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Britton LE, Kaur G, Zork N, Marshall CJ, George M. 'We tend to prioritise others and forget ourselves': How women's caregiving responsibilities can facilitate or impede diabetes self-management. Diabet Med 2023; 40:e15030. [PMID: 36537593 DOI: 10.1111/dme.15030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 11/23/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
AIM The objective of the parent study was to examine attitudes and experiences regarding counselling about preconception care among Black and/or Latina women in the United States with type 2 diabetes (T2DM). Here, we present emergent findings from a secondary analysis of caregiving. METHODS In this qualitative descriptive study, we used conventional content analysis to identify themes from semi-structured interviews with 32 Black and/or Latina women ages 18-40 who have T2DM in the United States recruited from online platforms and snowball sampling. RESULTS Caregiving responsibilities both motivate and disrupt diabetes self-management behaviours. Caregiving largely meant taking care of children, but women also had responsibilities to adult family members and romantic partners. Women were motivated to manage their diabetes in order to prevent negative health effects on their children and to stay healthy so they could fulfil caregiving responsibilities. However, caregiving competed for time, energy and money with self-management. Struggling to balance caregiving and self-management caused stress that women felt was intrinsically unhealthy and undermined self-management. CONCLUSIONS Young adult women with T2DM identified different ways that the roles and responsibilities in the family could affect their diabetes self-management. Providers and policymakers should develop health-promoting interventions that accommodate caregiving responsibilities.
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Affiliation(s)
- Laura E Britton
- Columbia University School of Nursing, New York, New York, USA
| | - Guneet Kaur
- University of California Los Angeles David Geffen School of Medicine, California, Los Angeles, USA
| | - Noelia Zork
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, Columbia University, New York, New York, USA
| | - Cassondra J Marshall
- School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Maureen George
- Columbia University School of Nursing, New York, New York, USA
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Novak JR, August KJ, Kavookjian J, Whitley H, Burnett D. Exploring typologies of appraisals, involvement, and distress in type 2 diabetes family members. J Health Psychol 2023; 28:133-148. [PMID: 35924837 DOI: 10.1177/13591053221115326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The present study conducted a latent profile analysis from a US national sample of 446 family members to identify and predict unique clusters of family members' PWD illness appraisals, involvement, and psychological distress. Time since diagnosis, diabetes adherence, the relationship with the PWD, age, gender, race/ethnicity, income, and economic pressure were included as predictors. Class membership was used to predict the family members' own health behaviors (sleep quality, days of physical activity, and diet quality). Results revealed four distinct classes: Moderately Concerned, Involved, and Distressed (32.51%), Least Concerned, Distressed, and Involved (27.13%), Less Concerned and Distressed, Moderately Involved (23.77%), and Most Concerned, Involved, and Distressed (16.82%). The significant predictors and outcomes of class membership revealed interesting patterns in associations with class membership. Consequently, in addition to involving family members, health promotion and intervention efforts must consider the psychological health and illness appraisals of family members rather than a one-size-fits-all approach.
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Affiliation(s)
- Josh R Novak
- Department of Human Development and Family Science, Auburn University, Auburn, AL, USA.,Boshell Diabetes and Metabolic Diseases Research Program, Auburn University, Auburn, AL, USA
| | - Kristin J August
- Department of Psychology and Health Sciences Center, Rutgers University, Camden, NJ, USA
| | - Jan Kavookjian
- Boshell Diabetes and Metabolic Diseases Research Program, Auburn University, Auburn, AL, USA.,Harrison School of Pharmacy, Auburn University, Auburn, AL, USA
| | - Heather Whitley
- Boshell Diabetes and Metabolic Diseases Research Program, Auburn University, Auburn, AL, USA.,Harrison School of Pharmacy, Auburn University, Auburn, AL, USA
| | - Donna Burnett
- Boshell Diabetes and Metabolic Diseases Research Program, Auburn University, Auburn, AL, USA.,Nutrition, Dietetics, and Hospitality Management, Auburn University, Auburn, AL, USA
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OUP accepted manuscript. Health Promot Int 2022; 37:ii73-ii82. [DOI: 10.1093/heapro/daac014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lawless MT, Tieu M, Feo R, Kitson AL. Theories of self-care and self-management of long-term conditions by community-dwelling older adults: A systematic review and meta-ethnography. Soc Sci Med 2021; 287:114393. [PMID: 34534780 DOI: 10.1016/j.socscimed.2021.114393] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/02/2021] [Accepted: 09/08/2021] [Indexed: 02/03/2023]
Abstract
RATIONALE The proportion of older adults living with long-term conditions (LTCs) is increasing. Self-care and self-management approaches are seen as valuable in helping older people with LTCs to manage their health and care, yet the theoretical overlaps and divergences are not always clear. OBJECTIVES The objectives of this review were to: (1) systematically identify and appraise studies of self-care or self-management of LTCs by community-dwelling older adults (aged ≥60 years) either informed by, applying, creating, or testing theory; (2) explore similarities or points of convergence between the identified theories; and (3) use a meta-ethnographic approach to synthesise the theories and group related concepts into core constructs. METHODS We conducted a systematic theory synthesis, searching six electronic databases. Three reviewers independently screened titles and abstracts followed by full texts and two reviewers appraised study quality. Theoretical data were synthesised within and across individual theories using meta-ethnographic line-of-argument synthesis. RESULTS A total of 141 articles (138 studies) and 76 theories were included in the review. Seven core constructs were developed: (1) temporal and spatial context; (2) stressors; (3) personal resources; (4) informal social resources; (5) formal social resources; (6) behavioural adaptations; and (7) quality of life outcomes. A line of argument was developed that conceptualised older adults' self-care and self-management as a dynamic process of behavioural adaptation, enabled by personal resources and informal and formal social resources, aimed at alleviating the impacts of stressors and maintaining quality of life. CONCLUSION This synthesis provides an overview of theories used in research on older adults' LTC self-care and self-management. Our synthesis describes the complex interplay of intrinsic and extrinsic factors influencing self-care and self-management behaviours and provides considerations for future research, intervention design, and implementation. The utility of the constructs in research and practice requires further attention and empirical validation.
