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A multi-component, family-focused and literacy-sensitive intervention to improve medication adherence in patients with heart failure-A randomized controlled trial. Heart Lung 2019; 48:507-514. [PMID: 31182217 DOI: 10.1016/j.hrtlng.2019.05.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 05/14/2019] [Accepted: 05/15/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Medication nonadherence is prevalent and links to serious outcomes (e.g., rehospitalization/death) in heart failure (HF) patients; therefore, an urgent need exists for an intervention to improve and sustain adherence after intervention completion. OBJECTIVES To test the efficacy of a multi-component, family-focused, literacy-sensitive (FamLit) intervention on medication adherence in HF patients. METHODS Forty-three HF patients and their care partners were enrolled and randomized to receive FamLit or attention-only intervention, including an in-person session at baseline and bi-weekly phone boosters for 3 months. We measured medication adherence from baseline to 3-month post-intervention using the Medication Event Monitoring System. RESULTS After 3-month intervention, intervention patients had significantly better medication adherence than control patients. At 6 months (3-months post-intervention), intervention effect on adherence was sustained in the FamLit intervention group, while adherence decreased in the control group. CONCLUSION Incorporating care partner support and providing an easy-to-understand intervention to patients-care partners may improve/sustain adherence.
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Won AL, Yoo SH, You MS. Factors Related to Perceived Health Status in Patients with Type 2 Diabetes. ACTA ACUST UNITED AC 2014. [DOI: 10.14367/kjhep.2014.31.3.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Pyatak EA, Florindez D, Peters AL, Weigensberg MJ. "We are all gonna get diabetic these days": the impact of a living legacy of type 2 diabetes on Hispanic young adults' diabetes care. DIABETES EDUCATOR 2014; 40:648-58. [PMID: 24867918 DOI: 10.1177/0145721714535994] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE The purpose of this study was to investigate how an intergenerational legacy of type 2 diabetes affected the knowledge, attitudes, and treatment strategies of Hispanic young adults with diabetes. METHODS Eight Hispanic young adults (ages 18-30 years) participated in a series of in-home longitudinal qualitative interviews, and 11 of their family members completed single in-home interviews, regarding their diabetes management practices. Interview transcripts were analyzed thematically by a team of researchers. RESULTS Five themes emerged that characterized the influence of an intergenerational legacy of diabetes on young adults: food and family (how meal preparation and eating are shared within families), doing together (activity participation is contingent on others' participation), knowledge and expectations (expectations for the future and understandings of diabetes are shaped by family members), miscarried helping (well-intentioned actions have negative consequences), and reciprocal support (children and parents support each other's diabetes care). CONCLUSIONS Hispanic young adults' knowledge, attitudes, and self-care practices related to diabetes are strongly influenced by the diabetes management practices of family members with diabetes, which often depart from current standards of diabetes care. Care providers should consider family members as a potentially significant influence, either positive or negative, on the diabetes self-care practices of this population.
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Affiliation(s)
- Elizabeth A Pyatak
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California (Dr Pyatak, Ms Florindez)
| | - Daniella Florindez
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California (Dr Pyatak, Ms Florindez)
| | - Anne L Peters
- Division of Endocrinology, Keck School of Medicine, University of Southern California, Los Angeles, California (Dr Peters)
| | - Marc J Weigensberg
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California (Dr Weigensberg)
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Markis NE. Assessing Families of Adult Type 2 Diabetic Populations. West J Nurs Res 2013; 35:403-4. [DOI: 10.1177/0193945912471927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Family diabetes matters: a view from the other side. J Gen Intern Med 2013; 28:428-35. [PMID: 23054922 PMCID: PMC3579978 DOI: 10.1007/s11606-012-2230-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 07/30/2012] [Accepted: 09/13/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Typically, chronic disease self-management happens in a family context, and for African American adults living with diabetes, family seems to matter in self-management processes. Many qualitative studies describe family diabetes interactions from the perspective of adults living with diabetes, but we have not heard from family members. OBJECTIVE To explore patient and family perspectives on family interactions around diabetes. DESIGN Qualitative study using focus group methodology. PARTICIPANTS & APPROACH: We conducted eight audiotaped focus groups among African Americans (four with patients with diabetes and four with family members not diagnosed with diabetes), with a focus on topics of family communication, conflict, and support. The digital files were transcribed verbatim, coded, and analyzed using qualitative data analysis software. Directed content analysis and grounded theory approaches guided the interpretation of code summaries. RESULTS Focus groups included 67 participants (81 % female, mean age 64 years). Family members primarily included spouses, siblings, and adult children/grandchildren. For patients with diabetes, central issues included shifting family roles to accommodate diabetes and conflicts stemming from family advice-giving. Family members described discomfort with the perceived need to police or "stand over" the diabetic family member, not wanting to "throw diabetes in their [relative's] face," perceiving their communications as unhelpful, and confusion about their role in diabetes care. These concepts generated an emergent theme of "family diabetes silence." CONCLUSION Diabetes silence, role adjustments, and conflict appear to be important aspects to address in family-centered diabetes self-management interventions. Contextual data gathered through formative research can inform such family-centered intervention development.
