Patient-centered diabetes self-management education

What users seek and share in online diabetes communities: examining similarities and differences in expressions and themes

Purpose

This paper aims to investigate user health information seeking and sharing patterns and content in an online diabetes community and explore the similarities and differences in the ways and themes they expressed.

Design/methodology/approach

Multiple methods are applied to analyze the expressions and themes that users seek and share based on large-scale text data in an online diabetes community. First, a text classifier using deep learning method is performed based on the expression category this study developed. Second, statistical and social network analyses are used to measure the popularity and compare differences between expressions. Third, topic modeling, manual coding and similarity analysis are used to mining topics and thematic similarity between seeking and sharing threads.

Findings

There are four different ways users seek and share in online health communities (OHCs) including informational seeking, situational seeking, objective information sharing and experiential information sharing. The results indicate that threads with self-disclosure could receive more replies and attract more users to contribute. This study also examines the 10 topics that were discussed for information seeking and 14 topics for information sharing. They shared three discussion themes: self-management, medication and symptoms. Information about symptoms can be largely matched between seeking and sharing threads while there is less overlap in self-management and medication categories.

Originality/value

Being different from previous studies that mainly describe one type of health information behavior, this paper analyzes user health information seeking and sharing behaviors in OHCs and investigates whether there is a correspondence or discrepancy between expressions and information users spontaneously seek and share in OHCs.

Evaluation of provider documentation patterns as a tool to deliver ongoing patient-centred diabetes education and support

BACKGROUND

Diabetes mellitus (DM) is one of the most common chronic diseases in the world. As a disease with long-term complications requiring changes in management, DM requires not only education at the time of diagnosis, but ongoing diabetes self-management education and support (DSME/S). In the United States, however, only a small proportion of people with DM receive DSME/S, although evidence supports benefits of ongoing DSME/S. The diabetes education that providers deliver during follow-up visits may be an important source for DSME/S for many people with DM.

METHODS

We collected 200 clinic notes of follow-up visits for 100 adults with DM and studied the History of Present Illness (HPI) and Impression and Plan (I&P) sections. Using a codebook based on the seven principles of American Association of Diabetes Educators Self-Care Behaviors (AADE7), we conducted a multi-step deductive thematic analysis to determine the patterns of DSME/S information occurrence in clinic notes. Additionally, we used the generalised linear mixed models for investigating whether providers delivered DSME/S to people with DM based on patient characteristics.

RESULTS

During follow-up visits, Monitoring was the most common self-care behaviour mentioned in both HPI and I&P sections. Being Active was the least common self-care behaviour mentioned in the HPI section and Healthy Coping was the least common self-care behaviour mentioned in the I&P section. We found providers delivered more information on Healthy Eating to men compared to women in I&P section. Generally, providers delivered DSME/S to people with DM regardless of patient characteristics.

CONCLUSIONS

This study focused on the frequency distribution of information providers delivered to the people with DM during follow-up clinic visits based on the AADE7. The results may indicate a lack of patient-centred education when people with DM visit providers for ongoing management. Further studies are needed to identify the underlying reasons why providers have difficulty delivering patient-centred education.

Effectiveness of Diabetes Self-Management Educational Programs For Type 2 Diabetes Mellitus Patients In Middle East Countries: A Systematic Review

AIM

This review study aimed to determine the effectiveness and factors affecting the success of DSME programs in T2DM patients living in ME countries.

METHODS

An extensive manual literature search was conducted using PubMed and Google Scholar for clinical trials assessing the effect of diabetes self-management education (DSME) for type 2 diabetes mellitus patients in Middle East countries. Information from the included studies was summarized in relation to study population, sample size, duration of follow-up, characteristics of DSME program, and follow-up time, besides in addition to parameters used in assessment, results, and conclusions. The risk of bias in the included studies was assessed using the Cochrane risk of bias tool. The effect of DSME on clinical and patient-reported outcomes was measured by calculation of the percentage of DSME studies that produce a significant improvement in these outcomes for patients in intervention group as compared to those in control group. Additionally, the effect of DSME on each clinical outcome was assessed by calculating the mean for the absolute effect of DSME on that outcome.