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Affiliation(s)
- Michael T Lawless
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia; Caring Futures Institute, Flinders University, Bedford Park, SA, 5042, Australia.
| | - Matthew Tieu
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia; College of Humanities, Arts, and Social Sciences, Flinders University, Bedford Park, SA, 5042, Australia
| | - Rebecca Feo
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia; Caring Futures Institute, Flinders University, Bedford Park, SA, 5042, Australia
| | - Alison L Kitson
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia; Caring Futures Institute, Flinders University, Bedford Park, SA, 5042, Australia
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Sibounheuang P, Olson PS, Kittiboonyakun P. Patients' and healthcare providers’ perspectives on diabetes management: A systematic review of qualitative studies. Res Social Adm Pharm 2020; 16:854-874. [DOI: 10.1016/j.sapharm.2019.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 08/22/2019] [Accepted: 09/01/2019] [Indexed: 12/23/2022]
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Dimova ED, Swanson V, Evans JMM. Is diagnosis of type 2 diabetes a "teachable moment"? A qualitative study. Diabetes Res Clin Pract 2020; 164:108170. [PMID: 32360712 DOI: 10.1016/j.diabres.2020.108170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/24/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
Abstract
AIMS To explore the potential of type 2 diabetes diagnosis to be a "teachable moment". METHODS Semi-structured interviews were conducted with 23 participants (10 people with type 2 diabetes, 13 relatives of people with type 2 diabetes) in Scotland, UK. They explored cognitive, emotional and behavioural changes following diagnosis of type 2 diabetes in oneself or in a relative. Data were analysed using Framework approach. RESULTS Strong emotional responses are not always related to the occurrence of a teachable moment. Risk perception and outcome expectancy were found to be teachable moment factors for patients with type 2 diabetes and their offspring, but not their partners. Change in self-concept increases the likelihood of type 2 diabetes diagnosis to be a teachable moment for patients but not for relatives. In some cases, type 2 diabetes is perceived as incompatible with current roles thus hindering diabetes self-management. Relatives often engage in caring for patients and "policing" their behaviour but did not report perceived changes in social roles. CONCLUSIONS The study suggests that diagnosis of type 2 diabetes is a teachable moment for some patients and their relatives. These findings have implications for interventions to address diabetes self-management in patients and primary prevention in their relatives.
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Affiliation(s)
- Elena Dimcheva Dimova
- Faculty of Health Sciences and Sport, University of Stirling, FK9 4LA Scotland, United Kingdom.
| | - Vivien Swanson
- Faculty of Natural Sciences, University of Stirling, FK9 4LA Scotland, United Kingdom
| | - Josie M M Evans
- Faculty of Health Sciences and Sport, University of Stirling, FK9 4LA Scotland, United Kingdom
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Grabowski D, Andersen TH. Barriers to intra-familial prevention of type 2 diabetes: A qualitative study on horizons of significance and social imaginaries. Chronic Illn 2020; 16:119-130. [PMID: 30079742 DOI: 10.1177/1742395318789464] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives In families living with type 2 diabetes, relatives have a significantly heightened risk of developing the disease. In many families, both the person with type 2 diabetes and his/her relatives lack detailed knowledge about this risk. One obstacle to constructive intra-familial prevention and risk reduction is the lack of perceived familial disease relevance. The objective of the present study is to explore barriers to prevention in families with at least one adult with type 2 diabetes. Methods Data were gathered during eight problem assessment and ideation workshops with families. The data were analyzed using radical hermeneutics and interpreted using Taylor’s concepts of social imaginaries and horizons of significance. Results The analysis revealed three main barriers: (1) Sole responsibilities and the absence of collective practices, (2) intra-familial differences in perceptions of risks and future health, and (3) lack of perceived disease significance and the ensuing lack of mutual care. The participating families all experienced one or more of the three identified primary barriers. Discussion The study has produced important knowledge about barriers to familial prevention of type 2 diabetes. The findings confirm that familial prevention is indeed a complex matter that calls for the use of complexity-oriented approaches in health care practice.
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Ratzki-Leewing A, Parvaresh Rizi E, Harris SB. Family Members: The Forgotten Players in the Diabetes Care Team (The TALK-HYPO Study). Diabetes Ther 2019; 10:2305-2311. [PMID: 31502110 PMCID: PMC6848298 DOI: 10.1007/s13300-019-00687-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The objective of this study was to establish the burden of hypoglycemia on family members of people with diabetes (PWDs) and to gain an understanding of how conversations about hypoglycemia can contribute to diabetes care. METHODS This was a multinational cross-sectional study of family members of people with type 1 or type 2 diabetes taking insulin and/or secretagogues for ≥ 12 months who voluntarily completed an online questionnaire. RESULTS Overall, 4300 family members of PWDs (type 1 [29%], type 2 [46%], unknown [25%]) were surveyed. Two in three family members (66%) reported thinking about the hypoglycemia of the PWD at least monthly, and 64% felt worried or anxious about the PWD's risk for hypoglycemia. There was general agreement among family members that more conversations about hypoglycemia would have a positive impact on the PWD's life (76%). CONCLUSIONS Hypoglycemia can present a burden on the lives of family members of PWDs. Conversations about hypoglycemia, facilitated by a healthcare professional, may reduce this burden and hypoglycemia risk. FUNDING Novo Nordisk A/S.