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Anaforoğlu I, Ramazanoğulları I, Algün E, Kutanis R. Depression, anxiety and quality of life of family caregivers of patients with type 2 diabetes. Med Princ Pract 2012; 21:360-5. [PMID: 22188726 DOI: 10.1159/000334622] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 10/24/2011] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE It was our aim to investigate the quality of life (QOL) among family caregivers of patients with type 2 diabetes mellitus. SUBJECTS AND METHODS The Short Form-36 QOL scale, Beck Depression Inventory and State-Trait Anxiety Inventory Form were used to evaluate the presence and degree of depression and anxiety and their association with sociodemographic features of 50 family caregivers of diabetic patients compared to 54 controls. RESULTS The groups were similar in terms of age, sex, health insurance, educational status and marital and financial status. Beck Depression Inventory scores were significantly higher in family caregivers (p = 0.001) than in controls. Depression as a categorical variable was significantly more frequent among family caregivers of diabetic patients than among controls (p < 0.001). The social function component of the QOL of controls was better than that of family caregivers (p < 0.005). There was no difference between groups in terms of anxiety. CONCLUSION Family caregivers of diabetic patients appeared to be more prone to depression and tended to have a poorer QOL.
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Affiliation(s)
- Inan Anaforoğlu
- Department of Endocrinology and Metabolism, Trabzon Numune Education and Research Hospital, Trabzon, Turkey.
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Löfvenmark C, Karlsson MR, Edner M, Billing E, Mattiasson AC. A group-based multi-professional education programme for family members of patients with chronic heart failure: effects on knowledge and patients' health care utilization. PATIENT EDUCATION AND COUNSELING 2011; 85:e162-e168. [PMID: 21050694 DOI: 10.1016/j.pec.2010.09.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Revised: 09/27/2010] [Accepted: 09/28/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE The aim was to investigate if family members of patients with chronic heart failure (CHF) increased knowledge about CHF through a group-based multi-professional educational programme and whether there was an effect on patients' health care utilization. METHODS Family members (n=128) were randomly assigned to intervention-group (IG) who received CHF education programme or control-group (CG) who received information according to hospital routines. Programme effects were evaluated with CHF knowledge questionnaire, patient readmissions and number of days hospitalised during 18 months. RESULTS Knowledge about CHF increased in both groups, significantly higher in IG at second assessment (IG 16±1.9 vs. CG 14.9±2.1, p=0.006), and knowledge maintained at third assessment. In IG 17 patients were re-admitted at least once and 28 patients in CG due to CHF (p=0.085). There were no differences in frequency of readmissions or number of days hospitalised. CONCLUSION A group-based multi-professional education programme increased family members' knowledge about CHF. Despite this, effect on patient's health care utilization could not be seen during follow-up period. PRACTICAL IMPLICATIONS We suggest that CHF education programmes for family members should be provided at clinics, with information preferably repeated 2-3 times during a period of six months to maintain knowledge level.
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Affiliation(s)
- Caroline Löfvenmark
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Stockholm, Sweden.
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Kang CM, Chang SC, Chen PL, Liu PF, Liu WC, Chang CC, Chang WY. Comparison of family partnership intervention care vs. conventional care in adult patients with poorly controlled type 2 diabetes in a community hospital: A randomized controlled trial. Int J Nurs Stud 2010; 47:1363-73. [DOI: 10.1016/j.ijnurstu.2010.03.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Revised: 03/09/2010] [Accepted: 03/12/2010] [Indexed: 12/20/2022]
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Bowen ME, Rothman RL. Multidisciplinary management of type 2 diabetes in children and adolescents. J Multidiscip Healthc 2010; 3:113-24. [PMID: 21197360 PMCID: PMC3004606 DOI: 10.2147/jmdh.s7840] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Indexed: 12/16/2022] Open
Abstract
Although once considered a disease of adults, the prevalence of type 2 diabetes in youth is increasing at a significant rate. Similar to adults, youth with type 2 diabetes are at increased risk for developing hypertension, lipid abnormalities, renal disease, and other diabetes-related complications. However, children and adolescents with type 2 diabetes also face many unique management challenges that are different from adults with type 2 diabetes or children with type 1 diabetes. To deliver safe, effective, high-quality, cost-effective health care to adolescents with type 2 diabetes, reorganization and redesign of health care systems are needed. Multidisciplinary health care teams, which allow individuals with specialized training to maximally utilize their skills within an organized diabetes treatment team, may increase efficiency and effectiveness and may improve outcomes in children with type 2 diabetes. This review article provides a brief review of type 2 diabetes in children and adolescents, provides an overview of multidisciplinary health care teams, and discusses the role of multidisciplinary health care management in youth with type 2 diabetes.
