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As part of comprehensive clinical care for people with diabetes, there is a need for multifaceted interventions that address the primary lifestyle factors that contribute to women's type 2 diabetes and place them at elevated risk for heart disease. The Mediterranean Lifestyle Program (MLP) demonstrated that a multiple-behavior-change intervention focusing on diet, exercise, stress management, and social support had beneficial effects on biological, behavioral, and psychosocial outcomes within the first 2 years of the program. A cultural adaptation of MLP, ¡Viva Bien!, partially replicated those effects when it was extended to Latina women recruited from a large health maintenance organization and a community health center. Both projects indicated that refinements are warranted to increase the sustainability of intervention effects and the feasibility of dissemination. [ABSTRACT FROM AUTHOR]

Objectives: To explore issues of intervention tailoring for ethnic minorities based on information and experiences shared by researchers affiliated with the Health Maintenance Consortium (HMC). Methods: A qualitative case study methodology was used with the administration of a survey (n=17 principal investigators) and follow-up telephone interviews. Descriptive and content analyses were conducted, and a synthesis of the findings was developed. Results: A majority of the HMC projects used individual tailoring strategies regardless of the ethnic background of participants. Follow-up interview findings indicated that key considerations in the process of intervention tailoring for minorities included formative research; individually oriented adaptations; and intervention components that were congruent with participants' demographics, cultural norms, and social context. Conclusions: Future research should examine the extent to which culturally tailoring long-term maintenance interventions for ethnic minorities is efficacious and should be pursued as an effective methodology to reduce health disparities. [ABSTRACT FROM AUTHOR]

Objectives: To describe recruitment of Latinas in a randomized clinical trial conducted within 2 health care organizations. Methods: The study relied on projectinitiated telephone calls as part of a multifaceted recruitment approach. Chi-square and t tests were conducted to compare participants and nonparticipants on a number of variables. Results: From 4045 telephone contacts, 280 Latinas agreed to participate. Most were ineligible due to non- Latino ethnicity (89%). Of eligible candidates, 61% took part. Few significant differences were found on participant vs nonparticipant characteristics. Conclusion: Using appropriate recruitment procedures, a representative sample of Latinas can be obtained. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Internet-based programs offer potential for practical, cost-effective chronic illness self-management programs. Methods: We report 12-month results of an Internet-based diabetes self-management program, with and without additional support, compared to enhanced usual care in a 3-arm practical randomized trial. Patients (n =463) were randomized: 77.3% completed 12-month follow-up. Primary outcomes were changes in health behaviors of healthy eating, physical activity, and medication taking. Secondary outcomes were hemoglobin A1c, body mass index, lipids, blood pressure, and psychosocial factors. Results: Internet conditions improved health behaviors significantly vs. usual care over the 12-month period (d for effect size=.09–.16). All conditions improved moderately on biological and psychosocial outcomes. Latinos, lower literacy, and higher cardiovascular disease risk patients improved as much as other participants. Conclusions: The Internet intervention meets the reach and feasibility criteria for a potentially broad public health impact. However, 12-month magnitude of effects was small, suggesting that different or more intensive approaches are necessary to support long-term outcomes. Research is needed to understand the linkages between intervention and maintenance processes and downstream outcomes. Practice implications: Automated self-management interventions should be tailored and integrated into primary care; maintenance of patient self-management can be enhanced through links to community resources. [Copyright &y& Elsevier]