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Affiliation(s)
- Alexandria Ratzki-Leewing
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | | | - Stewart B Harris
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
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Mutual Involvement in Families Living with Type 2 Diabetes: Using the Family Toolbox to Address Challenges Related to Knowledge, Communication, Support, Role Confusion, Everyday Practices and Mutual Worries. SOCIAL SCIENCES-BASEL 2019. [DOI: 10.3390/socsci8090257] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Family involvement plays a key role in diabetes management. Challenges related to type 2 diabetes (T2D) often affect the whole family, and relatives are at increased risk of developing diabetes themselves. Creating family involvement in families living with T2D is a complex matter. This article studies potential effects of working with dialogue tools specifically developed to create family involvement. The data consist of 18 semi-structured family interviews. The data were analyzed using radical hermeneutics and theories on family identity and healthcare authenticity. The analysis revealed five themes: (1) Working with the tools created better and broader intra-familial involvement; (2) the tools enabled new roles and self-understandings for all family members; (3) the tools facilitated mutual insights into each other’s thoughts and worries; (4) after working with the tools, it was easier to discover potential challenges and possible behavior change; and (5) gaining new knowledge and the motivation to seek more knowledge was easier after working with the tools. Working with the tools changed how the families perceive themselves and the ways in which they can affect their own T2D-related health behavior together. This has direct implications for healthcare practitioners working with people with T2D.
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Gupta L, Khandelwal D, Lal PR, Gupta Y, Kalra S, Dutta D. Factors Determining the Success of Therapeutic Lifestyle Interventions in Diabetes - Role of Partner and Family Support. EUROPEAN ENDOCRINOLOGY 2019; 15:18-24. [PMID: 31244906 PMCID: PMC6587903 DOI: 10.17925/ee.2019.15.1.18] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 10/31/2018] [Indexed: 12/29/2022]
Abstract
Background and aims: Knowledge of therapeutic lifestyle interventions is one of the most important pillars of diabetes care; however, its incorporation in real-world settings is poor. This review evaluates the role of partner and family support in diabetes management. Methods: Literature searches were performed in PubMed, Medline and Embase for articles published before July 2018, using the terms “therapeutic lifestyle intervention” [MeSH Terms], OR “diet changes” [All Fields], OR “spousal participation” [All Fields], OR “lifestyle interventions” [All Fields], “lifestyle changes” [All Fields] AND “diabetes” [All Fields]. The search was not restricted to English-language literature; literature in Spanish, French and German were also evaluated. Results: A total of 66 of articles were reviewed, which included 33 original work, 21 review articles, and 12 systematic reviews and meta-analyses. Studies and meta-analyses have showed that if one partner has type-2 diabetes this increases the risk in other by 5–26%. Partner and family have similar diet, lifestyle, and micro- and macro-environments which could explain the similar increased risk of diabetes and non-communicable diseases. Studies have consistently shown that spousal and family support plays a key role in overcoming negative behaviours and optimising behaviours in diabetes control. Partner support has major role in prevention and control of diabetes distress, associated depression, and medication non-compliance which have an adverse impact in glycaemic outcomes. These data are predominantly available from observational studies. There is paucity of data from interventional trials evaluating effects of family and spousal participation on health, glycaemic control and quality of life. Conclusion: The support of family and spouse/partner is beneficial to improve adherence to the lifestyle interventions and pharmacotherapy required to achieve optimum glycaemic control and avoid associated complications.
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Affiliation(s)
- Lovely Gupta
- Department of Food and Nutrition, Lady Irwin College, University of Delhi, New Delhi, India
| | | | - Priti Rishi Lal
- Department of Food and Nutrition, Lady Irwin College, University of Delhi, New Delhi, India
| | - Yasheep Gupta
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospitals, Karnal, Haryana, India
| | - Deep Dutta
- Department of Endocrinology, Diabetes & Metabolic Disorders, Venkateshwar Hospitals, New Delhi, India
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Withidpanyawong U, Lerkiatbundit S, Saengcharoen W. Family-based intervention by pharmacists for type 2 diabetes: A randomised controlled trial. PATIENT EDUCATION AND COUNSELING 2019; 102:85-92. [PMID: 30150128 DOI: 10.1016/j.pec.2018.08.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 05/27/2018] [Accepted: 08/10/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To investigate the effectiveness of family intervention for type 2 diabetes and to examine predictors of glycaemic control. METHODS This was a prospective randomised controlled trial. Participants with type 2 diabetes were randomly assigned to an intervention group (n = 98) or a control group (n = 98). A pharmacist delivered the educational sessions and encouraged family members to take an active role in self-management practices for the intervention patients. The control patients received usual care. RESULTS At the end of the study (9-month follow-up), greater reduction in glycosylated haemoglobin (HbA1c) occurred in the intervention group than in the control group (-1.37% and -0.21%, respectively; P < 0.001). Between-group differences in the improvements of low-density lipoprotein cholesterol (LDL-C) and blood pressure were found (P < 0.05). Higher scores in diabetes knowledge of patients, family support, medication adherence, self-management and self-efficacy were seen in the intervention group than in the control group (P < 0.05). Multivariable analysis showed family members who were spouses or women were strong predictors of improved glycaemic control. CONCLUSION Family-involvement intervention is helpful in diabetes management, especially having spouses or women as caregivers. PRACTICE IMPLICATIONS Family involvement should be encouraged in diabetes care.