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Affiliation(s)
- Michael E Bowen
- Veterans Affairs Quality Scholars Fellowship Program, Tennessee Valley Healthcare System, Tennessee Valley Geriatric Research Education Clinical Center, Nashville, TN, USA
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Glasdam S, Timm H, Vittrup R. Support Efforts for Caregivers of Chronically Ill Persons. Clin Nurs Res 2010; 19:233-65. [DOI: 10.1177/1054773810369683] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
An increasing number of people today live with chronic diseases that affect their quality of life and that of their families. Health professionals confirm this finding based on their clinical interventions targeting families of chronically ill patients. The aim of this study was to describe and evaluate these interventions. A systematic literature review was conducted, including previous reviews and controlled studies from 1997 to 2007 of interventions targeting caregivers of adults with stroke, diabetes, cardiovascular disease, and cancer.Ten out of the 32 studies included found the interventions to have no effect, whereas effects were found in the other 22 studies in one or more areas, including burden, knowledge level, mastering skills, and satisfaction. The literature review concludes that the impact of these interventions is neither unique nor significant. The defined concepts of the randomized clinical studies appear problematic when implemented and underscore the importance of strict requirements on future randomized, controlled designs.
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Affiliation(s)
- Stinne Glasdam
- Center for Health and Social Care Integration, Metropolitan University College, Copenhagen, Denmark,
| | - Helle Timm
- Centre for Palliative Care, Copenhagen, Denmark
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Yun JO, Kim KN. Relationships of family support, diet therapy practice and blood glucose control in typeII diabetic patients. Nutr Res Pract 2009; 3:141-8. [PMID: 20016715 PMCID: PMC2788168 DOI: 10.4162/nrp.2009.3.2.141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Revised: 06/08/2009] [Accepted: 06/10/2009] [Indexed: 11/04/2022] Open
Abstract
The purpose of this study was to investigate the degree of family support for diabetic patients and the diet therapy practice of patients themselves, and to analyze the relationship between family support and diet therapy practice and blood glucose control, and thus to prepare basic data for the development of effective education programs to improve blood glucose control in diabetic patients. The study subjects were 82 patients with type II diabetes, aged over 20 in the Chungbuk area. The gender distribution of subjects was 52.4% males and 47.6% females, and BMI showed 29.3% overweight and 35.3% obesity. Among the 82 study subjects, the relationship between diet therapy related family support and blood glucose control was examined in 67 subjects who answered practicing diet therapy, and the results showed that the family support score of a group with excellent blood glucose control was significantly higher than those of groups with fair or poor control (p<0.001) and the correlation between the two factors was very high (r=0.341, p<0.001). For the relationship between diet therapy practice by patients themselves and blood glucose control, diet therapy practice of a group with excellent blood glucose control was significantly higher than those of other groups (fair or poor control groups) (p<0.001) and the correlation between two factors was very high (r=0.304, p<0.001). For other factors influencing blood glucose control, a group with diabetes education showed significantly better blood glucose control compared to other groups without education (p<0.05). From the above results, diet therapy practice by patients, family support, and the necessity of diabetes education were confirmed to control blood glucose of diabetic patients. In conclusion, development and operation of education program should include not only patients but also their family members.
