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Muhali SS, Muhali FS, Mfinanga SG, Sadiq AM, Marandu AA, Kyala NJ, Said FH, Nziku EB, Mirai TE, Ngocho JS, Mlay HL, Waria GG, Chambega A, Kessy SN, Kilonzo KG, Lyamuya FS, Mkwizu EW, Shao ER, Chamba NG. Impact of Self-Monitoring Blood Glucose on Glycaemic Control Among Insulin-Treated Patients With Diabetes Mellitus in Northeastern Tanzania: A Randomised Controlled Trial. J Diabetes Res 2024; 2024:6789672. [PMID: 38899147 PMCID: PMC11186681 DOI: 10.1155/2024/6789672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 05/24/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Introduction: Tracking of blood glucose levels by patients and care providers remains an integral component in the management of diabetes mellitus (DM). Evidence, primarily from high-income countries, has illustrated the effectiveness of self-monitoring of blood glucose (SMBG) in controlling DM. However, there is limited data on the feasibility and impact of SMBG among patients in the rural regions of sub-Saharan Africa. This study is aimed at assessing SMBG, its adherence, and associated factors on the effect of glycaemic control among insulin-treated patients with DM in northeastern Tanzania. Materials and Methods: This was a single-blinded, randomised clinical trial conducted from December 2022 to May 2023. The study included patients with DM who had already been on insulin treatment for at least 3 months. A total of 85 participants were recruited into the study and categorised into the intervention and control groups by a simple randomization method using numbered envelopes. The intervention group received glucose metres, test strips, logbooks, and extensive SMBG training. The control group received the usual care at the outpatient clinic. Each participant was followed for a period of 12 weeks, with glycated haemoglobin (HbA1c) and fasting blood glucose (FBG) being checked both at the beginning and at the end of the study follow-up. The primary and secondary outcomes were adherence to the SMBG schedule, barriers associated with the use of SMBG, and the ability to self-manage DM, logbook data recording, and change in HbA1c. The analysis included descriptive statistics, paired t-tests, and logistic regression. Results: Eighty participants were analysed: 39 in the intervention group and 41 in the control group. In the intervention group, 24 (61.5%) of patients displayed favourable adherence to SMBG, as evidenced by tests documented in the logbooks and glucometer readings. Education on SMBG was significantly associated with adherence. Structured SMBG improved glycaemic control with a HbA1c reduction of -1.01 (95% confidence interval (CI) -1.39, -0.63) in the intervention group within 3 months from baseline compared to controls of 0.18 (95% CI -0.07, 0.44) (p < 0.001). Conclusion: Structured SMBG positively impacted glycaemic control among insulin-treated patients with DM in the outpatient clinic. The results suggest that implementing a structured testing programme can lead to significant reductions in HbA1c and FBG levels. Trial Registration: Pan African Clinical Trials Registry identifier: PACTR202402642155729.
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Affiliation(s)
- Sophia S. Muhali
- Faculty of MedicineKilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Fatma S. Muhali
- Department of EndocrinologyMuhimbili National Hospital, Dar es Salaam, Tanzania
| | - Sayoki G. Mfinanga
- National Institute for Medical ResearchMuhimbili Research Centre, Dar es Salaam, Tanzania
| | - Abid M. Sadiq
- Faculty of MedicineKilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Internal MedicineKilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Annette A. Marandu
- Faculty of MedicineKilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Norman J. Kyala
- Faculty of MedicineKilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Fuad H. Said
- Faculty of MedicineKilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Eliada B. Nziku
- Faculty of MedicineKilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Tumaini E. Mirai
- Faculty of MedicineKilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Internal MedicineKilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - James S. Ngocho
- Institute of Public HealthKilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Henry L. Mlay
- Institute of Public HealthKilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Gilbert G. Waria
- Institute of Public HealthKilimanjaro Christian Medical University College, Moshi, Tanzania
| | | | - Stella N. Kessy
- Nutrition UnitKilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Kajiru G. Kilonzo
- Faculty of MedicineKilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Internal MedicineKilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Furaha S. Lyamuya
- Faculty of MedicineKilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Internal MedicineKilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Elifuraha W. Mkwizu
- Faculty of MedicineKilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Internal MedicineKilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Elichilia R. Shao
- Faculty of MedicineKilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Internal MedicineKilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Nyasatu G. Chamba
- Faculty of MedicineKilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Internal MedicineKilimanjaro Christian Medical Centre, Moshi, Tanzania
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Farford BA, Eglinger BJ, Kane L, Gilbert JN, Ball CT. Impact of a diabetes-designed meal delivery service on changes in hemoglobin A 1c and quality of life in patients with diabetes. Diabetes Metab Syndr 2024; 18:103004. [PMID: 38626649 DOI: 10.1016/j.dsx.2024.103004] [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: 09/07/2022] [Revised: 04/01/2024] [Accepted: 04/03/2024] [Indexed: 04/18/2024]
Abstract
BACKGROUND Over 34 million Americans have diabetes, and nutrition therapy is essential in self-management. AIMS The primary aim of the study was to evaluate the impact of meals designed for patients with type 2 diabetes (T2D) through a meal delivery program. The primary outcome was a 3-month change in hemoglobin A1c (HbA1c). Secondary outcomes included a 3-month change in weight, blood pressure, high-density lipoprotein, low-density lipoprotein, and triglycerides. Furthermore, the study aimed to evaluate the impact of the meal delivery program on the participants' quality of life. METHODS In this randomized crossover clinical trial, patients were allocated in a 1:1 fashion to treatment sequence AB or treatment sequence BA. In Phase 1, participants allocated to sequence AB received 10 meals per week for 3 months, followed by a 3-month washout period and a 3-month standard intervention period with no meals. Participants allocated to sequence BA received 3 months of standard intervention with no meals followed by a 3-month washout period and a 3-month period with 10 meals per week. A quality-of-life survey was obtained during weeks 0, 12, 24, and 36. RESULTS The mean 3-month change in HbA1c (primary outcome) was nearly a half point lower with meal delivery (-0.44% [95% CI: -0.85%, -0.03%]; P = 0.037). The estimated mean 3-month change in quality of life was approximately 2 points lower (better) with meal delivery (-2.2 points [95% CI: -4.2, -0.3]; P = .027). There were no statistically significant differences in secondary outcomes with meal delivery (all P ≥ 0.15). CONCLUSIONS A meal delivery system for patients with T2D improves glycemic control and quality of life.
