Andrea Cherrington

University of Alabama at Birmingham, Birmingham, Alabama, United States

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Publications (52)86.41 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Community health worker (CHW) interventions have potential to improve diabetes outcomes and reduce health disparities. However, few studies have explored patient perspectives of peer-delivered diabetes programs. The purpose of this qualitative study is to investigate possible benefits as well as risks of CHW-delivered peer support for diabetes from the perspectives of African American women living with type 2 diabetes in Jefferson County, Alabama. Four ninety-minute focus groups were conducted by a trained moderator with a written guide to facilitate discussion on the topic of CHWs and diabetes management. Participants were recruited from the diabetes education database at a safety-net hospital. Two independent reviewers performed content analysis to identify major themes using a combined deductive-inductive approach. There were 25 participants. Mean years with diabetes was 11.2 (range 6 months to 42 years). Participants were knowledgeable about methods for self-management but reported limited resources and stress as major barriers. Preferred CHW roles included liaison to the healthcare system and easily accessible information source. Participants preferred that the CHW be knowledgeable and have personal experience managing their own diabetes or assisting a family member with diabetes. Concerns regarding the CHW-model were possible breaches of confidentiality and privacy. The self-management strategies and barriers to management identified by participants were reflected in their preferred CHW roles and traits. These results suggest that African American women with diabetes in Alabama would support peer-led diabetes education that is community-based and socially and emotionally supportive.
    Journal of Community Health 03/2015; DOI:10.1007/s10900-015-0011-7 · 1.28 Impact Factor
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    ABSTRACT: The purpose of this single-group pilot study was to evaluate the feasibility, acceptability, and initial outcomes of a novel approach to delivering weight loss treatment in primary care using peer coaches and targeting predominantly African American patients with diabetes or prediabetes. Participants (N = 33) were recruited from a family medicine practice for a 6-month lifestyle intervention. Eligible patients were obese adults (body mass index [BMI] ≥30 kg/m(2)) with ≥1 additional cardiometabolic risk factor(s), including (1) elevated hemoglobin A1C or diagnosed diabetes, (2) elevated blood pressure, (3) elevated triglycerides, and/or (4) low high-density lipoprotein. The intervention included a combination of 12 group-based office visits with health professionals plus 12 individual phone contacts with peer coaches. Outcomes included weight loss, program adherence, and program satisfaction. Participants (mean age = 56 ± 10 years; BMI = 42.9 ± 11.0 kg/m(2)) were predominantly female (88%) and African American (85%). Treatment resulted in a significant mean weight loss of -4.5 ± 7.2 kg, and approximately 27% of participants lost ≥5% of their initial body weight. Participants completed approximately 50% of the group visits and 40% of the telephone calls with peer coaches. Participants rated both components of the intervention favorably. Results of this pilot study indicated that a primary care weight management program including group-based visits and peer-delivered telephone contacts achieved significant weight loss among predominantly African American patients with weight-related comorbidities, including diabetes and prediabetes. Additional research is needed to examine the long-term outcomes of this novel approach and to identify program components supporting patients' success. © 2015 The Author(s).
    The Diabetes Educator 03/2015; 41(3). DOI:10.1177/0145721715575356 · 1.92 Impact Factor
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    ABSTRACT: The purpose of this study was to examine the role of self, interpersonal (ie, family/friend), and organizational (ie, health care) support in performing diabetes-related self-management behaviors and hemoglobin A1C (A1C) levels among rural Latinos with type 2 diabetes. Cross-sectional data from baseline interviews and medical records were used from a randomized controlled trial conducted in rural Southern California involving a clinic sample of Latinos with type 2 diabetes (N = 317). Self-management behaviors included fruit and vegetable intake, fat intake, physical activity, glucose monitoring, daily examination of feet, and medication adherence. Multivariate linear and logistic regression models were used to assess the relationships of sources of support with self-management behaviors and A1C. Higher levels of self-support were significantly associated with eating fruits and vegetables most days/week, eating high-fat foods few days/week, engaging in physical activity most days/week, daily feet examinations, and self-reported medication adherence. Self-support was also related to A1C. Family/friend support was significantly associated with eating fruits and vegetables and engaging in physical activity most days/week. Health care support was significantly associated with consuming fats most days/week. Health care practitioners and future interventions should focus on improving individuals' diabetes management behaviors, with the ultimate goal of promoting glycemic control. Eliciting family/friend support should be encouraged to promote fruit and vegetable consumption and physical activity. © 2015 The Author(s).