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Affiliation(s)
- Urawan Withidpanyawong
- Pharmacy Division, Thepha Hospital, Lam Phai Thepha Road, Thepha, Songkhla, 90150, Thailand.
| | - Sanguan Lerkiatbundit
- Department of Pharmacy Administration, Faculty of Pharmaceutical Sciences, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, Songkhla, 90110, Thailand.
| | - Woranuch Saengcharoen
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, Songkhla, 90110, Thailand.
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Yakubu K, Malan Z, Colon-Gonzalez MC, Mash B. Perceptions about family-centred care among adult patients with chronic diseases at a general outpatient clinic in Nigeria. Afr J Prim Health Care Fam Med 2018; 10:e1-e11. [PMID: 30456976 PMCID: PMC6244322 DOI: 10.4102/phcfm.v10i1.1739] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 06/11/2018] [Accepted: 07/06/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Few studies in Africa have described patients' perceptions about family-centred care (FCC). AIM The aim of this study was to explore perceptions of FCC among patients with chronic diseases. SETTING The study was conducted at a general outpatient clinic (GOPC) in Jos, north-central Nigeria. METHODS We used a mixed-methods phenomenological study design and conducted structured and semi-structured interviews with 21 adult patients with chronic diseases at a general outpatient clinic in north-central Nigeria. RESULTS Patients described FCC using progressive levels of family engagement including the doctor inquiring about history of similar disease in the family, information sharing with family members and fostering of family ties. They described current family involvement in their care as either inquiring about their health, accompanying them to the clinic or offering material or social support and health advice. Also, patients considered the value of FCC based on how it meets information needs of the family, influences individual health behaviour and addresses family dynamics. Those who were literate and older than 50 years of age favoured FCC during history taking. Those who were literate, aged lesser than 50 years and had poor disease control showed preference for FCC during treatment decision-making. CONCLUSION The acceptability of FCC is a complex synthesis of age, socio-economic status, literacy and disease outcomes. Patients older than 50 years, with good treatment outcomes, and those without formal education may need further education and counselling on this approach to care.
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Affiliation(s)
- Kenneth Yakubu
- Department of Family Medicine, University of Jos and Jos University Teaching Hospital, Nigeria; and, Division of Family Medicine and Primary Care, Stellenbosch University, South Africa.
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Vongmany J, Luckett T, Lam L, Phillips JL. Family behaviours that have an impact on the self-management activities of adults living with Type 2 diabetes: a systematic review and meta-synthesis. Diabet Med 2018; 35:184-194. [PMID: 29150863 DOI: 10.1111/dme.13547] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2017] [Indexed: 12/27/2022]
Abstract
AIMS To identify family behaviours that adults with Type 2 diabetes' perceive as having an impact on their diabetes self-management. BACKGROUND Research suggests that adults with Type 2 diabetes perceive that family members have an important impact on their self-management; however, it is unclear which family behaviours are perceived to influence self-management practices. METHODS This meta-synthesis identified and synthesized qualitative studies from the databases EMBASE, Medline and CINAHL published between the year 2000 and October 2016. Studies were eligible if they provided direct quotations from adults with Type 2 diabetes, describing the influence of families on their self-management. This meta-synthesis adheres to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. RESULTS Of the 2606 studies screened, 40 were included. This meta-synthesis identified that adults with Type 2 diabetes perceive family behaviours to be either: 1) facilitators of diabetes self-management; 2) barriers to diabetes self-management; or 3) equivocal behaviours with the potential to both support and/or impede diabetes self-management. Seven sub-themes were identified within these themes, including: four facilitator sub-themes ('positive care partnerships'; 'family watchfulness'; 'families as extrinsic motivator' and 'independence from family'); two barrier sub-themes ('obstructive behaviours' and 'limited capacity for family support'); and one equivocal behaviours subtheme ('regular reminders and/or nagging'). CONCLUSION While most family behaviours are unambiguously perceived by adults with Type 2 diabetes to act as facilitators of or barriers to self-management, some behaviours were perceived as being neither clear facilitators nor barriers; these were termed 'equivocal behaviours'. If the concept of 'equivocal behaviours' is confirmed, it may be possible to encourage the adult living with Type 2 diabetes to reframe these behaviours so that they are perceived as enabling their diabetes self-management.
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Affiliation(s)
- J Vongmany
- Centre for Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - T Luckett
- Centre for Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - L Lam
- Centre for Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - J L Phillips
- Centre for Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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Jones V, Crowe M. How people from ethnic minorities describe their experiences of managing type-2 diabetes mellitus: A qualitative meta-synthesis. Int J Nurs Stud 2017; 76:78-91. [DOI: 10.1016/j.ijnurstu.2017.08.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 08/22/2017] [Accepted: 08/27/2017] [Indexed: 11/29/2022]
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Grabowski D, Andersen TH, Varming A, Ommundsen C, Willaing I. Involvement of family members in life with type 2 diabetes: Six interconnected problem domains of significance for family health identity and healthcare authenticity. SAGE Open Med 2017; 5:2050312117728654. [PMID: 28839943 PMCID: PMC5564858 DOI: 10.1177/2050312117728654] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 08/03/2017] [Indexed: 12/02/2022] Open
Abstract
Objectives: Family involvement plays a key role in diabetes management. Problems and challenges related to type 2-diabetes often affect the whole family, and relatives are at increased risk of developing diabetes themselves. We highlight these issues in our objectives: (1) to uncover specific family problems associated with mutual involvement in life with type 2-diabetes and (2) to analytically look at ways of approaching these problems in healthcare settings. Methods: Qualitative data were gathered in participatory problem assessment workshops. The data were analysed in three rounds using radical hermeneutics. Results: Problems were categorized in six domains: knowledge, communication, support, everyday life, roles and worries. The final cross-analysis focusing on the link between family identity and healthcare authenticity provided information on how the six domains can be approached in healthcare settings. Conclusion: The study generated important knowledge about problems associated with family involvement in life with type 2 diabetes and about how family involvement can be supported in healthcare practice.