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Affiliation(s)
- Jeong-Ok Yun
- Department of Food & Nutrition, Chungbuk National University, 410 Seongbong-ro, Heongduk-gu, Cheongju 361-763, Korea
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Reilly CM, Higgins M, Smith A, Gary RA, Robinson J, Clark PC, McCarty F, Dunbar SB. Development, psychometric testing, and revision of the Atlanta Heart Failure Knowledge Test. J Cardiovasc Nurs 2009; 24:500-9. [PMID: 19858959 PMCID: PMC2828039 DOI: 10.1097/jcn.0b013e3181aff0b0] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND RESEARCH OBJECTIVE Several heart failure (HF) knowledge tools have been developed and tested over the past decade; however, they vary in content, format, psychometric properties, and availability. This article details the development, psychometric testing, and revision of the Atlanta Heart Failure Knowledge Test (A-HFKT) as a standardized instrument for both the research and clinical settings. PARTICIPANTS AND METHODS Development and psychometric testing of the A-HFKT were undertaken with 116 New York Heart Association (NYHA) class II and III community-dwelling HF patients and their family members (FMs) participating in a family intervention study. Internal consistency, reliability, and content validity were examined. Construct validity was assessed by correlating education level, literacy, dietary sodium ingestion, medication adherence, and healthcare utilization with knowledge. RESULTS Content validity ratings on relevance and clarity ranged from 0.55 to 1.0, with 81% of the items rated from 0.88 to 1.0. Cronbach alpha values were .84 for patients, .75 for FMs, and .73 for combined results. Construct validity testing revealed a small but significant correlation between higher patient and FM knowledge on sodium restriction questions and lower ingested sodium, r = -0.17, P = .05 and r = -0.19, P = .04, respectively, and between patient knowledge and number of days that medications were taken correctly (diuretics: r = 0.173, P < .05, and angiotensin-converting enzyme: r = 0.223, P = .01). Finally, patients seeking emergency care or requiring hospitalization in the 4 months before study entry were found to have significantly lower FM knowledge using both t test and logistic regression modeling. CONCLUSIONS The A-HFKT was revised using the content and construct validity data and is available for use with HF patients and FMs. The construct validity testing indicates that patient knowledge has a significant relationship to aspects of self-care. Furthermore, family knowledge may influence patient adherence with sodium restriction and healthcare utilization behavior.
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Chesla CA, Chun KM, Kwan CML. Cultural and family challenges to managing type 2 diabetes in immigrant Chinese Americans. Diabetes Care 2009; 32:1812-6. [PMID: 19628812 PMCID: PMC2752925 DOI: 10.2337/dc09-0278] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Although Asians demonstrate elevated levels of type 2 diabetes, little attention has been directed to their unique cultural beliefs and practices regarding diabetes. We describe cultural and family challenges to illness management in foreign-born Chinese American patients with type 2 diabetes and their spouses. RESEARCH DESIGN AND METHODS This was an interpretive comparative interview study with 20 foreign-born Chinese American couples (n = 40) living with type 2 diabetes. Multiple (six to seven) semistructured interviews with each couple in individual, group, and couple settings elicited beliefs about diabetes and narratives of care within the family and community. Interpretive narrative and thematic analysis were completed. A separate respondent group of 19 patients and spouses who met the inclusion criteria reviewed and confirmed the themes developed from the initial couples. RESULTS Cultural and family challenges to diabetes management within foreign-born Chinese American families included how 1) diabetes symptoms challenged family harmony, 2) dietary prescriptions challenged food beliefs and practices, and 3) disease management requirements challenged established family role responsibilities. CONCLUSIONS Culturally nuanced care with immigrant Chinese Americans requires attentiveness to the social context of disease management. Patients' and families' disease management decisions are seldom made independent of their concerns for family well-being, family face, and the reciprocal responsibilities required by varied family roles. Framing disease recommendations to include cultural concerns for balance and significant food rituals are warranted.
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Affiliation(s)
- Catherine A Chesla
- Department of FamilyHealth Care Nursing, University of California San Francisco, San Francisco, California, USA.
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Abstract
Many patient education guidelines for teaching heart failure patients recommend inclusion of the family; however, family-focused interventions to promote self-care in heart failure are few. This article reviews the state of the science regarding family influences on heart failure self-care and outcomes. The literature and current studies suggest that family functioning, family support, problem solving, communication, self-efficacy, and caregiver burden are important areas to target for future research. In addition, heart failure patients without family and those who live alone and are socially isolated are highly vulnerable for poor self-care and should receive focused attention. Specific research questions based on existing science and gaps that need to be filled to support clinical practice are posed.
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Kim ES, Lee SJ, Ryu OH, Lee JY, Yun HS, Choi MG. The Relationship of Family Support with Blood Glucose Control in Elderly Type 2 Diabetic Patients. ACTA ACUST UNITED AC 2007. [DOI: 10.4093/jkda.2007.31.5.435] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Eun Suk Kim
- Department of Social Work, ChunCheon Sacred Heart Hospital, Korea
| | - Seong Jin Lee
- Department of Internal Medicine, Collage of Medicine, Hallym University, Korea
| | - Ohk Hyun Ryu
- Department of Internal Medicine, Collage of Medicine, Hallym University, Korea
| | - Jee Youn Lee
- Department of Social Work, ChunCheon Sacred Heart Hospital, Korea
| | - Hyun Suk Yun
- Department of Social Welfare, College of Social Sciences, Hallym University, Korea
| | - Moon Gi Choi
- Department of Internal Medicine, Collage of Medicine, Hallym University, Korea
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