    The Diabetes Educator 02/2015; DOI:10.1177/0145721715569078 · 1.92 Impact Factor
  • Andrea Cherrington, April A. Agne, James Willig, Alfredo Guzman
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    ABSTRACT: Community Health Worker interventions offer a promising strategy for improving diabetes self-management and health outcomes, with evidence to support its effectiveness, particularly in underserved communities. However, there is limited evidence on how to most effectively integrate CHW programs with primary care efforts. Mobile health technology (mHealth) can connect CHWs to members of the health care team, creating synergy through the bidirectional exchange of information. This project represents a partnership between an academic institution, a safety net health system, and a local community based organization of African American Churches. Our overarching goal was to develop an effective model for the integration of a community health worker (CHW) delivered peer support program with primary care-based efforts to improve glycemic control and health outcomes. We employed an iterative, user-centered approach to develop an mHealth tool that allows for the effective and secure exchange of information between CHWs and the primary care team, allowing patients to benefit from coordinated efforts. Five CHWs and three health care providers were trained to use the system and provide real time feedback to the study team. To date, satisfaction with the system is high. We have enrolled 120 low-income African American patients with diabetes into an ongoing randomized controlled trial designed to demonstrate feasibility and provide an estimate of the intervention’s effectiveness. In this presentation we will describe development of the mHealth communication system in terms of both the process and the content. The integration of mHealth technology into CHW programs is innovative, advancing the science of developing and delivering sustainable community-based interventions.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Background: African Americans are disproportionately affected by the diabetes epidemic; they suffer greater diabetes-related complications and face more problems with diabetes self-management than non-Hispanic whites. Increasingly, the community health worker (CHW) model has been implemented in an effort to improve health outcomes in underserved populations. While diabetes CHW interventions in the literature have been successful, the majority of CHWs as well as the participants have been women. Further research is needed regarding men’s perceptions of how community-based interventions to promote diabetes self-management might best be implemented. The purpose of this qualitative study is to explore how African American men living with type 2 diabetes perceive the role and duties of the community health worker in the context of a community-delivered diabetes management program. Methods: Four ninety-minute focus groups were guided by a trained moderator with a written guide to facilitate discussion on the topic of community health workers (CHWs) and diabetes management. Participants were recruited from the diabetes education database at Cooper Green Mercy Hospital in Birmingham, AL. Two independent reviewers performed content analysis to identify major themes using an iterative, combined deductive and inductive approach. Results: There were 25 male participants. Mean years living with diabetes was 9.6 (range 1-20). Participants demonstrated knowledge of self-management strategies and identified various hardships including emotional and physical manifestations of diabetes, dietary restrictions and non-adherence, and institutional frustrations with the medical system that contributed to self-management barriers. Participants preferred CHWs be knowledgeable with a shared experience. Their preferred CHW duties were to educate, hold support groups, help track daily activities, and help find resources. Potential concerns regarding CHWs included cultural competency and confidentiality. The participants also discussed the importance of family-focused support dynamics. Conclusions: Participants identified critical self-management strategies but endure hardships that present barriers to achieving these methods. Many of the strategies and barriers to self-management that participants identified mirrored their preferred CHW duties and traits. Results from this study suggest that African American men in Alabama would participate in and benefit from a community-delivered diabetes management program.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Objectives: Research and interventions have been directed at physicians in order to attempt to address perceived racial/ethnic discrimination in medical care and potentially provide more equitable care across the US population. However, little is known about the contributions of other ancillary medical staff (e.g., nurses, medical assistants, and receptionists) to perceived discrimination in medical care. Methods: We conducted focus group interviews with African-American (AA) and European-American (EA) participants stratified by race and gender who interacted with the Alabama health care system in the previous 12 months. We utilized a focus group topic guide, based on Social Cognitive Theory, in order to probe for personal, behavioral, and environmental factors that contribute to perceived discrimination in health care. Group interviews were audio recorded. Two investigators independently analyzed the transcribed focus group interviews for relevant themes. Results: 29 AA women (mean age and standard deviation, 47±10 years), 24 AA men (53±11 years), 18 EA women (54±15 years), and 19 EA men (39±13 years) participated in 12 focus groups. We identified several main themes related to perceptions of staff bias including communication and personal attitudes/behaviors. Communication included both verbal and non-verbal forms of communication. For example, “It’s the way they talk to you…they can talk to you like you’re below average, you know, just the tone of the voice.” Personal attitudes/behavior themes were identified with words such as “personable”, “respectful”, and “takes their time.” Some focus group response examples included, “I mean, [they] look at you, like, up and down, like you ain’t nothing,” and “they’re kind to somebody right before you, and they’re not to you. They’re short-spoken to you.” Conclusions: The behaviors of ancillary staff in the health care setting can potentially contribute to patients’ perceptions of discrimination. Future efforts to reduce health care discrimination interventions should include a focus on staff’s cultural competence and customer service skills.