Abstract
Assessing the Feasibility and Acceptability of Yoga For Systemic Lupus Erythematosus (SLE)
Kimberly R. Middleton, BSN, MPH, MS, RYT5001, Sarfaraz Hasni, MD2, Steffany Moonaz, PhD, RYT5003, Miriam Magaña López, BA, RYT2004, Gladys Tataw-Ayuketah, RN, MPH5 and Gwenyth R. Wallen, PhD, RN6
(1)NIH/Clinical Center, Bethesda, MD, (2)National Institute of Arthritis and Musculoskeletal and Skin Disease, Bethesda, MD, (3)Maryland University of Integrative Health, Laurel, MD, (4)UC Berkeley School of Public Health, Berkeley, CA, (5)National Institutes of Health/Clinical Center, Bethesda, MD, (6)National Institutes of Health Clinical Center, Bethesa, MD
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Systemic lupus erythematosus (SLE) is an autoimmune disease that leads to widespread inflammation and tissue damage. SLE is more common and severe in some ethnic groups, specifically blacks, Hispanics, and Asians. Standard medical treatment seeks to prevent flares, and reduce organ damage. However even with improved clinical parameters, up to 50% of patients perceive their health to be suboptimal, which may indicate a physician/patient disconnect. Two previous studies, using the SLE Needs Questionnaire, revealed 94-100% of patients have at least one illness-related unmet need, most commonly fatigue/tiredness (81%) and pain (73%). Fatigue and joint pain symptoms, coupled with the unpredictable nature of disease activity, can lead to depression, anger, and feelings of hopelessness. Recently published treatment guidelines have focused on improving the overall quality of life.
Yoga interventions have been shown to produce improvements in quality-of-life measures, sleep, and fatigue. While there is growing evidence that yoga therapy may help osteoarthritis (OA) and rheumatoid arthritis (RA) symptoms, only one reference in the literature discusses SLE. An adjunct study was undertaken to evaluate the feasibility of adapting the Yoga as Self Care for Arthritis in Minority Communities study to persons with SLE. This original pilot study offered therapeutic yoga to patients with RA and OA served by the NIAMS Community Health Center in the Washington DC area.
Formative work included 1) interviewing patients diagnosed with SLE; 2) interviewing yoga instructors with SLE; and 3) convening an expert panel of yoga instructors. Twenty-eight bilingual (English and Spanish) clinic patients diagnosed with SLE were interviewed and indicated an interest in yoga for stretching and relaxation; as well as desiring help with fatigue, sleep, and flexibility. Their feedback was used to amend the study to add patients with SLE. Of 14 eligible patients, 7 were enrolled and 3 completed the yoga series. Enrolling patients provided clarity on revisions for intake questionnaires and symptom considerations that may impact class participation.
Subjects participated in 60-minute bilingual Hatha yoga classes, twice per week for 8 weeks. In comparison to participants with RA/OA, the SLE cohort appeared to have increased body awareness, increased ability to hold balancing poses, willingness to attempt more challenging poses, and the ability to tolerate a faster-paced yoga class. Qualitative data (personal narratives and exit interviews) produced participant themes related to: increased stretching and flexibility, reduced lupus symptoms, enjoyment, feelings of well-being, self-confidence, and expectation of future benefits from learning yoga.
In addition to information obtained from participant experiences, three yoga instructors diagnosed with lupus were interviewed to better understand the unique yoga needs for this diagnosis. Discussions highlighted the need to modify yoga based on energy levels and changes in physical ability. Finally, an expert panel of yoga teachers was convened to suggest SLE-specific revisions for the class series. Future recommendations include starting each class with meditation to cultivate body awareness and assess energy level. Also teaching restorative poses in every class for use as ‘gentle’ practice options when experiencing flares. Preliminary work affirms the feasibility of progressing to a larger study design.