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Affiliation(s)
- Bryan A Farford
- Department of Family Medicine (Farford), Department of Research (Eglinger), and Department of Quantitative Health Sciences (Ball), Mayo Clinic, Jacksonville, FL, USA; Director of Nutrition (Kane), Sunbasket, Philadelphia, PA, USA; Chief Medical Officer (Gilbert), Aspire Health Plan, Monterey, CA, USA.
| | - Brian J Eglinger
- Department of Family Medicine (Farford), Department of Research (Eglinger), and Department of Quantitative Health Sciences (Ball), Mayo Clinic, Jacksonville, FL, USA; Director of Nutrition (Kane), Sunbasket, Philadelphia, PA, USA; Chief Medical Officer (Gilbert), Aspire Health Plan, Monterey, CA, USA
| | - Lindsey Kane
- Department of Family Medicine (Farford), Department of Research (Eglinger), and Department of Quantitative Health Sciences (Ball), Mayo Clinic, Jacksonville, FL, USA; Director of Nutrition (Kane), Sunbasket, Philadelphia, PA, USA; Chief Medical Officer (Gilbert), Aspire Health Plan, Monterey, CA, USA
| | - James N Gilbert
- Department of Family Medicine (Farford), Department of Research (Eglinger), and Department of Quantitative Health Sciences (Ball), Mayo Clinic, Jacksonville, FL, USA; Director of Nutrition (Kane), Sunbasket, Philadelphia, PA, USA; Chief Medical Officer (Gilbert), Aspire Health Plan, Monterey, CA, USA
| | - Colleen T Ball
- Department of Family Medicine (Farford), Department of Research (Eglinger), and Department of Quantitative Health Sciences (Ball), Mayo Clinic, Jacksonville, FL, USA; Director of Nutrition (Kane), Sunbasket, Philadelphia, PA, USA; Chief Medical Officer (Gilbert), Aspire Health Plan, Monterey, CA, USA
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Wong SKW, Soon W, Griva K, Smith HE. Diabetes knowledge, self-efficacy and dietary, psychological and physical health barriers: Comparing young and usual-onset type 2 diabetes. Diabet Med 2024; 41:e15207. [PMID: 37597247 DOI: 10.1111/dme.15207] [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: 06/26/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 08/21/2023]
Abstract
AIMS Young-onset (21-39 years old) type 2 diabetes (YOD) is associated with high complication rates and glycaemic levels, and poor self-management plays a significant role. Knowledge, skills and barriers influence self-management behaviours considerably. Therefore, this study assessed diabetes knowledge, self-efficacy and barriers (situational dietary barriers, physical health, mental health and diabetes-related distress) between participants with young and usual-onset (40-59 years old) (UOD) diabetes. METHODOLOGY A cross-sectional survey was conducted. Differences between YOD and UOD were analysed using bivariate analysis and effect sizes were estimated with Cohen's d. Differences were further adjusted by demographic factors (gender, ethnicity, marital status, educational level, income level) and diabetes duration. RESULTS A total of 409 (97 YOD, 312 UOD) participants were recruited. Participants with YOD had lower self-efficacy levels (adjusted B = -0.19, CI -0.35 to -0.03) and higher dietary barriers (adjusted B = 3.6, CI 2.1-5.1), lower mental health scores (adjusted B = -3.5, CI -5.7 to -1.4) and higher diabetes-related distress levels (adjusted B = 0.2, CI 0.2-0.4). CONCLUSIONS Our study found that participants with YOD faced more challenges with adapting to life with diabetes when compared with UOD. More effective self-management programmes are needed to support the multifaceted needs of adults with YOD.
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Affiliation(s)
- Sabrina K W Wong
- National Healthcare Group Polyclinics, Singapore, Singapore
- Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Winnie Soon
- National Healthcare Group Polyclinics, Singapore, Singapore
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Aksoy M, Büyükbayram Z, Özüdoğru O. Reliability and validity of the Diabetic foot self-care questionnaire in Turkish patients. Prim Care Diabetes 2023; 17:513-517. [PMID: 37302937 DOI: 10.1016/j.pcd.2023.06.005] [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: 01/30/2023] [Revised: 03/26/2023] [Accepted: 06/07/2023] [Indexed: 06/13/2023]
Abstract
AIM This study was conducted to examine the psychometric, properties of the Turkish version of the Diabetic, Foot Self-Care, Questionnaire. METHODS This was a descriptive- methodological study conducted on 193 diabetes patients. Data were collected, using Descriptive, Information Form and Diabetic Foot Self-Care Questionnaire. Data were analyzed using exploratory factor analysis, item-total score correlation, Cronbach's alpha, and test-retest analysis. RESULTS The Diabetic, Foot Self-Care, Questionnaire consists of 16 items and three sub-dimensions. The three sub-dimensions recorded a variance of 58.137%. The total Cronbach's alpha coefficient of the Turkish version of the Diabetic, Foot Self-Care, Questionnaire was 0.87, and Cronbach's alpha values of its sub-dimensions were 0.71 and 0.88. The two-month test-retest credibility interpreted with intra-class correlation was 0.97. CONCLUSIONS It has been shown that the questionnaire is a valid and reliable tool for assessing foot self-care behavior in diabetic patients.