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Purpose: Trust in your physician has been previously linked to better glycemic control. We examined the relationship between general trust in physicians and diabetic outcomes as measured through blood pressure and glycemic control (HbA1c). Methods: This is a secondary data analysis using cross-sectional data from a community-based trial. Patients were mostly African Americans with diabetes living in southern, rural Alabama. Face-to-face interviews by trained interviewer assessed general trust in physicians using a previously validated instrument (TMP-11). HbA1c and blood pressure were measured at baseline using a standardized protocol. Categorical variables were compared using chi square tests. Continuous variables were compared using bivariate linear regression. Multivariable analyses included general linear regression models adjusted for gender, income, education, insulin use, medication adherence, number of ambulatory visits, perceived discrimination, and depressive symptoms. Results: 418 patients provided information for the trust scale (6 were missing). Mean age was 59, 75% were female and 87% were African American. High Trust (TMP > 30) was associated with older age, less perceived discrimination, and lower medication adherence. In bivariate analyses, HbA1c (p=0.26) and mean blood pressure (p=0.64) showed no significant association with provider trust. Discussion: General trust in physicians was not associated with change in glycemic control or blood pressure at follow-up in unadjusted analyses. Though it did not reach statistical significance, higher general trust was associated with higher systolic blood pressure. Future research should further explore these relationships.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Background: Diabetes Connect is a small-randomized control trial designed to test a 6 month community-based peer support intervention that is integrated into primary care efforts for low-income African American patients with type 2 diabetes in Jefferson County, Alabama. The study is a collaboration between a university, a local safety-net health system, and a community-based organization (CBO) of 10 African American Churches. This paper describes the recruitment activities employed in the study along with lessons learned. Methods: Potential participants with type 2 diabetes were identified from the health system database. Patients were sent letters inviting them to recruitment events near their homes. An average of 144 letter invitations was sent for each event. Study staff also made phone calls to personally invite the patients. An average of 120 calls was made per event date. Of those who were called, 58% did not answer or were disconnected numbers, 27% declined, and 15% accepted the invitation. All potential participants received a 5-hour diabetes education program; events were held at local churches or at the local safety-net health system. Following the class, eligible individuals were invited to participate in the study. Food was provided at the class and all potential participants received a $15 gift card. Individuals who qualified for the study and completed the baseline questionnaire received an additional $15. Results: There were 18 recruitment events. Fourteen were hosted by local churches and 4 were held at diabetes education classes. On average, 8% of those who the study team attempted to contact by phone attended recruitment events, making up 39% of total attendees. The other 61% of attendees had either received a letter invitation, were referred to diabetes education class by their health care provider, or both. All were consented and screened for participation in the study. Of the 239 patients who attended the events, 120 met inclusion criteria and were enrolled into the study. A mean of 13 (range 1 to 23) patients was screened and a mean of 6 (range 1 to 15) was enrolled at each event. Conclusions: For this study, recruitment strategies included letters followed by personal phone calls, provision of education to all interested individuals, classes at trusted community locations with food provided, and small incentives for all potential participants. Recruitment in underserved communities can be enhanced by strong community partnerships, a flexible, iterative approach that acknowledges and attempts to address participants’ potential barriers to participation.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: The purpose of the study is to explore African American men's perceptions of how community-based, community-health worker (CHW)-delivered diabetes interventions might best be implemented.
    The Diabetes Educator 11/2014; 41(1). DOI:10.1177/0145721714557043 · 1.92 Impact Factor
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    ABSTRACT: The last decade has seen many changes in graduate medical education training in the USA, most notably the implementation of duty hour standards for residents by the Accreditation Council of Graduate Medical Education. As educators are left to balance more limited time available between patient care and resident education, new methods to augment traditional graduate medical education are needed.
    Postgraduate Medical Journal 10/2014; 90(1070). DOI:10.1136/postgradmedj-2013-132486 · 1.55 Impact Factor
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    ABSTRACT: We examined the efficacy of a community-based, culturally relevant intervention to promote healthy eating and physical activity among African American (AA) women between the ages of 45-65, residing in rural Alabama.
    Preventive Medicine 08/2014; 69. DOI:10.1016/j.ypmed.2014.08.016 · 2.93 Impact Factor
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    ABSTRACT: This study evaluated a culturally relevant, social cognitive theory-based, Internet-enhanced physical activity (PA) pilot intervention developed for overweight/obese African American (AA) female college students.