Conduct evaluation related to programs, research, and other areas of practice Diversity and culture Public health or related research
Abstract
Touching Others Using Caring Hands (TOUCH)SM: Training Minority Massage Therapists to deliver community-based cancer survivor stress reduction techniques
Fornessa Randal, MCRP1, Yashika Watkins, PhD, MPH2, Gina Curry, MPH2, Thomas Britt, MD, MPH2, Karen Kim, MD, MS3, Helen Lam, PhD, RN3 and Krisitn Moulden, LMT
(1)University of Chicago, Center for Asian Health Equity, Chicago, IL, (2)Chicago State University, Chicago, IL, (3)University of Chicago, Chicago, IL
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Massage therapy is one of the 10 most common complementary health approaches used in improving health and health care. The National Center for Complementary and Integrative Health (NCCIH) identifies as its 4th objective to increase the workforce of scientists and researchers in Complementary and Integrative Health(CIH) Research. Over the past three years the Chicago Southside Cancer Disparities Initiative (CSCDI) introduced the Touching Others Using Caring Hands (TOUCH)SM massage therapy program to target cancer patient education and survivorship support for Chicago’s Southside Chinese and African American communities. This initiative is based in part on a National Cancer Institute supported program, “Touch, Caring, and Cancer.” These types of innovative programs can help provide alternative support for cancer survivors in underrepresented minority communities.
The (CSCDI) is a joint effort between Chicago State University (CSU) a minority serving institution and University of Chicago Comprehensive Cancer Center (UCCCC) to provide a foundation of cancer disparities and public health research education for underrepresented minority Master of Public Health (MPH) students. The partnership targets the cancer disparities issues disproportionately affecting Chicago Southside residents.
Researchers at CSU and University of Chicago Center for Asian Health Equity (CAHE) and the UCCCC are training massage therapist from the Chinese and African American communities in (CIH) approaches utilizing the NIH supported program. These trained therapists then work with researchers from CAHE and CSU along with the MPH students at CSU to understand the importance of complementary medicine as it relates to community based survivorship programs (patient education) for cancer survivors, and explain the process for effective development of community based survivorship through complementary health approaches.
Presenters will describe the massage therapists, cancer survivor, caregiver, and graduate students’ responses observed and recorded during an 18 week period in which three training sessions were provided. They will share the methodology used in training culturally competent massage therapists in CIH in the research project and provide the data and results gained from pre/posttest given to participants.
Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs Program planning
Abstract
Integrative, Complementary and Traditional Health Practices Among Latino Children with Asthma and Influence on Asthma Control
Kimberly Arcoleo, PhD, MPH1, Jonathan Feldman, PhD2 and Colleen McGovern, RN, MPH3
(1)University of Rochester, Rochester, NY, (2)Yeshiva University, Bronx, NY, (3)The Ohio State University, Columbus, OH
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Background: Caregivers’ (CGs) desire for their children with asthma to be medication free has led to increasing use of integrative, complementary and traditional health practices (ICTHP) for managing children’s asthma. In addition, Puerto Rican (PR) children are disproportionally affected by asthma (14%) compared to other ethnic groups, particularly Mexican children (6%). There are few studies making direct comparisons between Mexican and PR children with asthma and ICTHP and controller medication use; no studies have utilized growth models to identify the sociodemographic, cultural, environmental, and contextual pathways leading to these disparities.
Aim: Are disparities in asthma control between Mexican and PR children due to differences in CGs’ use of controller medications and ICTHP?
Design: 1 year longitudinal study conducted among 268 Mexican and PR CGs and 268 children ages 5–12 with asthma. The study was conducted at 2 school-based health centers and Breathmobile in Phoenix, AZ and 1 pediatric asthma and allergy clinic in Bronx, NY. Interviews and child pulmonary function tests were completed at baseline and 3, 6, 9, & 12 months; medical record reviews conducted at 12 months. Structural equation models (SEM) were used.