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Hurt TR, Seawell AH, Cutrona C, O'Connor MC, Camp RD, Duran R, Elderts R, Green C, Hara V, Pattee J. Black Women's Recommendations for Developing Effective Type 2 Diabetes Programming. Glob Qual Nurs Res 2017; 4:2333393617715335. [PMID: 28804746 PMCID: PMC5484429 DOI: 10.1177/2333393617715335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 05/13/2017] [Accepted: 05/22/2017] [Indexed: 01/28/2023] Open
Abstract
The purpose of this study was to learn from 29 Black women how to develop effective Type 2 diabetes programming. Three focus groups were held in Des Moines, Iowa, during fall 2012. Results highlighted themes related to diabetes knowledge, diabetes management and prevention, physical activity, diet, and diabetes management programming. Opinions were shared as to whether family members should be included in programs for supporting those diagnosed with diabetes. These results provided guidance and ideas to scholars and health care professionals aiming to improve effectiveness of diabetes programs for Black women and families.
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Samuel-Hodge CD, Holder-Cooper JC, Gizlice Z, Davis G, Steele SP, Keyserling TC, Kumanyika SK, Brantley PJ, Svetkey LP. Family PArtners in Lifestyle Support (PALS): Family-based weight loss for African American adults with type 2 diabetes. Obesity (Silver Spring) 2017; 25:45-55. [PMID: 27911049 PMCID: PMC5182111 DOI: 10.1002/oby.21700] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 08/30/2016] [Accepted: 09/19/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To develop and test a family-centered behavioral weight loss intervention for African American adults with type 2 diabetes. METHODS In this randomized trial, dyads consisting of an African American adult with overweight or obesity and type 2 diabetes (index participant) paired with a family partner with overweight or obesity but not diagnosed with diabetes were assigned in a 2:1 ratio to a 20-week special intervention (SI) or delayed intervention (DI) control group. The primary outcome was weight loss among index participants at the 20-week follow-up. RESULTS One hundred eight participants (54 dyads-36 (SI) and 18 (DI) dyads) were enrolled: 81% females; mean age, 51 years; mean weight,103 kg; and mean BMI, 37 kg/m2 . At post-intervention, 96 participants (89%) returned for follow-up measures. Among index participants, mean difference in weight loss between groups was -5.0 kg, P <0.0001 (-3.6 kg loss among SI; 1.4 kg gain in DI). SI index participants showed significantly greater improvements in hemoglobin A1c, depressive symptoms, family interactions, and dietary, physical activity, and diabetes self-care behaviors. SI family partners also had significant weight loss (-3.9 kg (SI) vs. -1.0 kg (DI), P = 0.02). CONCLUSIONS A family-centered, behavioral weight loss intervention led to clinically significant short-term weight loss among family dyads.
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Affiliation(s)
- Carmen D Samuel-Hodge
- Department of Nutrition, Gillings School of Global Public Health, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Judith C Holder-Cooper
- Department of Psychiatry and Behavioral Science, Duke University, Durham, North Carolina, USA
- Department of Community and Family Medicine, Duke University, Durham, North Carolina, USA
| | - Ziya Gizlice
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Gwendolyn Davis
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sonia P Steele
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Thomas C Keyserling
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of General Internal Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Shiriki K Kumanyika
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Phillip J Brantley
- Behavioral Medicine Laboratory, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Laura P Svetkey
- Department of Medicine, Division of Nephrology, Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina, USA
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Stuckey HL, Mullan-Jensen C, Kalra S, Reading J, Wens J, Vallis M, Kokoszka A, Malek R, Kovacs Burns K, Piana N, Skovlund SE, Peyrot M. Living with an adult who has diabetes: Qualitative insights from the second Diabetes Attitudes, Wishes and Needs (DAWN2) study. Diabetes Res Clin Pract 2016; 116:270-8. [PMID: 27321345 DOI: 10.1016/j.diabres.2016.04.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 03/10/2016] [Accepted: 04/16/2016] [Indexed: 12/18/2022]
Abstract
AIMS The second Diabetes Attitudes, Wishes and Needs (DAWN2) study identified the experiences of family members who support adults living with diabetes. METHODS Participants were 2057 adult family members living with the person with diabetes from 17 countries. Qualitative data were responses to open-ended survey questions about how living with a person with diabetes has impacted family members and the ways they choose to be involved in the diabetes care for the person with whom they live. Emergent coding with input from multinational collaborators identified thematic content about psychosocial aspects. RESULTS Family members wanted to do what was best for the person with diabetes and help in whatever way possible. Four themes branched from that principle: (1) family members worry about day-to-day struggles of the person with diabetes, such as hypoglycemia and employment stability; (2) diabetes negatively affects the person with diabetes-family member relationship, creating an emotional strain and shift in relationship; (3) family members have some support resources to deal with the burdens and lifestyle changes of diabetes, but would like more; and (4) the person with diabetes has provided inspiration to the family member, and helped the family member make positive life changes in eating healthier. CONCLUSIONS These data provide insight into the ways that family members experience living with diabetes, including their challenges, motivations and intentions in supporting their person with diabetes. Family members speak eloquently and with emotion about their role in a family with diabetes.
