=20) all received their primary care from inner city outpatient clinics; the average age of participants was 51; 15 identified as African American and 7 as Latino; over half of the participants were on sick leave or disability (n=11); over half of the participants were on food stamps (n=12); 6 participants were using a Section 8 housing subsidy; the average pain level was 6 (range =0-9). Emerging themes include the significance of the group in providing social support, universality, affiliation with a clinician, health directed behavior and self-efficacy. We explore the multiple meanings of efficacy in an integrative group care delivery model.

Conclusions: IMGV is a multi-faceted intervention that increases social support, universality, affiliation with a clinician and self-efficacy.

Purpose: The purpose of this pilot study is to evaluate the feasibility of introducing a tablet computer with an Embodied Conversational Agent (ECA) into an integrative medical group visit (IMGV) for patients with chronic pain and depression.

 

Methods: This prospective observational cohort study enrolled 20 participants who were attending an integrative medicine group visit. Patients attended a 9-session integrative medical group visit and received a tablet computer with an Embodied Conversational Agent (ECA). Participants were encouraged to interact with the ECA between groups at home. Participants completed questionnaires at baseline and 9 weeks. We recorded socio-demographics and feasibility outcomes including ECA helpfulness, satisfaction with the ECA, areas of interest for the ECA to discuss (nutrition and stress) and what could be improved about the ECA.

 

Results: All participants receive their primary care in inner city outpatient clinics; the average age of participants was 47; 13 participants identified as African American and 3 as Latino; 16 participants with an annual income under $30,000; 12 participants were on disability. Of the participants who completed surveys, 100% reported they used the ECA’s suggestions to reduce stress; 89% used the ECA’s suggestions to eat healthier; 67% said they were extremely confident they could continue to use the ECA’s recommendations post-study. Sixty seven percent said it was easy to talk with the ECA; 78% said they trusted the ECA very much; 44% said they would prefer the ECA over speaking with a clinician; and 89% said they would definitely recommend the ECA to a friend. Emerging themes included participants’ feeling like the ECA was a friend and someone to talk and relate to, ability to use the ECA whenever they wanted (accessibility), ability to dive deeper into curriculum at their own pace and review material with the ECA when needed.

Conclusions: It is feasible to introduce an ECA into a 9-week IMGV program for an underserved patient population with chronic pain and depression.

Background: In 2014, approximately 29.1 million people in the US were estimated to have type 2 diabetes.  Latino farmworkers carry a disproportionate burden of type 2 diabetes and face numerous challenges to accessing health care and self-management.  Cultural beliefs of Latino diabetics have been found to have an impact on their treatment behaviors. The majority of Latinos use some type of complementary and alternative medicine (CAM) to control their glucose levels. This presentation focuses on the understanding of the CAM practices among diabetic Latinos living in a farmworking community.

Methods: Latinos diagnosed with type 2 diabetes were recruited from a faith-based community clinic in Central West Florida. Ethnographic interviews (n=30) were conducted in Spanish using socio-demographic, freelist and open-ended questions.  Applied thematic analysis techniques were employed to analyze qualitative data using Atlas.ti7. 

Results: More than half of the participants indicated current or previous use of CAM (specifically home remedies) as a form of diabetes management. Various home remedies utilized by participants included: bitter herbal teas, fruit shakes, sabila (aloe vera), and nopal (prickly pear cactus).  Participants reported having learned about home remedies mainly from family members and acquaintances, many of whom were diabetics.  Reasons for using home remedies included: inability to afford medications and/or access medical care, to maintain glucose levels, relieve common symptoms, improve quality of life, complement prescribed medications, and to a lesser extent cure diabetes. Participants who did not use home remedies discussed their uncertainty of the safety and usefulness of the ingredients, personal preference for biomedical treatment and compliance with health care provider recommendations. Mixed perceptions and assumptions of providers’ views and reactions influenced whether participants disclosed the use of home remedies.