RESULTS

Twelve studies were included in this review. Heterogeneity was found among included studies in terms of DSME program characteristics, the enrolled patients, duration of follow-up, assessment methods, and obtained outcomes. All clinical glycemic outcomes (glycosylated hemoglobin, fasting, and non-fasting blood glucose), lipid profile (total cholesterol and triglycerides), and body mass index were significantly improved for patients in intervention group as compared to those in control group in at least 60% of the included studies. All patients' reported outcomes (medication adherence, self-management behavior, knowledge, self-efficacy, health belief and quality of life) were significantly improved by the DSME program.

CONCLUSION

DSME programs are highly effective in improving glycemic control, lipid profile and BMI, and modestly effective in improving BP. Thus, they can reduce the risks of developing diabetes complications. Patient diabetes knowledge, DSM behaviors, adherence to medications, self-efficacy, and quality of life can also be significantly improved by DSME.

Structural model of patient-centered communication and diabetes management in early emerging adults at the transfer to adult care

Early emerging adulthood (ages 18-25) is a time of risk for type 1 diabetes (T1D) when relationships with parents and providers are changing. We examined whether individuals' high-quality relationships with mothers are associated with greater perceptions of patient-centered communication (PCC) with their doctor and whether PCC is associated with better adherence and glycemic control through diabetes-related self-efficacy. Additionally, we tested whether associations of PCC with self-efficacy and diabetes outcomes are stronger among those who had transferred to adult care. One-year post-high school, 217 individuals with T1D (60% women, 53% in adult care) reported perceptions of maternal relationship quality, PCC, self-efficacy, and adherence. Glycemic control was measured via HbA1c assay kits. Structural equation modeling indicated good model fit and revealed indirect paths linking higher maternal relationship quality to better adherence through higher PCC, and higher PCC to better HbA1c through adherence. Transfer status moderated the link between PCC and self-efficacy, suggesting PCC may be especially important when emerging adults transfer to adult care.

Metabolic factors that affect health-related quality of life in type 2 diabetes patients: a multivariate regression analysis

PURPOSE

In the past few decades, an increase in the life span of the population has caused more people to experience chronic diseases, such as type 2 diabetes. Since chronic diseases influence the whole life of patients and do not have a specific remedy, improving their health-related quality of life (HRQoL) becomes more important. The aim of the present study was to investigate the metabolic variables that influenced HRQoL questionnaire scores most significantly among patients with type 2 diabetes.

PATIENTS AND METHODS

The population of this cross-sectional study included 163 patients with type 2 diabetes and 214 healthy people who were asked to complete the HRQoL questionnaire, and their metabolic blood variables were recorded simultaneously. The effects of metabolic variables and some other demographic ones on two main scales of HRQoL, Mental Component Summary (MCS) and Physical Component Summary (PCS), were evaluated using multivariate regression.

RESULTS

Multivariate regression analysis showed that PCS score was most negatively influenced by cigarette smoking (P=0.009, β-15.761), maximum blood pressure (P=0.008, β=-0.108), minimum blood pressure (P=0.009, β=-0.039), low-density lipoprotein cholesterol (P=0.008, β=-0.721), cholesterol (P=0.006, β=-0.648), HbA1c (P=0.004, β=-0.878), FBS (p=0.006, β=-0.769), and body mass index (BMI) (P=0.034, β=-0.287). The MCS score was influenced positively by smoking cigarettes (P=0.041, β=13.032), gender (P=0.018, β=15.633), and BMI (P=0.048, β=-0.088). Men had a higher MCS score compared to women.

CONCLUSION

The HRQoL questionnaire (as a concept of health) score could be improved by controlling the variation of some metabolic variables in patients with type 2 diabetes. Some metabolic variables could be the main causes of a decrease in physical and mental HRQoL among patients with type 2 diabetes.