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Affiliation(s)
- Meyreme Aksoy
- Siirt University, Faculty of Health Sciences,Department of Nursing Fundamentals, Siirt, Turkey.
| | - Zeliha Büyükbayram
- Siirt University, Faculty of Health Sciences, Department of Internal Medicine Nursing, Siirt, Turkey
| | - Osman Özüdoğru
- Siirt University, Medical Faculty, Department of Internal Medicine, Siirt, Turkey
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Jiang T, Li A, Zhang M, Zhou Z, Wang L, Zhang X, Zhang Y, Zhang Q. Measuring Self-management Among People with Diabetes Mellitus: A Systematic Review of Patient-Reported Diabetes-Specific Instruments in English and Chinese. Adv Ther 2023; 40:769-813. [PMID: 36607543 DOI: 10.1007/s12325-022-02361-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/13/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Effective behavioral management is critical for people with diabetes to achieve glycemic control. Many instruments have been developed to measure diabetes-specific self-management. This review aimed to retrieve existing self-management-related instruments and identify well-validated instruments suitable for clinical research and practice. METHODS First, PubMed, Psych INFO, ERIC, and two Chinese databases (CNKI and Wanfang Data) were searched to identify existing instruments for self-management in diabetes systematically. Second, instruments were screened based on the pre-specified inclusion and exclusion criteria. Third, the psychometric property data of each included instrument were retrieved, and instruments with poor psychometric properties were excluded. Fourth, selected instruments were categorized into four categories: knowledge and health literacy, belief and self-efficacy, self-management behaviors, and composite scales. Finally, recommendations were made according to the application status and quality of the instruments. Instruments in English and Chinese were screened and summarized separately. RESULTS A total of 406 instruments (339 English instruments and 67 Chinese instruments) were identified. Forty-three English instruments were included. Five focused on knowledge and literacy, 12 on belief and self-management perception-related constructs, 21 on self-management and behaviors, and 5 on composite measures. We further recommended 19 English scales with relatively good quality and are frequently applied. Twenty-five Chinese instruments were included, but none were recommended because of a lack of sufficient psychometric property data. CONCLUSION Many English instruments measuring diabetes self-management have been developed and validated. Further research is warranted to validate instruments adapted or developed in the Chinese population.
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Affiliation(s)
- Tian Jiang
- Department of endocrinology, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Shushan District, Hefei, Anhui, China
| | - Aihua Li
- Sanofi China, 19F, Tower III, Kerry Center 1228 Middle Yan'an Road, Shanghai, China
| | - Minlu Zhang
- Sanofi China, 19F, Tower III, Kerry Center 1228 Middle Yan'an Road, Shanghai, China
| | - Zhou Zhou
- Sanofi China, 19F, Tower III, Kerry Center 1228 Middle Yan'an Road, Shanghai, China
| | - Lu Wang
- Sanofi China, 19F, Tower III, Kerry Center 1228 Middle Yan'an Road, Shanghai, China
| | - Xiaoqian Zhang
- Department of endocrinology, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Shushan District, Hefei, Anhui, China
| | - Yi Zhang
- Department of endocrinology, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Shushan District, Hefei, Anhui, China
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, China
| | - Qiu Zhang
- Department of endocrinology, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Shushan District, Hefei, Anhui, China.
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Jalilian H, Javanshir E, Torkzadeh L, Fehresti S, Mir N, Heidari‐Jamebozorgi M, Heydari S. Prevalence of type 2 diabetes complications and its association with diet knowledge and skills and self-care barriers in Tabriz, Iran: A cross-sectional study. Health Sci Rep 2023; 6:e1096. [PMID: 36761031 PMCID: PMC9895320 DOI: 10.1002/hsr2.1096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 01/22/2023] [Accepted: 01/23/2023] [Indexed: 02/05/2023] Open
Abstract
Background and Aims Diabetes can lead to multiple complications that can reduce the quality of life, impose additional costs on the healthcare systems and ultimately lead to premature death. Proper self-care in diabetic patients can impede or delay the onset of diabetes complications. This study aimed to investigate diabetes complications and their association with diet knowledge, skills, and self-care barriers. Methods This was a cross-sectional study. A total of 1139 patients with Type 2 Diabetes Mellitus (T2DM) referring to health centers in Tabriz, Iran, were included from January to July 2019. Data were collected using two questionnaires: (1) a sociodemographic questionnaire and (2) a Personal Diabetes Questionnaire (PDQ). Data were analyzed using SPSS software version 22. χ 2 test was used to examine the association between the socioeconomic and disease-related variables and the prevalence of diabetes complications. T-test was used to examine the association between diet knowledge and skills, self-care barriers, and the incidence of diabetes complications. Results In this study, 76.1% of patients had at least one complication, and 30.2% had a history of hospitalization due to diabetes complications during the past year. Approximately 49% and 43% were diagnosed with high blood pressure and hyperlipidemia, respectively. Cardiovascular disease was the most common diabetes complication (15.9%) and the cause of hospitalization (11.01%) in patients with diabetes. Barriers to diet adherence, blood glucose monitoring, and exercise were significantly associated with self-reported diabetes complications (p < 0.001). Our results showed no significant association between the number of complications and diet knowledge and skills (p = 0.44). Conclusion This study indicated that the prevalence of diabetes complications was higher among patients with more barriers to self-care. In light of these findings, taking appropriate measures to reduce barriers to self-care can prevent or delay the onset of diabetes complications.
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Affiliation(s)
- Habib Jalilian
- Department of Health Services Management, School of HealthAhvaz Jundishapur University of Medical SciencesAhvazIran
- Social Determinants of Health Research CenterAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Elnaz Javanshir
- Cardiovascular Research CentreTabriz University of Medical SciencesTabrizIran
| | - Leila Torkzadeh
- Department of Health Policy and Management, School of Management and Medical InformaticsTabriz University of Medical SciencesTabrizIran
| | - Saeedeh Fehresti
- Department of Health Economics and Management, School of Public HealthTehran University of Medical SciencesTehranIran
| | - Nazanin Mir
- Health Management and Economics Research CenterIran University of Medical SciencesTehranIran
| | | | - Somayeh Heydari
- Social Determinants of Health Research CenterAhvaz Jundishapur University of Medical SciencesAhvazIran
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Dai Z, Jing S, Liu X, Zhang H, Wu Y, Wang H, Xiao W, Huang Y, Fu J, Chen X, Gao L, Su X. Development and validation of the diabetic self-management scale based on information-motivation-behavioral skills theory. Front Public Health 2023; 11:1109158. [PMID: 36908406 PMCID: PMC9998917 DOI: 10.3389/fpubh.2023.1109158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 02/07/2023] [Indexed: 03/14/2023] Open
Abstract
Background Self-management is important for the blood sugar control of middle-aged and elderly Type 2 diabetes mellitus (T2DM) patients, of which diet, exercise, and drug compliance are the most common components. The Information-Motivation-Behavioral Skills Model (IMB) has been widely used in health behavior management and intervention. Objective The purpose of this study is to develop and validate the Diabetic Self-Management Scale (DSMS) based on the IMB model. Methods Self-report survey data was collected from middle-aged and elderly T2DM patients in Zhongmu City, Henan Province, China in November 2021 using convenience sampling. The original DSMS was developed through a literature review and summary of previous similar scales using an inductive approach. Item modification was finished by a panel of specialists. Exploratory factor analysis and confirmatory factor analysis were used to evaluate the reliability, convergent validity, discriminant validity, and criterion validity of DSMS. Results Four hundred and sixty nine T2DM patients completed the questionnaire survey. The final DSMS consists of 22 items with three dimensions, including information (five items), motivation (eight items), and behavior skills (nine items). The results of simple factor analysis showed that the KMO value was 0.839, Bartlett spherical test 2 = 3254.872, P < 0.001. The results of confirmatory factor analysis showed that 2/df = 2.261, RMSEA = 0.073, CFI = 0.937, TLI = 0.930, and SRMR = 0.096. The standardized factor loadings of 22 DSMS items were all above 0.6, and the CR values of 3 dimensions were all higher than 0.9. In addition, DSMS also showed good discriminant and criterion validity. Conclusion The 22-item DSMS has good reliability and validity, and can be used to make diabetic self-management assessment regarding diet, physical activity, and medication among middle-aged and elderly Chinese T2DM patients. DSMS is of moderate length and easy to understand. It can be promoted in China in the future to understand the self-management status of middle-aged and elderly T2DM patients in China.