Conclusion: Family and cultural beliefs, as well as financial means are factors that determine the use of home remedies to self-manage type 2 diabetes among Latinos in this farmworking community. There is a clear need and desire for providers to acknowledge the cultural practices and preferences of this subgroup of Latino diabetics and to discuss the potential positive and negative interactions between home remedies and biomedical treatment for the management of type 2 diabetes. The findings of this study contribute to a better understanding the patterns of home remedy use and the decision-making processes regarding their use. Our findings can inform the design of culturally appropriate diabetes education and self-management plans. Further research is needed to investigate the efficacy of these home remedies and the use of other types of CAM treatments among diabetic Latinos in farmworking communities.  

Tunjuelito Hospital participated of a pilot project to integrate Complementary and Alternative Medicine (CAM) services into the Health Department´s public healthcare network in Bogota, Colombia. Along with the implementation of the CAM service, the Health Department required that participant institutions develop a research project.  Tunjuelito Hospital prioritized patients with chronic pain. The aim of the study was to understand the participants’ perceptions of their experience at the newly-established CAM service. Participants were referred to the CAM service by their primary care physicians or the nurse in charge of the hospital´s chronic diseases´ program.  Twenty-one patients, randomly selected, were interviewed. After consenting, interviews were audiotaped and transcribed. Data was analyzed using NVivo.  Participants’ ages ranged between 36 and 85 years old and lived in neighborhoods classified on the lowest two (out of six) socio-economic status categories, as defined by the city. Only a third of them had some education higher than sixth grade. Chronic pain duration ranged between 3 months and several years; patients often had other concurrent chronic illnesses.  Analysis of interviews showed the social, cultural and clinical importance of non-conventional health practices in the local context, particularly, in the treatment of patients with chronic pain. The data showed that boundaries between conventional and non-conventional health practices are blurry, often overlap, and represent a continuum of care in the local context. Nevertheless, participants also pointed to differences among the two and discussed specific characteristics of the CAM service they valued.  Access to CAM services, safety, and clinical effectiveness were examined.

Background: In the U.S., Latinos have a higher prevalence (12-19%) of type 2 diabetes and poorer diabetes outcomes relative to whites (8%). Successfully managing diabetes is complex and may be difficult for this group because they generally have fewer economic resources and less access to health promoting environments. Latinos also face various toxic socioeconomic stressors that can act as barriers for diabetes self-care activities. Stress as it relates to diabetes, is important to address particularly because within Latino culture there is a traditional belief that stress or strong emotions (i.e., susto) causes the onset of diabetes and influences its management. Rationale: Given this historical and cultural belief, the purpose of this study is to: a) describe how susto is understood among Latino patients with type 2 diabetes and b) discuss how diabetes causation beliefs influence diabetes management. Methods:  Patients’ diabetes causation beliefs were quantitatively assessed using the Illness Perception Questionnaire-Revised (IPQ-R) and qualitatively assessed via focus group discussions. The IPQ-R includes a list of 20 diabetes causation items and patients were asked to endorse whether they agreed or disagreed with the item. Two semi-structured focus groups were conducted with 13 Latino patients with type 2 diabetes. Results: The top three endorsed diabetes causation items included: 1) Stress and Worry, 2) My own Behaviors, and 3) Hereditary-it runs in my family. The qualitative results demonstrated that the majority participants believe that diabetes is caused by susto and also referred to this concept as coraje (i.e., anger). “My uncle was afraid because of what he saw…it’s like fear, more like because of susto he fell in coma or shock. When they took him to the hospital they cured his shock and 15 days later they diagnosed him with sugar”. Stress was described as a result of experiencing busy and fast paced work environments, “The pressure from work … every day to survive….I struggle with my stress, my illness, and all of that”. Participants also believed that diabetes was inherited or caused by an unhealthy diet, “it came from heredity or because of the food and the stress”. Understanding a patient’s health belief was perceived as an important factor for treating and managing the disease, “it helps the doctor to better understand the person he's dealing with”, “That's the key to a little bit of understanding between the doctor and the patient”, “if the patient does answer it was the stress…or diet they could be helped”. Diabetes orientation programs for families and support groups were other primary theme that emerged. Conclusion:  Stress was identified as a cause of diabetes in addition to several behavioral and hereditary factors. Asking Latinos with diabetes about health beliefs could help prioritize treatment and management goals.