Analysis of the Relationship between the Referral and Evolution of Patients with Type 2 Diabetes Mellitus

Type 2 Diabetes Mellitus (T2DM) is a chronic disease that has risen in prominence in recent years and can cause serious complications. Several studies show that the level of adherence to different types of treatment has a direct correlation with the positive evolution of chronic diseases. While such studies relate to patient adherence to medication, those that concern adherence to medical appointments do not distinguish between the different disciplines that attend to or refer patients. This study analyses the relationship between adherence to referrals made by three distinct disciplines (doctors, nurses, and nutritionists) and the results of HbA1c tests from a sample of 2290 patients with T2DM. The aim is to determine whether a relationship exists between patient improvement and the frequency with which they attend scheduled appointments in a timely manner, having been previously referred from or to a particular discipline. Results showed that patients tended to be more adherent when their next appointment is with a doctor, and less adherent when it is with a nurse or nutritionist. Furthermore, patients that remained stable had higher rates of adherence, whereas those with lower adherence tended to be more decompensated. The results can enable healthcare professionals to monitor patients and place particular emphasis on those who do not attend their scheduled appointments in a timely manner.

A Revised Version of Diabetes Quality of Life Instrument Maintaining Domains for Satisfaction, Impact, and Worry

BACKGROUND

Diabetes quality of life (DQoL) instrument has been widely used to measure quality of life among diabetes patients. This study aimed to develop a revised version of DQoL instrument that incorporated issues of redundancies in the items and strengthen the basis of validity of the instrument.

METHODS

This was a cross-sectional study where diabetes patients were recruited from December 1, 2014, until end of March 2015 at a public health clinic in Peninsular Malaysia. A questionnaire that included patients' information and DQoL instrument was distributed to patients. Item selection of DQoL instrument was conducted to screen and finalize the items based on issues of missing values and redundancy. Validity testing was conducted for the revised DQoL instrument based on exploratory factor analysis, confirmatory factor analysis, and Rasch analysis.

RESULTS

The pattern structure matrix yielded three domains similar to the original version with 18 items. The minimum factor loading from the structure matrix was 0.358. The item's and person's reliability was excellent with 0.92 and 0.84 for "satisfaction" domain, 0.98 and 0.60 for "impact" domain, and 0.99 and 0.57 for "worry" domain, respectively. Confirmatory factor analysis has dropped 5 items and the revised version of DQoL contained 13 items. Composite reliability of the revised version was computed for "satisfaction" domain (0.922; 95% CI: 0.909-0.936), "impact" domain (0.781; 95% CI: 0.745-0.818), and "worry" domain (0.794; 95% CI: 0.755-0.832).

CONCLUSION

A revised version of DQoL that maintains the conceptualization of "satisfaction," "impact," and "worry" with 13 items was successfully developed.

Achieving self-management of prophylactic treatment in adolescents: The case of haemophilia

OBJECTIVE

Adolescents with a chronic disorder, such as haemophilia, need to attain responsibility for their disease. The aim was to gain insight into how adolescents achieve self-management of prophylactic treatment.

METHODS

In three Dutch Haemophilia Treatment Centres, adolescents (10-25 years) received structured questions on treatment responsibility and self-management (pre-specified definitions) during routine nursing consultation.

RESULTS

In total, 155 interviews were performed in 100 patients (median age 14.4 years). Self-infusion was initiated at a median age of 12.3 years (IQR 11.5-13.0) and self-management was achieved 9.6 years later, at a median age of 22.6 years. This process included three phases coinciding with known stages of adolescence. In early adolescence, patients acquired the technique of self-infusion (12.3 years) leading to independent self-infusion in middle adolescence (17.2 years). In late adolescence, patients demonstrated an increase in more complex skills, such as bleeding management and communication with the haemophilia physician (19.9-22.6 years).