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Affiliation(s)
- Zhenwei Dai
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu Jing
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoyang Liu
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haoran Zhang
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yijin Wu
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hao Wang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weijun Xiao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yiman Huang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiaqi Fu
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xu Chen
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei Gao
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, and Center for Tuberculosis Research, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaoyou Su
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Mayberry LS, El-Rifai M, Nelson LA, Parks M, Greevy RA, LeStourgeon L, Molli S, Bergner E, Spieker A, Aikens JE, Wolever RQ. Rationale, design, and recruitment outcomes for the Family/Friend Activation to Motivate Self-care (FAMS) 2.0 randomized controlled trial among adults with type 2 diabetes and their support persons. Contemp Clin Trials 2022; 122:106956. [PMID: 36208719 PMCID: PMC10364455 DOI: 10.1016/j.cct.2022.106956] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 08/11/2022] [Accepted: 10/01/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Self-care behaviors help reduce hemoglobin A1c (HbA1c) and prevent or delay type 2 diabetes (T2D) complications. Individualized interventions that support goal setting and self-monitoring improve self-care and HbA1c in the short-term; engaging family and friends may enhance and/or sustain effects. Family/Friend Activation to Motivate Self-care (FAMS) is a mobile phone-delivered intervention (i.e., phone coaching and text message support) based on Family Systems Theory which was successfully piloted among diverse adults with T2D. METHODS We made improvements to FAMS and conducted iterative usability testing to finalize FAMS 2.0 before evaluation in a randomized controlled trial (RCT). Adult persons with diabetes (PWDs) who enrolled were asked to invite a support person (friend or family member) to participate alongside them. For the RCT, dyads were randomly assigned to FAMS 2.0 or enhanced treatment as usual (control) for the first 9 months of the 15-month trial. Outcomes include PWDs' HbA1c and psychosocial well-being (including diabetes distress) and support persons' own diabetes distress and support burden. RESULTS We recruited RCT participants from April 2020 through October 2021 (N = 338 PWDs with T2D; 89% [n = 300] with a support person). PWDs were 52% male, 62% non-Hispanic White, aged 56.9 ± 11.0 years with HbA1c 8.7% ± 1.7% at enrollment; 73% cohabitated with their enrolled support person. Data collection is ongoing through January 2023. CONCLUSION Findings will inform the utility of engaging family/friends in self-care behaviors for both PWD and support person outcomes. Using widely available mobile phone technology, FAMS 2.0, if successful, has potential for scalability. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04347291 posted April 15, 2020.
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Affiliation(s)
- Lindsay S Mayberry
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Merna El-Rifai
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lyndsay A Nelson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Makenzie Parks
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert A Greevy
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lauren LeStourgeon
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Samuel Molli
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Erin Bergner
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andrew Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James E Aikens
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ruth Q Wolever
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA; Osher Center for Integrative Health at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN, USA
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Ledford CJW, Cafferty LA, Fulleborn S, Carriere R, Ledford CC, Seehusen AB, Rogers TS, Jackson JT, Womack J, Crawford PF, Rider HA, Seehusen DA. Patient outcomes of a clinician curriculum on how to deliver a diabetes diagnosis. Prim Care Diabetes 2022; 16:452-456. [PMID: 35256315 DOI: 10.1016/j.pcd.2022.02.007] [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: 07/26/2021] [Revised: 02/02/2022] [Accepted: 02/21/2022] [Indexed: 10/18/2022]
Abstract
AIMS To investigate the effects of a curriculum that teaches medical decision making and interpersonal communication in the context of prediabetes (preDM) and type 2 diabetes (T2DM). METHODS This evaluation was an active-controlled trial of 56 patients, including patients who received their diagnosis from intervention-trained clinicians or a control group. Patients attended a research appointment for informed consent and collection of baseline measures. Over the following six months, both groups were mailed surveys and informational handouts monthly. Upon conclusion, we recorded the most recent A1c from the patient's record. RESULTS An analysis of covariance test revealed patients who received a T2DM diagnosis from an intervention-trained clinician reported higher reassurance from the diagnosing clinician and had a higher perception of threat. Although not statistically significant, patients with T2DM in the intervention group had a lower A1c at follow up and patients in the intervention group reported less poor eating and a higher degree of diet decision making. CONCLUSIONS The curriculum itself does not influence glycemic control, but our results demonstrate the positive impact on patients of the curriculum to teach critical skills to clinicians delivering a diabetes diagnosis.