Results: Caregivers were asked “Have you ever tried medications or treatments other than those prescribed by your doctor to manage your child’s asthma?” 19% of Mexican and 11% of PR CGs stated “Yes.” These proportions increased dramatically to 73% and 83%, respectively, when asked structured questions about specific types of ICTHP (e.g., herbs, rubs, syrups). Current ICTHP use was 54% for Mexican and 70% for PR CGs. Only 38% of PR children’s asthma was rated by the clinician as well-controlled compared to 60% of Mexican children. There were no differences in Asthma Illness Representation Scale (AIRS) scores between Mexican and PR CGs. Rubs (52%), prayer for health (30%), and herbal teas (24%) were the most prevalent types of ICTHP used. SEM results revealed that poverty, CG education, AIRS, relationship with the healthcare provider and triggers were significant predictors of ICTHP use (RMSEA=.05, CFI=.96, TLI=.86). There were significant ethnic differences. For Mexican CGs, the model accounted for 16% of variance in ICTHP and 5% in controller medication use. AIRS scores aligned with the professional model of asthma management were associated with decreased likelihood of ICTHP (β=-.26) but not controller medication use. ICTHP use was not associated with children’s asthma control. A very different picture emerged for PR CGs. The model accounted for 48% of variance in ICTHP and 50% in controller medication use. AIRS scores congruent with the professional model were significantly associated with increased controller medication (β=.69) and decreased ICTHP use (β=-.57). For PR children, ICTHP use was significantly related to poorly controlled asthma.
Conclusions: This study demonstrated that the majority of CGs are using ICTHP to manage their children’s asthma and believe their children’s asthma to be well-controlled (78%) which is in stark contrast to clinician ratings (49%). CGs asthma illness representations had a differential influence on ICTHP use and subsequent impact on asthma control which may partially explain the observed health disparities.
Chronic disease management and prevention Diversity and culture Planning of health education strategies, interventions, and programs
Abstract
“We all have the drug that keeps us moderately functional, but I don’t want to just exist. I want to be better than that.": Interest in and use of integrative health approaches in primary care migraine management in a socioeconomically diverse patient group
Deanna Befus, PhD, RN1, Sharon Hull, MD, MPH2, Justine Strand de Oliveira, DrPH, PA-C3, Gillian Sanders4, Morris Weinberger, PhD5 and Remy Coeytaux, MD, PhD1
(1)Wake Forest University School of Medicine, Winston-Salem, NC, (2)Duke Medicine, Durham, NC, (3)University of London, London, United Kingdom, (4)Duke, Durham, NC, (5)University of North Carolina at Chapel Hill, Chapel Hill, NC
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Background: Migraine is a highly disabling neurological disorder affecting over 45 million people in the US. The WHO has declared migraine--the sixth biggest cause of disability worldwide—a major public health problem due to a paucity of knowledge about cause and effective treatment options. Both in incidence and severity, migraine disproportionately affects people occupying low social locations (LSL), that is, people with high levels of chronic stress due to the unequal distribution of health-damaging experiences (e.g., lack of access to clean and reliable food sources, education, healthcare; toxic and/or dangerous built environments; social stigma and prejudice, etc.).
Managed pharmacologically, migraine is treated with daily preventive and as-needed abortive medications. Both come with high literal and figurative costs: intolerable side effects, medication interactions, and prohibitive prices. Currently, none of the available preventive medications were designed specifically for migraine and are effective in only 50% of people taking them, 50% of the time.
Cost prohibitive, ineffective, and unsustainable pharmacological treatment options have contributed to high reported levels of interest and use of complementary approaches by people with migraine, but little is known about their motivations or patterns of use or access, or how these may vary by social location.
Method: We conducted focus groups with 30 primary care migraine patients to explore their most meaningful outcomes and goals in migraine treatment. We used structural coding techniques and qualitative content analysis both within and across groups to identify themes. Using a combination of race, education, and number of times receiving public assistance as an adult, we determined social location. We present the overall themes, as well as how they differed by social location.