    Journal of Transcultural Nursing 06/2014; DOI:10.1177/1043659614539176 · 0.83 Impact Factor
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    ABSTRACT: Intuitive eating programs that improve self-efficacy and dietary habits could enhance glycemic control in African-American women with type 2 diabetes. The goal of our study was to investigate how current eating practices and beliefs of African-American women living with diabetes aligned with intuitive eating concepts. African-American women with type 2 diabetes referred for diabetes education class during 2009-2012 were recruited for a qualitative study using focus groups for data collection. Verbatim group transcriptions were analyzed by two independent reviewers for themes using a combined inductive-deductive approach. Participants (n=35) had an average age 52±9 years, mean body mass index 39±7, and mean time with a type 2 diabetes diagnosis of 10±10 years. Participants' self-reported dietary practices were poorly aligned with intuitive eating concepts. The women reported a lack of self-control with food and regularly eating in the absence of hunger, yet stated that the determinant factor for when to stop eating was to recognize a feeling of fullness. Participants reported knowing they were full when they felt physically uncomfortable or actually became sick. Women frequently cited the belief that individuals with diabetes have to follow a different diet than that recommended for the general public. Many women also discussed diabetes-related stigma from family/friends, and often did not tell others about their diabetes diagnosis. These findings demonstrate that intuitive eating techniques are not currently applied by the women in this sample. Future studies should assess the influence of intuitive eating interventions on dietary habits among low-income African-American women with type 2 diabetes.
    Journal of the American Academy of Nutrition and Dietetics 06/2014; 114(6). DOI:10.1016/j.jand.2014.02.004 · 2.44 Impact Factor
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    ABSTRACT: In 2011, the Accreditation Council of Graduate Medical Education implemented updated guidelines for medical resident duty hours, further limiting continuous work hours for first-year residents. We sought to investigate the impact of these restrictions on graduate medical education among internal medicine residents. We conducted eight focus groups with internal medicine residents at the University of Alabama at Birmingham in 06/2012-07/2012. Discussion questions included, "How do you feel the 2011 ACGME work hour restrictions have impacted your graduate medical education?" Transcripts of the focus groups were reviewed and themes identified using a deductive/inductive approach. Participants completed a survey to collect demographic information and future practice plans. Thirty-four residents participated in our focus groups. Five themes emerged: decreased teaching, decreased experiential learning, shift-work mentality, tension between residency classes, and benefits and opportunities. Residents reported that since implementation of the guidelines, teaching was often deferred to complete patient-care tasks. Residents voiced concern that PGY-1 s were not receiving adequate clinical experience and that procedural and clinical reasoning skills are being negatively impacted. PGY-1 s reported being well-rested and having increased time for independent study. Residents noted a decline in teaching and are concerned with the decrease in "hands-on" clinical education that is inevitably impacted by fewer hours in the hospital, though some benefits were also reported. Future studies are needed to further elucidate the impact of decreased resident work hours on graduate medical education.
    BMC Medical Education 04/2014; 14(1):84. DOI:10.1186/1472-6920-14-84 · 1.41 Impact Factor
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    Journal of Adolescent Health 02/2014; 54(2). DOI:10.1016/j.jadohealth.2013.10.148 · 2.75 Impact Factor
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    Journal of Adolescent Health 02/2014; 54(2). DOI:10.1016/j.jadohealth.2013.10.103 · 2.75 Impact Factor
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    ABSTRACT: Objective: To examine and compare the relationships among diet, physical activity, and adiposity between home-schooled children (HSC) and traditionally-schooled children (TSC). Design and Methods: Subjects were HSC (n=47) and TSC (n=48) aged 7 to 12 years old. Dietary intakes were determined via two 24-hour recalls and physical activity was assessed with 7 days of accelerometry. Fat mass (FM), trunk fat, and percent body fat (%BF) were measured by dual-energy x-ray absorptiometry (DXA). Results: Relative to HSC, TSC demonstrated significantly higher BMI percentiles, FM, trunk fat, and %BF; consumed 120 total kilocalories more per day; and reported increased intakes of trans fats, total sugar, added sugars, calcium, and lower intakes of fiber, fruits, and vegetables (p<0.05). At lunch, TSC consumed significantly more calories, sugar, sodium, potassium, and calcium compared to HSC (p<0.05). Physical activity did not differ between groups. Traditional schooling was associated with increased consumption of trans fat, sugar, calcium (p<.05); lower intakes of fiber, and fruits and vegetables (p<.05); and higher FM, %BF, and trunk fat (p<0.01), after adjustment for covariates. Conclusions: These data suggest HSC may consume diets that differ in energy and nutrient density relative to TSC, potentially contributing to differences in weight and adiposity.