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Affiliation(s)
- Christy J W Ledford
- Department of Family Medicine, Uniformed Services University of the Health Sciences, USA; Department of Family Medicine, Medical College of Georgia at Augusta University, USA
| | - Lauren A Cafferty
- Department of Family Medicine, Uniformed Services University of the Health Sciences, USA; Military Primary Care Research Network, Uniformed Services University of the Health Sciences, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, USA
| | | | | | | | - Angela B Seehusen
- Department of Family Medicine, Uniformed Services University of the Health Sciences, USA; Military Primary Care Research Network, Uniformed Services University of the Health Sciences, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, USA
| | - Tyler S Rogers
- Department of Primary Care, Martin Army Community Hospital, Fort Benning, USA
| | - Jeremy T Jackson
- Department of Family Medicine, Uniformed Services University of the Health Sciences, USA; Military Primary Care Research Network, Uniformed Services University of the Health Sciences, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, USA.
| | - Jasmyne Womack
- Department of Family Medicine, Uniformed Services University of the Health Sciences, USA; Military Primary Care Research Network, Uniformed Services University of the Health Sciences, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, USA
| | - Paul F Crawford
- Department of Family Medicine, Uniformed Services University of the Health Sciences, USA; Military Primary Care Research Network, Uniformed Services University of the Health Sciences, USA; Family Medicine, Mike O'Callaghan Military Medical Center, USA
| | - Heather A Rider
- Department of Family Medicine, Uniformed Services University of the Health Sciences, USA; Military Primary Care Research Network, Uniformed Services University of the Health Sciences, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, USA
| | - Dean A Seehusen
- Department of Family Medicine, Medical College of Georgia at Augusta University, USA
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10
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Marengo CM, Aronson BD, Sittner KJ, Walls ML. A longitudinal study of the stress of poor glucose control and diabetes distress. J Health Psychol 2021; 26:1966-1975. [PMID: 31814451 PMCID: PMC7280073 DOI: 10.1177/1359105319893004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Poor glucose control can be viewed as a stressor, possibly promulgating diabetes distress. We examined the relationship between perceived blood glucose control and diabetes distress over time using a partially controlled cross-lagged path analysis model. After controlling for demographics, control at 6 months was directly related to change in distress at 12 months. Subsequently, distress at 12 months was directly related to change in control at 18 months. Both 6-month control and distress had significant indirect effects on 18-month control and distress. This demonstrates the nuanced bi-directional relationship between the stress of poor perceived control and diabetes distress.
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Affiliation(s)
| | | | | | - Melissa L Walls
- Department of International Health, Johns Hopkins Center for American Indian Health, Great Lakes Hub, Duluth, MN, USA
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11
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Diabetic foot disease: a systematic literature review of patient-reported outcome measures. Qual Life Res 2021; 30:3395-3405. [PMID: 34109501 DOI: 10.1007/s11136-021-02892-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE Diabetic foot disease is one of the most serious and expensive complications of diabetes. Patient-reported outcome measures (PROMs) analyse patients' perception of their disability, functionality and health. The goal of this work was to conduct a systematic review regarding the specific PROMs related to the evaluation of diabetic foot disease and to extract and analyse the values of their measurement properties. METHODS Electronic databases included were PubMed, CINAHL, Scopus, PEDro, Cochrane, SciELO and EMBASE. The search terms used were foot, diabet*, diabetic foot, questionnaire, patient-reported outcome, self-care, valid*, reliabil*. Studies whose did not satisfy the Critical Appraisals Skills Programme (CASP) Diagnostic Study Checklist were excluded. The measurement properties extracted were: Internal Consistency, Test-retest, Inter-rater and Intra-rater, Standard Error of Measurement, Minimum Detectable Measurement Difference, Content Validity, Construct Validity, Criterion Validity and Responsiveness. RESULTS The PROMs selected for this review were 12 questionnaires. The Diabetic foot self-care questionnaire (DFSQ-UMA) and the Questionnaire for Diabetes Related Foot Disease (Q-DFD) were the PROMs that showed the highest number of completed measurement properties. CONCLUSION According to the results, it is relevant to create specific questionnaires for the evaluation of diabetic foot disease. It seems appropriate to use both DFSQ-UMA and Q-DFD when assessing patients with diabetic foot disease.
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12
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Mahmoodi H, Abdi K, Navarro-Flores E, Karimi Z, Sharif Nia H, Gheshlagh RG. Psychometric evaluation of the Persian version of the diabetic foot self-care questionnaire in Iranian patients with diabetes. BMC Endocr Disord 2021; 21:72. [PMID: 33865367 PMCID: PMC8052781 DOI: 10.1186/s12902-021-00734-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/07/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Diabetic foot self-care refers to a group of self-management behaviors that can reduce the incidence of foot ulcers and amputations. It is necessary to have a valid and reliable standard tool to measure foot self-care in diabetic patients. This study aimed to evaluate the psychometric properties of the Persian version of the Diabetic Foot Self-Care Questionnaire of the University of Malaga, Spain (DFSQ-UMA) in Iran. METHODS This cross-sectional study was conducted with 407 diabetic patients who were selected using a convenient sampling method. Construct validity was assessed by exploratory (with 207 patients) and confirmatory (with 200 patients) factor analyses. Internal consistency was calculated using Cronbach's alpha and McDonald's omega coefficients. RESULTS In the exploratory factor analysis, three factors with eigenvalues of 3.84, 2.41, and 2.26 were extracted that together explained 56.74% of the total variance of diabetic foot self-care. A Cronbach's alpha of 0.865 was found for the total instrument. CONCLUSIONS The Persian version of the DFSQ-UMA has good validity and reliability, and given its good psychometric properties, it can be used in future studies.