CONCLUSION

Although, the first steps in self-management with regard to self-infusion are taken in early adolescence, complete self-management was achieved in late adolescence after almost 10 years.

PRACTICE IMPLICATIONS

Insight in this transitional process helps to provide individualized support and emphasizes the need for continued education with regard to self-management skills.

Feasibility, reliability and validity of the Iranian version of the Diabetes Quality of Life Brief Clinical Inventory (IDQOL-BCI)

AIMS

To validate and culturally adapt the Diabetes-specific Quality of Life Brief Clinical Inventory (DQOL-BCI) for the Iranian population.

METHODS

After translation - back translation, content validity was assessed utilizing a panel of six experts. Based on a sample of 180 diabetic patients referred to two Diabetics Clinic Centers from September to May 2011 in Karaj, Iran, construct validity via detecting the factor structure, and convergent and discriminant validity were evaluated by scale-item correlations and known group analyses. Internal consistency and test-retest reliability were assessed in sample of 30 patients by Cronbach's and intraclass correlation coefficient (ICC).

RESULTS

The IDQOL-BCI showed good content validity (CVI values>0.75 and CVR values>0.99), internal consistency (α=0.75) and test-retest reliability (ICC=0.81). A 3-factor solution was found. In addition, high values of item-scale correlations confirmed the convergence validity, and some subscales and total scores differentiate between groups defined by sex, disease duration, income levels, drug using status and physical activity demonstrated the discriminant validity.

CONCLUSIONS

Our findings demonstrate the initial feasibility, reliability and validity of the Iranian version of the IDQOL-BCI as a measure of diabetic-specific QOL measure in Iranian patients.

Assessing the need for diabetes self-management education in the Oklahoma city vietnamese community

INTRODUCTION

To assess the diabetes self-management educational (DSME) needs of the Vietnamese diabetic population in the Oklahoma City metropolitan area.

METHODS

Participants in this explorative study included 50 Vietnamese adults with type 1 or type 2 diabetes recruited from the offices of four primary care physicians in the Oklahoma City metropolitan area. Participants completed a culturally sensitive survey focused on their diabetes history, knowledge and need of DSME, and health beliefs. Responses were evaluated using means and frequency analysis.

RESULTS

The mean age of participants was 62.7±9.1 years. Over 80% of participants were most comfortable speaking and reading Vietnamese, and 62% had never received a high school diploma. Less than 50% of participants reported ever receiving education regarding diabetic complications, nutrition, desirable glycated hemoglobin values, diabetic medications, daily self-care, risk of smoking, or cardiovascular risk associated with diabetes. More than 80% of participants requested more education in all areas of DSME except smoking risk in diabetes, with all participants requesting delivery of this education in Vietnamese.

CONCLUSION

DSME is needed and desired in the Vietnamese community of the Oklahoma City metropolitan area. Education should be provided in the Vietnamese language with most targeted to lower literacy levels. Vietnamese diabetes educators should facilitate increased access to DSME knowledge and skills in efforts to improve glycemic control and overall health status for this community.

Making diabetes self-management education culturally relevant for Filipino Americans in Hawaii

PURPOSE

The purpose of this study was to identify the cultural values, traditions, and perceptions of diabetes risk and self-care among Filipino Americans in Hawaii with type 2 diabetes that facilitate or impede engagement in diabetes self-management behaviors and education classes.

METHODS

This qualitative study used 2 rounds of semistructured focus groups and interviews. Participants included 15 patients with type 2 diabetes recruited from a large health-maintenance organization in Hawaii and 7 health care and cultural experts recruited from the community. The taped and transcribed focus groups and interviews were coded thematically. Participants evaluated example materials for diabetes self-management education (DSME) with Filipino Americans.

RESULTS

Several aspects of Filipino American culture were identified as central to understanding the challenges of engaging in self-management behaviors and DSME: (1) undertaking self-management while prioritizing the family and maintaining social relationships, (2) modifying diet while upholding valued symbolic and social meanings of food, (3) participating in storytelling in the face of stigma associated with diabetes, and (4) reconciling spiritual and biomedical interpretations of disease causality and its management. Respondents also emphasized the role of several qualitative aspects of perceived risk (eg, dread, control) in moderating their behaviors. Participants suggested ways to make DSME culturally relevant.