    Obesity 02/2014; DOI:10.1002/oby.20610 · 4.39 Impact Factor
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    ABSTRACT: In community-based interventions involving lay health workers, or "community health workers," peer-client interactions are not typically observed by investigators, creating challenges in assessing intervention fidelity. In the context of a community-based randomized controlled trial of the effectiveness of peer support on diabetes outcomes of people with diabetes in rural Alabama, a region characterized by poverty and low literacy, we developed a video assessment tool that assessed participant perceptions of peer-client interactions. The video assessment consisted of four short skits on areas of emphasis during peer training: directive versus nondirective counseling style and setting a specific versus a more general goal. The video tool was evaluated for association with questionnaire-derived measures of counseling style and goal setting among 102 participants. For counseling style, 44% of participants reported that their peer advisor was most similar to the nondirective skit. For goal setting, 42% reported that their peer advisor was most similar to the specific goal skit. There was no statistically significant relationship between skit selection and questionnaire-derived measures. The video assessment was feasible, but results suggest that video and questionnaire assessments in this population yield different results. Further validation to better understand the differences between questionnaire reports and video assessment is warranted.
    Health Promotion Practice 01/2014; 15(5). DOI:10.1177/1524839913518560 · 0.55 Impact Factor
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    ABSTRACT: Innovative approaches are needed to promote physical activity among young adult overweight and obese African American women. We sought to describe key elements that African American women desire in a culturally relevant Internet-based tool to promote physical activity among overweight and obese young adult African American women. A mixed-method approach combining nominal group technique and traditional focus groups was used to elicit recommendations for the development of an Internet-based physical activity promotion tool. Participants, ages 19 to 30 years, were enrolled in a major university. Nominal group technique sessions were conducted to identify themes viewed as key features for inclusion in a culturally relevant Internet-based tool. Confirmatory focus groups were conducted to verify and elicit more in-depth information on the themes. Twenty-nine women participated in nominal group (n = 13) and traditional focus group sessions (n = 16). Features that emerged to be included in a culturally relevant Internet-based physical activity promotion tool were personalized website pages, diverse body images on websites and in videos, motivational stories about physical activity and women similar to themselves in size and body shape, tips on hair care maintenance during physical activity, and online social support through social media (eg, Facebook, Twitter). Incorporating existing social media tools and motivational stories from young adult African American women in Internet-based tools may increase the feasibility, acceptability, and success of Internet-based physical activity programs in this high-risk, understudied population.
    Preventing chronic disease 01/2014; 11:E09. DOI:10.5888/pcd11.130169 · 1.96 Impact Factor
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    ABSTRACT: The Internet presents a widely accessible, 24-h means to promote chronic disease management. The objective of this review is to identify studies that used Internet based interventions to promote lifestyle modification among adults with type 2 diabetes. We searched PubMed using the terms: [internet, computer, phone, smartphone, mhealth, mobile health, web based, telehealth, social media, text messages] combined with [diabetes management and diabetes control] through January 2013. Studies were included if they described an Internet intervention, targeted adults with type 2 diabetes, focused on lifestyle modification, and included an evaluation component with behavioral outcomes. Of the 2803 papers identified, nine met inclusion criteria. Two studies demonstrated improvements in diet and/or physical activity and two studies demonstrated improvements in glycemic control comparing web-based intervention with control. Successful studies were theory-based, included interactive components with tracking and personalized feedback, and provided opportunities for peer support. Website utilization declined over time in all studies that reported on it. Few studies focused on high risk, underserved populations. Web-based strategies provide a viable option for facilitating diabetes self-management. Future research is needed on the use of web-based interventions in underserved communities and studies examining website utilization patterns and engagement over time.
    Journal of diabetes and its complications 12/2013; DOI:10.1016/j.jdiacomp.2013.07.003 · 1.93 Impact Factor

Publication Stats

532 Citations
86.41 Total Impact Points

Institutions

  • 2007–2015
    • University of Alabama at Birmingham
      • • Division of Preventive Medicine
      • • Department of Medicine
      Birmingham, Alabama, United States
  • 2010
    • University of Alabama
      Tuscaloosa, Alabama, United States
  • 2006
    • University of North Carolina at Chapel Hill
      • Cecil G. Sheps Center for Health Services Research
      Chapel Hill, NC, United States