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Affiliation(s)
- Hassan Mahmoodi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Kamel Abdi
- Nursing Department, Faculty of Medicine, Komar University of Science and Technology, Sulaymaniyah, Kurdistan Region Iraq
| | - Emmanuel Navarro-Flores
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Málaga, Spain
| | - Zaniar Karimi
- Faculty of Nursing, Kurdistan University of Medical Sciences, Sananda, Iran
| | - Hamid Sharif Nia
- School of Nursing and Midwifery Amol, Mazandaran University of Medical Sciences, Sari, Iran
| | - Reza Ghanei Gheshlagh
- Spiritual Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
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13
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Montagut-Martínez P, Pérez-Cruzado D, Gutiérrez-Sánchez D. The dietary knowledge measurement instruments in diabetes: A systematic psychometric review. J Adv Nurs 2021; 77:2595-2622. [PMID: 33559373 DOI: 10.1111/jan.14762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/25/2020] [Accepted: 12/16/2020] [Indexed: 12/22/2022]
Abstract
AIMS To identify, critically appraise, and summarize instruments to measure dietary knowledge in patients with diabetes mellitus type 1 or 2. DESIGN Psychometric systematic review. DATA SOURCES A comprehensive search was carried out during March 2020 in the followed databases: Medline, Web of Science, Open Grey, Cochrane Library, COSMIN database, and Scielo. REVIEW METHODS In accordance with the most up-to-date COnsensus-based Standards for the selection of health status Measurement INstruments methodology (COSMIN) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements. A systematic review of the measurement properties of the instruments that assess the level of dietary knowledge in the diabetic population was carried out. The COSMIN checklist was used to assess the measurement properties of existing patient-reported outcome measures to select the most appropriate outcome measurement instrument. The protocol of this systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42020186516). RESULTS Nine instruments were identified. The Michigan Diabetes Knowledge Test (DKT) was the questionnaire included in the largest volume of studies. The Diabetes Knowledge Questionnaire (DKQ) was the questionnaire with the most evaluated psychometric characteristics. The Personal Diabetes Questionnaire (PDQ) was the second with the highest number of psychometric characteristics evaluated and with a better score regarding the quality of the evidence. CONCLUSION According to the quality methodological results; DKT, DKQ and PDQ are the recommended instruments to assess dietary knowledge in people with diabetes types 1 and 2. IMPACT STATEMENT What problem did the study address? One of the main factors that lead to greater difficulty for patients with diabetes mellitus is dietary management, and it is necessary to evaluate whether the patient has sufficient knowledge about dietetics to practice a healthy diet. What were the main findings? Nine instruments were identified that were specifically designed to assess dietary knowledge in patients with diabetes mellitus (DM) type 1 or 2. Michigan Diabetes Knowledge Test, Diabetes Knowledge Questionnaire, and Personal Diabetes Questionnaire are the recommended instruments to assess dietary knowledge in people with diabetes. Where and on whom will the research have impact? The evaluation of this construct is very useful both in clinical practice; at hospital, community and primary care levels, in patients with type 1 and / or 2 diabetes mellitus (DM), as in research.
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Affiliation(s)
| | - David Pérez-Cruzado
- Department of Occupational Therapy, Universidad Catolica de Murcia UCAM, Guadalupe, Murcia, Spain.,Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain
| | - Daniel Gutiérrez-Sánchez
- Biomedical Research Institute of Málaga (IBIMA), Málaga, Spain.,Faculty of Health Sciences, Department of Nursing, University of Málaga, Málaga, Spain
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14
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Hou G, Fang Z, Cao W, Shi Y, Xu X, Han M, Dong J. Development and validation of a diabetes mellitus treatment adherence scale. Diabetes Res Clin Pract 2021; 172:108629. [PMID: 33347898 DOI: 10.1016/j.diabres.2020.108629] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 12/01/2020] [Accepted: 12/10/2020] [Indexed: 12/16/2022]
Abstract
AIMS The aim of this study was to develop a Diabetes Mellitus Treatment Adherence Scale (DMTAS) to fill the gap in the internationally accepted comprehensive scale. METHODS An initial item pool for the Diabetes Mellitus Treatment Adherence Scale (DMTAS) was generated based on a review of the literature and an open-ended interview. An expert group screened this initial item pool using an item-level content validity index. Then, pilot testing with 116 participants was conducted. After removing redundant and cross-loading items by exploratory factor analysis, 630 subjects were recruited to evaluate the reliability and validity of DMTAS. Analyses included internal consistency, test-retest reliability, split-half reliability, construct validity, convergent validity, and discriminant validity analysis. RESULTS The final DMTAS consisted of 19 items and six dimensions. The results of the exploratory factor analysis indicated that the variances of each factor explained were 23.07%, 12.28%, 9.50%, 8.25%, 7.85%, and 5.80%, and all six factors explained 66.75% of the variance in the 19 items. The items' factor loadings were all above 0.6. The results of the confirmatory factor analysis indicated that adequate fit indices (χ2 value to degrees of freedom = 3.62; root mean square error of approximation = 0.06; goodness-of-fit index = 0.92) were achieved. The Cronbach's alpha coefficient was 0.79, test-retest reliability was 0.73, and split-half reliability was 0.75. CONCLUSIONS The DMTAS showed good validity and reliability to measure the out-of-hospital treatment adherence in patients with diabetes mellitus.
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Affiliation(s)
- Guoqiang Hou
- Changzhi Maternal and Child Care Hospital, Changzhi 046000, Shanxi, China
| | - Ziwei Fang
- Graduate School, Changzhi Medical College, Changzhi 046000, Shanxi, China
| | - Wenjun Cao
- Department of Preventive Medicine, Changzhi Medical College, Changzhi 046000, Shanxi, China.
| | - Yan Shi
- Department of Preventive Medicine, Changzhi Medical College, Changzhi 046000, Shanxi, China
| | - Xinrong Xu
- Department of Preventive Medicine, Changzhi Medical College, Changzhi 046000, Shanxi, China
| | - Mei Han
- Department of Preventive Medicine, Changzhi Medical College, Changzhi 046000, Shanxi, China
| | - Jiaxin Dong
- Department of Preventive Medicine, Changzhi Medical College, Changzhi 046000, Shanxi, China
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15
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Mayberry LS, Bergner EM, Harper KJ, Laing S, Berg CA. Text messaging to engage friends/family in diabetes self-management support: acceptability and potential to address disparities. J Am Med Inform Assoc 2021; 26:1099-1108. [PMID: 31403688 DOI: 10.1093/jamia/ocz091] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/19/2019] [Accepted: 05/22/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Explore acceptability of engaging family/friends in patients' type 2 diabetes (T2D) self-management using text messaging. MATERIALS AND METHODS Participants (N = 123) recruited from primary care clinics for a larger trial evaluating mobile phone support for T2D completed self-report measures and a hemoglobin A1c test and then had the option to invite an adult support person to receive text messages. We examined characteristics and reasons of participants who did/did not invite a support person, responses to the invitation, and feedback from patients and support persons. RESULTS Participants were 55.9 ± 10.1 years old, 55% female, 53% minority, and 54% disadvantaged (low income, less than high school degree/GED, uninsured, and/or homeless). Participants who invited a support person (48%) were slightly younger, more likely to be partnered, and reported more depressive symptoms and more emergency department visits in the year prior to study enrollment as compared to participants who did not (all p <.05). Participants' reasons for inviting a support person included needing help and seeing benefits of engaging others, while reasons for not inviting a support person included concerns about being a "burden" and support person's ability or desire to text. Support persons reported the texts increased awareness, created dialogue, and improved their own health behaviors. DISCUSSION Patients inviting a support person had higher need and thus may stand to benefit most. Most support persons were open to engagement via text messages. CONCLUSION Across race and socioeconomic status, text messaging may engage support persons to increase health-related support-particularly for patients with higher levels of need. TRIAL REGISTRATION Clinicaltrials.gov NCT02409329.