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Affiliation(s)
- Heather L Stuckey
- Department of Medicine, College of Medicine, Pennsylvania State University, Hershey, PA, USA.
| | | | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital & B.R.I.D.E., Karnal, India
| | - Jean Reading
- Department of Medicine, College of Medicine, Pennsylvania State University, Hershey, PA, USA
| | - Johan Wens
- Department of Medicine and Health Sciences, Primary and Interdisciplinary Care Antwerp, University of Antwerp, Antwerp, Belgium
| | - Michael Vallis
- Departments of Family Medicine and Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrzej Kokoszka
- II Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Rachid Malek
- Department of Internal Medicine, Setif University Hospital, Algeria
| | - Katharina Kovacs Burns
- Interdisciplinary Health Research Academy, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta, Canada
| | - Natalia Piana
- Healthy Lifestyle Institute, (C.U.R.I.A.MO.: Centro Universitario di Ricerca Interdipartimentale Attività Motoria), University of Perugia, Perugia, Italy
| | | | - Mark Peyrot
- Department of Sociology, Loyola University Maryland, Baltimore, MD, USA
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19
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Shi M, Xu MY, Liu ZL, Duan XY, Zhu YB, Shi HM, Jiang B, Zhang XM, Yu XH. Effectiveness of family involvement in newly diagnosed type 2 diabetes patients: a follow-up study. PATIENT EDUCATION AND COUNSELING 2016; 99:776-782. [PMID: 26763869 DOI: 10.1016/j.pec.2015.12.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 12/22/2015] [Accepted: 12/26/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To investigate the effects of family-involvement on health education for T2DM from the aspects of knowledge, attitude and practice (KAP), health-related quality of life (HRQoL), body mass index (BMI) and glucose control. METHODS A follow-up study was performed and patients with newly diagnosed T2DM were divided into family-involved group (FIG, n=60) and single-involved group (SIG, n=60). Hierarchical linear models were used to assess within-group changes and between-group differences in the glycosylated hemoglobin A1c (HbA1c), KAP, SF-36 and BMI. RESULTS Significant improvements in FIG along with significant differences between-group were seen for HbA1c levels (9.73, 8.92, 5.55, 5.79, 5.30 vs. 10.05, 9.53, 6.36, 8.41, 6.58) in baseline, M3, M6, M12, M24 compared with SIG, respectively (all P≤0.001). Significant improvements in FIG along with significant differences between-group were seen for KAP (16.23, 46.98, 48.93 vs. 16.65, 29.07, 37.62), SF-36 (78.04, 92.68, 92.34 vs. 74.96, 77.03, 78.25), and BMI (24.74, 23.46, 22.96 vs. 24.00, 23.45, 23.50) in baseline, M12 and M24, respectively (all P≤0.05). CONCLUSION Family involvement is beneficial to the control of T2DM and should be suggested for T2DM newly diagnosed. PRACTICE IMPLICATIONS Health education should encourage the family to participate in the whole process to improve the efficacy of education.
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Affiliation(s)
- Mai Shi
- School of Management, Beijing University of Chinese Medicine, Beijing 100029, China; Department of Clinical Nutrition, China-Japan Friendship Hospital, Beijing 100029, China
| | - Mei-Yan Xu
- Department of Clinical Nutrition, The Central Hospital of China Aerospace Corporation, Beijing 100049, China
| | - Zhao-Lan Liu
- Centre for Evidence-based Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Xue-Ying Duan
- Department of Clinical Nutrition, Yan-Hua Hospital, Beijing 100250, China
| | - Yan-Bo Zhu
- School of Management, Beijing University of Chinese Medicine, Beijing 100029, China.
| | - Hui-Mei Shi
- School of Management, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Bo Jiang
- School of Management, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Xiao-Mei Zhang
- School of Management, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Xiao-Han Yu
- School of Management, Beijing University of Chinese Medicine, Beijing 100029, China
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20
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BeLue R. The role of family in non-communicable disease prevention in Sub-Saharan Africa. Glob Health Promot 2016; 24:71-74. [PMID: 27056434 DOI: 10.1177/1757975915614190] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Non-communicable diseases (NCDs), including cardiovascular disease risk factors such as diabetes (DM) and hypertension (HTN), are becoming an increasing burden in Sub-Saharan Africa (SSA); by 2030, NCDs are expected to eclipse communicable diseases as the leading causes of death. DM and HTN require daily management to prevent stroke, myocardial infarction, or other complications including kidney failure. In SSA, the concept of family is critical for DM and HTN management behaviors such as adhering to medications and possessing the ability to purchase related goods. Many management behaviors also serve as primary prevention for DM and HTN. For example, including family in primary and secondary prevention strategies for NCDs in SSA may enhance existing interventions by exposing the whole family to positive NCD management methods and reinforcing better NCD outcomes for family members with NCDs. Furthermore, family inclusion may encourage preventive behaviors and, as a result, increase primary prevention of NCDs among other family members.
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Affiliation(s)
- Rhonda BeLue
- 1 Penn State University - Health Policy and Administration, University Park, PA, USA
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21
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Berry E, Lockhart S, Davies M, Lindsay JR, Dempster M. Diabetes distress: understanding the hidden struggles of living with diabetes and exploring intervention strategies. Postgrad Med J 2015; 91:278-83. [PMID: 25827438 DOI: 10.1136/postgradmedj-2014-133017] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 03/06/2015] [Indexed: 11/04/2022]
Abstract
Diabetes distress is a rational emotional response to the threat of a life-changing illness. Distinct from depression, it is conceptually rooted in the demands of diabetes management and is a product of emotional adjustment. Diabetes distress has been found to be significantly associated with glycated haemoglobin (HbA1c) level and the likelihood of an individual adopting self-care behaviours. The lack of perceived support from family, friends and healthcare professionals significantly contributes to elevated diabetes distress, and this issue tends to be overlooked when designing interventions. Pioneering large-scale research, DAWN2, gives voices to the families of those with diabetes and reaffirms the need to consider psychosocial factors in routine diabetes care. Structured diabetes education programmes are the most widely used in helping individuals cope with diabetes, but they tend not to include the psychological or interpersonal aspects of diabetes management in their curricula. The need for health practitioners, irrespective of background, to demonstrate an understanding of diabetes distress and to actively engage in discussion with individuals struggling to cope with diabetes is emphasised.
