Lung cancer (LC) is the second leading cause of death and leading cause of cancer death in the United States. Support and care for patients with LC are often provided by a network of informal caregivers composed of family and friends who are essential in helping individuals cope with the challenges associated with their disease. The extent and diversity of the caregiving experience may jeopardize psychological well-being (i.e., anxiety, depression, health-related quality of life [HRQOL]). Complementary and alternative medicine (CAM) approaches have been used in other populations with promising outcomes. However, in the LC-caregiver population, the use of CAM is currently in its infancy. The aims of this exploratory, descriptive study were to 1) describe caregiver experience and psychological well-being; 2) examine relationships between caregiver characteristics, caregiver experiences, and psychological well-being; and 3) identify independent predictors of CAM attitudes, CAM use, anxiety, and depression. A convenience sample of 62 caregivers were recruited using social media and referrals in Orange County, CA. Inclusion criteria included > 18 years of age, self-identified primary caregiver of a patient diagnosed with LC, patient has received treatment in the past 12 months, able to speak, read, and understand English, and willing to participate in surveys. Mean participant age was 37.9  9.1, 33(53%) female, 34(55%) white, and 25(40%) were spouses of the patient. Over 53(85%) had positive CAM attitudes, and CAM mean use of 4.8  2.47 of 26. Caregiver burden dimensions ranged from 19.4% to 25.8% out of 100%. Clinically significant levels of anxiety (61%) depression (64.5%) were found. Physical and mental HRQOL were reduced compared to the national average at 39.1  6.6 and 39.2  6.3, respectively. Significant associations were found between CAM attitudes and CAM use, and college graduate (p = .029, p = .034), full-time employment (p = .001, p = .012), and income ≥ $76,000 (p = .001, p = .002), respectively. Multiple regression found that relationship to the patient and income explained 32% of the variability in CAM use. Future research should focus on intervention studies with specific CAM modalities of interest and the impact on psychological well-being.

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Background: Survivors of single ventricle heart disease (SVHD) must cope with challenges related to physical health, neurodevelopmental delays, and psychosocial sequelae of SVHD, which also affect academic achievement and social relationships. Despite these challenges, SVHD survivors often rate their health and quality of life (QOL) relatively highly. However, there are few studies that examine the life experiences of adolescents with SVHD.

Purpose: The purpose of this study was to examine the lived experiences of school, social relationships and healthcare in adolescents with SVHD.

Methods: A descriptive phenomenological methodology was employed, utilizing interviews of adolescents who had previously undergone a Fontan procedure for SVHD. The interviews were analyzed using the phenomenological analysis technique developed by Giorgi. Participants also completed a demographic and clinical information form that included one-dimensional questions related to overall health, changes in health, and overall QOL. A medical chart review was completed to obtain information on medical and surgical history and current status.

Results: Fourteen adolescents (ages 14 to 19 years, seven males) participated. The interviews lasted from 24 to 81 minutes. Self-reported health was rated as excellent to good in 12/14 participants and median self-reported QOL was 87.5 on a 0 to 100 scale. Seven themes emerged from the interviews, including 1) I am learning to take care of myself; 2) I have some limitations, but don’t assume: dealing with ableism; 3) I see myself as healthy; 4) I have big plans for the future, but there is also health uncertainty; 5) School can be a challenge; 6) My QOL is very good, and: 7) I have lots of healthcare experiences. The overall essence from these themes was “Thriving in the Face of Uncertainty.”

Conclusions: Adolescents with SVHD identified their physical limitations, school challenges, and the need to learn self-care in the face of an uncertain future related to their health. Despite these physical and psychosocial limitations, they consider themselves healthy with a high QOL and remain optimistic for the future, drawing strength from family, friend, teachers, and healthcare providers for support.

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A disproportionate number of Latinos share the burden of type 2 diabetes (T2D). Latinos comprise 16% of the U.S. population and the prevalence of self-reported diabetes is 11.9 % compared to 7.1% in non-Hispanic Whites. This dissertation describes three papers that address this disparity. The first is a systematic review and meta-analysis that investigated the effectiveness of diabetes self-management education (DSME) in reducing glycosylated hemoglobin (HbA1c) levels in adult Latinos with T2D. This review suggests that despite the heterogeneity observed in the 20 studies included in the review, DSME has a positive effect on HbA1c in this ethnic group. The second study focused on the disproportionate number of Latinos participating in research studies. Three themes emerged as facilitators for research participation: 1) barriers to access health-related expertise must be lowered; 2) language concordance was critical; and 3) a trusting relationship was essential. Conversely, perceived barriers included childcare, transportation issues, work schedules and ethnic beliefs and practices. The third study compared the effectiveness of shared medical appointments versus shared medical appointments plus coached care on HbA1c, lipid profile (e.g., cholesterol, LDL, HDL triglycerides), weight, body mass index and blood pressure at 12 weeks (short-term). Forty Latino adults with T2D (mean age 51.4±8.5 years; female (80%); HbA1c 10.1±1.2%) participated in a 24-week study. Improvements in glycemic control were similar in both groups at 12 weeks; there were no differences between groups in all other outcomes measured. These papers contribute to the growing body of research involving adult Latinos with T2D and confirm that 1) DSME interventions improve glycemic control; 2) addressing barriers to and facilitators of research participation can potentially reduce health disparities; and 3) SMA and SMA-CC both have the potential to also improve glycemic control. Additional research is needed to identify cultural interventions to improve health outcomes. These include but are not limited to: longitudinal studies with the current cohort of participants to assess efficacy of interventions, reengineering the process of coaching, i.e., pairing participants as dyads to support each other and/or focused interviews to identify barriers and facilitators of self-management behaviors.

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