Outcomes: We identified four themes for participants' migraine management priorities: (1) wanting a more holistic, collaborative, long-term treatment approach; (2) medication only as a short term solution; (3) high personal and economic costs of medication, and; (4) desire for more information and access to “alternative” and “natural” approaches. Across social locations, participants expressed keen interest in integrative approaches and wanted better access to complementary modalities. Participants with higher education, incomes, and who largely identified as white reported more and continued exposures to complementary modalities such as acupuncture, herbs and supplements, massage and bodywork, yoga, and meditation. LSL participants, especially people of color, described heavier reliance on traditional/folk remedies, including engagement with family and community healers (e.g., “root doctors”), who they described as more affordable and culturally accessible.
Conclusions: Holistic and integrative approaches were preferred over medication as long-term migraine management strategies. However, people in LSL, while disproportionately disabled by migraine and for whom many of the pharmacological options were cost prohibitive, did not feel as comfortable accessing integrative approaches through currently available channels. Engaging with LSL communities and using a critical lens to explore barriers to access can develop options to make complementary modalities more approachable, while also attending to more systemic blind spots in integrative approaches that may unintentionally alienate socially marginalized groups.
Assessment of individual and community needs for health education Chronic disease management and prevention Clinical medicine applied in public health Diversity and culture
Abstract
Evaluation of a ‘life reform’ program for the metabolic syndrome in Lima, Peru
Yolanda Angulo-Bazán, MD, MSc (c)1, Martha Villar2, Yessica Ballinas2 and César Gutierrez3
(1)Universidad de La Frontera, Temuco, Chile, (2)Peruvian Social Health Insurance (EsSalud), Lima, Peru, (3)School of Medicine. University of Piura (UDEP), Lima, Peru
APHA 2017 Annual Meeting & Expo (Nov. 4 - Nov. 8)
Introduction: Lifestyle change is the first-line therapy for the metabolic syndrome. It is recommended that each country implements socially and culturally accepted strategies, as well as cost-effective. To evaluate the decrease in the frequency of parameters of Metabolic Syndrome in workers who have received the health-promotion program "Reform of Life" from Social Health Insurance (EsSalud) from January to December 2015.
Methods: A non-concurrent study was conducted and the medical records of health centers with the largest amount of workers that received the intervention in the first quarter of 2015 were selected. Data from patients with premorbid Metabolic Syndrome was selected for statistical analysis. Demographic characteristics, systolic and diastolic blood pressure, abdominal circumference were evaluated at the beginning and after twelve weeks of the "Life Reform" intervention. In addition, laboratory tests (HDL, triglycerides, and fasting blood glucose) were also registered at the beginning and after twelve weeks of intervention. The difference between baseline and final values was analyzed with Student t test for paired data and Z test for difference of proportions.
Results: Between January and December 2015, 3,709 workers were screened with a median age of 36 years (interquartile range: 19 years). 66.1% were male. 43.5% were overweight at the time of the first evaluation; 902 workers (24.3%) met the criteria for pre-morbid metabolic syndrome and entered the Life Reform program; 247 workers completed the twelve sessions of the intervention, with an attendance rate of 27.3%. Significant differences were observed in mean glucose levels (p <0.001), abdominal perimeter (p <0.001), systolic pressure (p=0.002), diastolic pressure (p=0.012), triglyceride levels (p<0.001) and HDL cholesterol (p=0.016) in workers who completed the Life Reform program. After Life Reform program, 114 workers (46.4% of intervened workers) didn’t met criteria of pre-morbid metabolic syndrome. The percentage of metabolic syndrome indicators before and after the intervention was compared and the indicators with the largest decreases were hypertriglyceridemia (∆ 30.0%; CI95%: 23.6%-36.2%) and HDL (∆ 19.4%; CI95%: 12.9%-25.9%)
Conclusions: During the January-December period of 2015, the Life Reform program decreased all indicators for the metabolic syndrome, especially hypertriglyceridemia and low HDL-cholesterol, among workers recipients of the intervention in Lima, Peru. The main recommendation is to conduct a prospective study with a larger and more representative population to evaluate other intervening variables such as place of birth and occupation.
Chronic disease management and prevention Diversity and culture Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs Public health or related research Social and behavioral sciences