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Affiliation(s)
- Emma Berry
- School of Psychology, Queen's University Belfast, Belfast, UK
| | - Sam Lockhart
- School of Medicine, Dentistry and Biological Science, Queen's University Belfast, Belfast, UK
| | - Mark Davies
- Department of Clinical Psychology, Belfast City Hospital, Belfast, UK
| | - John R Lindsay
- Department of Diabetes and Endocrinology, Mater Infirmorum Hospital, Belfast, UK
| | - Martin Dempster
- School of Psychology, Queen's University Belfast, Belfast, UK
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22
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Cené CW, Haymore LB, Lin FC, Laux J, Jones CD, Wu JR, DeWalt D, Pignone M, Corbie-Smith G. Family member accompaniment to routine medical visits is associated with better self-care in heart failure patients. Chronic Illn 2015; 11:21-32. [PMID: 24740555 PMCID: PMC8099456 DOI: 10.1177/1742395314532142] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To examine the association between frequency of family member accompaniment to medical visits and heart failure (HF) self-care maintenance and management and to determine whether associations are mediated through satisfaction with provider communication. METHODS Cross-sectional survey of 150 HF patients seen in outpatient clinics. HF self-care maintenance and management were assessed using the Self-Care of Heart Failure Index. Satisfaction with provider communication was assessed using a single question originally included in the American Board of Internal Medicine Patient Satisfaction Questionnaire. Frequency of family member accompaniment to visits was assessed using a single-item question. We performed regression analyses to examine associations between frequency of accompaniment and outcomes. Mediation analysis was conducted using MacKinnon's criteria. RESULTS Overall, 61% reported accompaniment by family members to some/most/every visit. Accompaniment to some/most/every visit was associated with higher self-care maintenance (β = 6.4, SE 2.5; p = 0.01) and management (β = 12.7, SE 4.9; p = 0.01) scores. Satisfaction with provider communication may mediate the association between greater frequency of accompaniment to visits and self-care maintenance (1.092; p = 0.06) and self-care management (1.428; p = 0.13). DISCUSSION Accompaniment to medical visits is associated with better HF self-care maintenance and management, and this effect may be mediated through satisfaction with provider communication.
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Affiliation(s)
- Crystal W Cené
- Division of General Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Laura Beth Haymore
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Feng-Chang Lin
- NC Translational and Clinical Sciences (TraCS) Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jeffrey Laux
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Christine Delong Jones
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jia-Rong Wu
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Darren DeWalt
- Division of General Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mike Pignone
- Division of General Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Giselle Corbie-Smith
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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23
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Sadler E, Wolfe CDA, McKevitt C. Lay and health care professional understandings of self-management: A systematic review and narrative synthesis. SAGE Open Med 2014; 2:2050312114544493. [PMID: 26770733 PMCID: PMC4607208 DOI: 10.1177/2050312114544493] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 06/30/2014] [Indexed: 12/15/2022] Open
Abstract
Objectives: Self-management is widely promoted but evidence of effectiveness is limited. Policy encourages health care professionals to support people with long-term conditions to learn self-management skills, yet little is known about the extent to which both parties share a common understanding of self-management. Thus, we compared health care professional and lay understandings of self-management of long-term conditions. Methods: Systematic review and narrative synthesis of qualitative studies identified from relevant electronic databases, hand-searching of references lists, citation tracking and recommendations by experts. Results: In total, 55 studies were included and quality was assessed using a brief quality assessment tool. Three conceptual themes, each with two subthemes were generated: traditional and shifting models of the professional–patient relationship (self-management as a tool to promote compliance; different expectations of responsibility); quality of relationship between health care professional and lay person (self-management as a collaborative partnership; self-management as tailored support) and putting self-management into everyday practice (the lived experience of self-management; self-management as a social practice). Conclusion: Self-management was conceptualised by health care professionals as incorporating both a biomedical model of compliance and individual responsibility. Lay people understood self-management in wider terms, reflecting biomedical, psychological and social domains and different expectations of responsibility. In different ways, both deviated from the dominant model of self-management underpinned by the concept of self-efficacy. Different understandings help to explain how self-management is practised and may help to account for limited evidence of effectiveness of self-management interventions.
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Affiliation(s)
- Euan Sadler
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, King's College London, London, UK
| | - Charles D A Wolfe
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, King's College London, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Christopher McKevitt
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, King's College London, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
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24
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Fortmann AL, Roesch SC, Penedo FJ, Isasi CR, Carnethon MR, Corsino L, Schneiderman N, Daviglus ML, Teng Y, Giachello A, Gonzalez F, Gallo LC. Glycemic control among U.S. Hispanics/Latinos with diabetes from the HCHS/SOL Sociocultural Ancillary Study: do structural and functional social support play a role? J Behav Med 2014; 38:153-9. [PMID: 25107503 DOI: 10.1007/s10865-014-9587-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 07/14/2014] [Indexed: 12/25/2022]
Abstract
Social support is one potential source of health-related resiliency in Hispanics with diabetes. This study examined relationships of structural (i.e., social integration) and functional (i.e., perceived) social support with glycemic control (glycosylated hemoglobin; HbA1c) in the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study. This study included 766 men and women representing multiple Hispanic ethnic backgrounds, aged 18-74 years, with diagnosed diabetes who completed fasting blood draw, medication review, and measures of sociodemographic factors, medical history, structural support (Cohen Social Network Index), and functional support (Interpersonal Support Evaluation List-12). After adjusting for sociodemographic covariates and medication, a one standard deviation increase in functional support was related to an 0.18% higher HbA1c (p = 0.04). A similar trend was observed for structural support; however, this effect was non-significant in adjusted models. Greater functional support was associated with poorer glycemic control in Hispanics.