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Affiliation(s)
- Lindsay S Mayberry
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Erin M Bergner
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kryseana J Harper
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Simone Laing
- Meharry Medical College, Nashville, Tennessee, USA
| | - Cynthia A Berg
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
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16
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Hasanpour Dehkordi A, Chin YF, Huang TT, Ebadi A, Ghanei Gheshlagh R. Psychometric evaluation of the Farsi version of the diabetes foot self-care bahavior scale. J Foot Ankle Res 2020; 13:68. [PMID: 33256822 PMCID: PMC7708251 DOI: 10.1186/s13047-020-00437-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/23/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Diabetes foot self-care is one of the self-management behaviors of diabetic patients leading to a reduction in the incidence of pressure ulcers and amputation. Having a valid, reliable, simple and comprehensive tool is essential in measuring the self-care behavior of diabetic patients. The aim of this study was to evaluate the psychometric properties of the Farsi version of the diabetes foot self-care bahavior scale (DFSBS) in Iran. METHODS In this cross-sectional and methodological study, 500 patients with type 2 diabetes were recruited by convenience sampling. Construct validity was assessed by exploratory factor analysis (over 300 patients) and confirmatory factor analysis (over 200 patients). Internal consistency was calculated by Cronbach's alpha coefficient and its stability was calculated by intraclass correlation coefficient (ICC). RESULTS In the exploratory factor analysis, two self-care factors related to feet and shoes were extracted which had specific values of 38.49 and 1.24, respectively, and were able to account for 56.22% of the total self-care variance of diabetes foot. Confirmatory factor analysis had excellent fit model. The internal consistency and ICC of the whole instrument were 0.83 and 0.791 (95% CI: 0.575-0.925; P < 0.001), respectively. CONCLUSIONS The Farsi version of DFSBS (F-DFSBS) has good validity and reliability, and due to its appropriate psychometric properties, this tool can be used in future studies.
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Affiliation(s)
- Ali Hasanpour Dehkordi
- Social Determinants of Health Research Center, School of Allied Medical Sciences, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Yen-Fan Chin
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Tzu-Ting Huang
- Healthy Aging Research Center, and School of Nursing, Chang Gung University, Taoyuan City, Taiwan
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Reza Ghanei Gheshlagh
- Spiritual Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
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17
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Jafari S, Ahmadipour H. Self-Management Barriers Perceived by Patients with Type 2 Diabetes: A Confirmatory Factor Analysis. Int J Prev Med 2020; 11:152. [PMID: 33209222 PMCID: PMC7643576 DOI: 10.4103/ijpvm.ijpvm_195_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 08/12/2019] [Indexed: 11/30/2022] Open
Abstract
Background: Self-management remains poor among most of the diabetic patients due to various individual and environmental barriers which affect it. These barriers should be identified and intervened promptly. The current study aimed to determine self-management barriers perceived by patients with type 2 diabetes. Methods: A cross-sectional study carried out on 681 patients with type 2 diabetes who referred to the diabetes center which is affiliated to Kerman University of Medical Sciences, Kerman, Iran during 2018. Through a structured interview, demographic and disease-related data were recorded and the Persian version of the modified Personal Diabetes Questionnaire (PDQ) was used to assess self-management barriers. The tool has four subscales including diet, medication, monitoring, and exercise barriers. The higher score in each subscale indicates a higher level of barriers in that section. Data analyzed by SPSS 20 using T-test, ANOVA, and multiple linear regressions. Results: The majority of the patients (62.8%) were female, married (78.3%) with monthly income 10 to 20 million IRRLs (78.4%) and the mean age of 55.65 ± 14.65 years. Body Mass Index, marital status, monthly income, and HbA1C significantly predicted the barriers' score. The instrument had excellent reliability (α = 0.95). In confirmatory factor analysis, the fit indices had approximately acceptable levels. Conclusions: The Persian version of modified PDQ had good psychometric properties and can be used as a valid and reliable instrument in the primary health care setting. The significant perceived barriers should be identified and intervened by health care providers through the comprehensive management of diabetic patients.
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Affiliation(s)
- Shohreh Jafari
- Department of Community and Family Medicine, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Habibeh Ahmadipour
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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18
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Montagut-Martínez P, Pérez-Cruzado D, García-Arenas JJ. Nutritional Status Measurement Instruments for Diabetes: A Systematic Psychometric Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165719. [PMID: 32784695 PMCID: PMC7460259 DOI: 10.3390/ijerph17165719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 12/18/2022]
Abstract
Background: Diabetes is a serious chronic disease associated with a large number of complications and an increased risk of premature death. A dietary evaluation is of utmost importance for health promotion, disease prevention and individual treatment plans in patients with diabetes. Methods: An exhaustive search was carried out in various databases—Medline, Web of Science, Open Gray Cochrane Library and Consensus-based Standards for the selection of health status Measurement Instruments (COSMIN)—for systematic review of the measurement properties of instruments that evaluate the dietary intake of people with diabetes mellitus type 1 and/or 2 according to COSMIN standards. Results: Seven instruments were identified. There was no instrument measuring nutritional status for which all the psychometric properties were evaluated. The methodological quality for each of the psychometric properties evaluated was ‘inadequate’ or ‘doubtful’ for all instruments. The Food Frequency Questionnaire (FFQ) evaluated the most psychometric characteristics and with a better score in terms of quality of the evidence. Conclusions: Several instruments have been developed for the evaluation of dietary intake in people with diabetes. Evaluation of this construct is very useful, both in clinical practice and in research, requiring new knowledge in this area. The FFQ is the best instrument available to assess dietary intake in people with diabetes.