CONCLUSIONS

Awareness of cultural values and qualitative aspects of perceived risk that influence Filipino Americans' engagement in diabetes self-care behaviors and classes may help to improve teaching methods, materials, and recruitment strategies.

The art and science of diabetes education: a culture out of balance

In the past 20 years, behavioral science has helped create a growing body of theoretically derived, evidenced-based approaches to diabetes patient education. Health care professionals in all disciplines are being required to demonstrate that their practice is evidence based. For diabetes educators, behavioral science is the source of much of that evidence. However, effective diabetes education involves a combination of art and science. Establishing a therapeutic alliance with patients is an art. Diabetes educators must have the interpersonal skills, values, and personal traits needed to cultivate relationships with patients that are characterized by trust, respect, and acceptance. They must feel and be able to express compassion, empathy, and warmth. However, if someone outside the field were reviewing diabetes education evaluation research, they would probably conclude that diabetes educators are interchangeable cogs in a wheel. The positive impact of the therapeutic alliance is well documented in the counseling, psychotherapy, education, and nursing literature. However, evidence to support the important role of the diabetes educator's values, interpersonal skills, and ability to establish a therapeutic alliance with patients is absent from that literature. Valid and reliable measures used to document the impact of interpersonal skills counselors and teachers could be used in diabetes education with little or no adaptation. The evidence and tools exist; we now need to determine if the will exists.

Health goals among primary care patients

PURPOSE

To identify individuals' health goals and describe their preferences in attaining those goals and to explore associations of type of goals with individual characteristics.

DATA SOURCES

In a descriptive study, 60 adult patients from primary care clinics completed written questionnaires anonymously. Content analyses and frequencies were used to summarize data.

CONCLUSIONS

Health promotion interventions could be more effective if they were customized, in part, to individuals' health goals. There are few evidence-based descriptions of individuals' own health goals and their preferences in how to pursue them. Participants in this study shared common goals to get in shape, lose weight, and change consumption. Participants preferred to meet initially with practitioners to obtain advice and to connect subsequently by telephone for monitoring.

IMPLICATIONS

Participants did want to improve their health. More specific understanding of such goals and preferences is needed to guide future interventions. Findings can inform clinicians and guide researchers in how to design health behavior interventions.

Diabetes treatments

With the aging of the population, physical inactivity, and growing rates of obesity, there has been a dramatic rise in the incidence of diabetes. Diabetes and its treatment is a holistic and dynamic experience, shaping many aspects of a person's life and well-being. Despite the biopsychosocial nature of this chronic disease, medications tend to be the principal intervention among medical professionals. Over the past fifteen years, however, diabetes researchers and clinicians have begun to develop interventions addressing the psychosocial aspects of diabetes. The majority of these interventions fall within the knowledge base and clinical abilities of social work practitioners. This paper systematically reviews psychosocial intervention studies with older adults, identifying and summarizing treatment protocols.

Testing a Self-Determination Theory Process Model for Promoting Glycemic Control Through Diabetes Self-Management

A longitudinal study tested the self-determination theory (SDT) process model of health behavior change for glycemic control within a randomized trial of patient activation versus passive education. Glycosylated hemoglobin for patients with Type 2 diabetes (n=159) was assessed at baseline, 6 months, and 12 months. Autonomous motivation and perceived competence were assessed at baseline and 6 months, and the autonomy supportiveness of clinical practitioners was assessed at 3 months. Perceptions of autonomy and competence were promoted by perceived autonomy support, and changes in perceptions of autonomy and competence, in turn, predicted change in glycemic control. Self-management behaviors mediated the relation between change in perceived competence and change in glycemic control. The self-determination process model fit the data well.