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Affiliation(s)
- Addie L Fortmann
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, CA, USA
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25
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Pollard SL, Zachary DA, Wingert K, Booker SS, Surkan PJ. Family and Community Influences on Diabetes-Related Dietary Change in a Low-Income Urban Neighborhood. DIABETES EDUCATOR 2014; 40:462-469. [DOI: 10.1177/0145721714527520] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose The purpose of this study is to explore the influence of the social environment, including family and community relationships, on diabetes-related dietary change behaviors in a low-income, predominantly African American community with limited access to healthy foods. Methods Study methods included interviews and focus groups with adults with diabetes and family members of individuals with diabetes in a low-income African American community. In this analysis, interview participants included 11 participants with diabetes, one with prediabetes, and 8 family members or close friends with diabetes. Information from 4 participants with diabetes and 6 with family members with diabetes was included from 6 focus groups. Transcripts were analyzed via thematic iterative coding influenced by social cognitive theory to understand the influence of family and community relationships on dietary change. Results Participants’ social environments strongly influenced diet-related behavioral change. Family members without diabetes provided reinforcements for dietary change for those with diabetes by preparing healthy food and monitoring intake, as well as by adopting dietary changes made by those with diabetes. Family and community members served as sources of observational learning about the potential impacts of diabetes and enhanced behavioral capability for dietary change among people with diabetes by providing dietary advice and strategies for making healthy choices. Conclusions This study demonstrates the ways in which family and community members can influence dietary change in people with diabetes. Interventions targeting diabetes management should incorporate families and communities as sources of information, learning, and support.
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Affiliation(s)
- Suzanne L. Pollard
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA (Ms Pollard)
- Program in Social Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA (Ms Zachary)
- Program in Social and Behavioral Interventions, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA (Ms Wingert, Dr Surkan)
- Nutrition Education, School, and Community Nutrition Programs Branch, Maryland State Department of Education, Baltimore, MD, USA (Ms Booker)
| | - Drew A. Zachary
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA (Ms Pollard)
- Program in Social Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA (Ms Zachary)
- Program in Social and Behavioral Interventions, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA (Ms Wingert, Dr Surkan)
- Nutrition Education, School, and Community Nutrition Programs Branch, Maryland State Department of Education, Baltimore, MD, USA (Ms Booker)
| | - Katherine Wingert
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA (Ms Pollard)
- Program in Social Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA (Ms Zachary)
- Program in Social and Behavioral Interventions, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA (Ms Wingert, Dr Surkan)
- Nutrition Education, School, and Community Nutrition Programs Branch, Maryland State Department of Education, Baltimore, MD, USA (Ms Booker)
| | - Sara S. Booker
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA (Ms Pollard)
- Program in Social Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA (Ms Zachary)
- Program in Social and Behavioral Interventions, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA (Ms Wingert, Dr Surkan)
- Nutrition Education, School, and Community Nutrition Programs Branch, Maryland State Department of Education, Baltimore, MD, USA (Ms Booker)
| | - Pamela J. Surkan
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA (Ms Pollard)
- Program in Social Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA (Ms Zachary)
- Program in Social and Behavioral Interventions, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA (Ms Wingert, Dr Surkan)
- Nutrition Education, School, and Community Nutrition Programs Branch, Maryland State Department of Education, Baltimore, MD, USA (Ms Booker)
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26
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Kovacs Burns K, Nicolucci A, Holt RIG, Willaing I, Hermanns N, Kalra S, Wens J, Pouwer F, Skovlund SE, Peyrot M. Diabetes Attitudes, Wishes and Needs second study (DAWN2™): cross-national benchmarking indicators for family members living with people with diabetes. Diabet Med 2013; 30:778-88. [PMID: 23701236 DOI: 10.1111/dme.12239] [Citation(s) in RCA: 173] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/21/2013] [Indexed: 12/20/2022]
Abstract
AIMS The second Diabetes Attitudes, Wishes and Needs (DAWN2) study examined the experiences of family members of people with diabetes for benchmarking and identifying unmet needs or areas for improvement to assist family members and those with diabetes to effectively self-manage. METHODS In total, 2057 family members of people with diabetes participated in an online, telephone or in-person survey designed to assess the impact of diabetes on family life, family support for people with diabetes and educational and community support. RESULTS Supporting a relative with diabetes was perceived as a burden by 35.3% (range across countries 10.6-61.7%) of respondents. Over half of respondents [51.4% (22.5-76.0%)] rated their quality of life as 'good' or 'very good'. However, distress about the person with diabetes was high, with 61.3% (31.5-86.4%) worried about hypoglycaemia. The impact of diabetes on aspects of life was felt by 51.8% (46.9-58.6%). The greatest negative effect was on emotional well-being [44.6% (31.8-63.0%)], although depression was less common [11.6% (4.2-20.0%)]. Many respondents did not know how to help the person with diabetes [37.1% (17.5-53.0%)] and wanted to be more involved in their care [39.4% (15.5-61.7%)]. Participation in diabetes educational programmes was low [23.1% (9.4-43.3%)], although most of those who participated found them helpful [72.1% (42.1-90.3%)]. CONCLUSIONS Diabetes has a negative impact on family members of people with diabetes. DAWN2 provides benchmarking indicators of family members' psychosocial needs that will help identify the support required for, and from, them to improve the lives of people with diabetes and their families.
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Affiliation(s)
- K Kovacs Burns
- Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB, Canada.
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