Melissa Olfert

Limited research on diabetes education and support implementation in Appalachia, which is a critical knowledge gap considering barriers to care, and high prevalence rates. The aim was to understand what each facility is providing regarding diabetes education and services within West Virginia. This study reports cognitive interview qualitative findings from a multi-methods study. Individuals were recruited through an online search to identify clinics, organizations, and hospital staff that provided diabetes education in the state of West Virginia. Eligible participants were individuals who facilitated and managed diabetes education and support in counties of West Virginia. The interviews followed an 11-item interview guide, approved, and reviewed by a practicing Registered Dietitian and Certified Diabetes Care Education Specialist in West Virginia. All qualitative data from the interviews were hand-coded using grounded theory, by two researchers. 15 participating organizations from the state of West Virginia were included and described three phenomena: Diabetes Education Implementation (differences in: evaluation measures, modality, delivery format, topical areas); Barriers to Care (staffing, lack of training, evaluation, loss of research partnerships and funding); and Facilitators to Care (community-based involvement, interdisciplinary collaboration, capacity building (trainings). There are concerns with program drift and “risky” adaptations such as inconsistent evaluative measures, lack of training for program facilitators, variety of delivery formats, and content material. Findings recommend more alignment in program delivery to better implementation. Further studies should assess patient experiences with implemented diabetes education programs in West Virginia to further support the current research findings.

The prevalence of obesity continues to rise. Preventing obesity, especially childhood obesity, is critically important. Parents, especially mothers, play a vital role in preventing childhood obesity. Numerous factors, such as maternal employment, may influence maternal weight-related practices and home environment characteristics that affect the risk of childhood obesity. Given the prevalence of both childhood obesity and maternal employment, this study was conducted to examine how weight-related maternal, child, and household behaviors as well as home environment characteristics differ by maternal employment hours and extends existing research by examining work impact on behaviors and home characteristics. U.S. mothers (n = 527) with at least one school-age child (6 to 11 years), who were between the ages of 25 and 54 years and the main food gatekeeper in the household completed an online survey. ANOVA comparisons of non-working, part-time employed, and full-time employed mothers revealed few differences in any of the variables studied. Cluster analysis of the 336 employed mothers based on six work impact scale scores found three unique clusters characterized as Enthusiastic Earners, Indifferent Earners, and Strained Earners. Few differences in sociodemographic and job characteristics occurred among clusters and the differences noted had small effect sizes. Clusters did not differ by maternal BMI or perceived child weight status. However, the clusters differed in numerous weight-related behaviors and home environment characteristics. Future research should aim to determine the direction of the associations of work impact with weight-related behaviors and home environments as well as identify potential strategies for overcoming the negative effects of employment on weight-related behaviors and environments and weight status as well as clarify other factors that may affect maternal work impact, such as time management, reasons for employment, and stress.