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Affiliation(s)
- Pedro Montagut-Martínez
- Health Sciences PhD Program, Campus de los Jerónimos, Universidad Católica de Murcia UCAM, 30107 Murcia, Spain;
| | - David Pérez-Cruzado
- Department of Occupational Therapy, Campus de los Jerónimos, Universidad Catolica de Murcia UCAM, 30107 Murcia, Spain;
- Institute of Biomedicine of Malaga (IBIMA), 29071 Málaga, Spain
- Correspondence: ; Tel.: +34-6-5314-1109
| | - José Joaquín García-Arenas
- Department of Occupational Therapy, Campus de los Jerónimos, Universidad Catolica de Murcia UCAM, 30107 Murcia, Spain;
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19
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White RO, Chakkalakal RJ, Wallston KA, Wolff K, Gregory B, Davis D, Schlundt D, Trochez KM, Barto S, Harris LA, Bian A, Schildcrout JS, Kripalani S, Rothman RL. The Partnership to Improve Diabetes Education Trial: a Cluster Randomized Trial Addressing Health Communication in Diabetes Care. J Gen Intern Med 2020; 35:1052-1059. [PMID: 31919724 PMCID: PMC7174470 DOI: 10.1007/s11606-019-05617-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 12/12/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Effective type 2 diabetes care remains a challenge for patients including those receiving primary care in safety net settings. OBJECTIVE The Partnership to Improve Diabetes Education (PRIDE) trial team and leaders from a regional department of health evaluated approaches to improve care for vulnerable patients. DESIGN Cluster randomized controlled trial. PATIENTS Adults with uncontrolled type 2 diabetes seeking care across 10 unblinded, randomly assigned safety net clinics in Middle TN. INTERVENTIONS A literacy-sensitive, provider-focused, health communication intervention (PRIDE; 5 clinics) vs. standard diabetes education (5 clinics). MAIN MEASURES Participant-level primary outcome was glycemic control [A1c] at 12 months. Secondary outcomes included select health behaviors and psychosocial aspects of care at 12 and 24 months. Adjusted mixed effects regression models were used to examine the comparative effectiveness of each approach to care. KEY RESULTS Of 410 patients enrolled, 364 (89%) were included in analyses. Median age was 51 years; Black and Hispanic patients represented 18% and 25%; 96% were uninsured, and 82% had low annual income level (< $20,000); adequate health literacy was seen in 83%, but numeracy deficits were common. At 12 months, significant within-group treatment effects occurred from baseline for both PRIDE and control sites: adjusted A1c (- 0.76 [95% CI, - 1.08 to - 0.44]; P < .001 vs - 0.54 [95% CI, - 0.86 to - 0.21]; P = .001), odds of poor eating (0.53 [95% CI, 0.33-0.83]; P = .01 vs 0.42 [95% CI, 0.26-0.68]; P < .001), treatment satisfaction (3.93 [95% CI, 2.48-6.21]; P < .001 vs 3.04 [95% CI, 1.93-4.77]; P < .001), and self-efficacy (2.97 [95% CI, 1.89-4.67]; P < .001 vs 1.81 [95% CI, 1.1-2.84]; P = .01). No significant difference was observed between study arms in adjusted analyses. CONCLUSIONS Both interventions improved the participant's A1c and behavioral outcomes. PRIDE was not more effective than standard education. Further research may elucidate the added value of a focused health communication program in this setting.
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Affiliation(s)
- Richard O White
- Division of Community Internal Medicine, Mayo Clinic, Jacksonville, FL, USA.
| | - Rosette James Chakkalakal
- Department of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kenneth A Wallston
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kathleen Wolff
- School of Nursing, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Becky Gregory
- Vanderbilt Diabetes Research and Training Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Dianne Davis
- Vanderbilt Diabetes Research and Training Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David Schlundt
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Karen M Trochez
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shari Barto
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Laura A Harris
- Mid-Cumberland Regional Office, Tennessee Department of Health , Nashville, TN, USA
| | - Aihua Bian
- Department of Biostatistics, Vanderbilt University, Nashville, TN, USA
| | | | - Sunil Kripalani
- Department of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA.,Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Russell L Rothman
- Department of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA.,Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA
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20
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Mokhlesi S, Simbar M, Ramezani Tehrani F, Kariman N, Alavi Majd H. Quality of life questionnaire for women with gestational diabetes mellitus (GDMQ-36): development and psychometric properties. BMC Pregnancy Childbirth 2019; 19:454. [PMID: 31783733 PMCID: PMC6884843 DOI: 10.1186/s12884-019-2614-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 11/19/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus carries serious risks to mother and fetus and causes social, mental, and psychological consequences which can affect mothers' quality of life. Accordingly, this study aims to develop and assess the psychometric properties of quality of life questionnaire for women with gestational diabetes mellitus. METHODS A methodological study of sequential exploratory mixed method was developed and implemented. It included qualitative (development of a quality of life questionnaire for mothers with GDM) and quantitative (assessment of psychometric prosperities of quality of life questionnaire for mothers with GDM) phases. RESULTS Based on the findings of the qualitative phase and literature review, the primary questionnaire was prepared with 142 items. The outcome of face validity and content validity assessment was a 67-item questionnaire. S-CVI and S-CVR turned out to be 0.92 and 0.68, respectively. The results of exploratory factor analysis yielded an instrument with 36 items in five domains including concerns about high-risk pregnancy, perceived constraints, disease complications, medication and treatment, and support. Five factors explained 46.68% of the total variance of the questionnaire. The results indicated a moderate and significant correlation between the questionnaire of "Diabetes Clients Quality Of Life" and the researcher-made questionnaire (r = 0.63). Cronbach's alpha coefficient for the entire scale was 0.93 and the intra-class correlation coefficient was 0.95. CONCLUSION Quality of life questionnaire for mothers with GDM is a valid and reliable tool capable of measuring the quality of life of women with GDM.
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Affiliation(s)
- S. Mokhlesi
- Department of medical science,Qom branch, Islamic azad University, Qom, Iran
| | - M. Simbar
- Professor, Midwifery and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - F. Ramezani Tehrani
- Professor, Gynecology Department, Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - N. Kariman
- Midwifery and Reproductive Health Department, school of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - H. Alavi Majd
- Professor, Department of Biostatistics,Faculty of Paramedical Sciences, Shahid Beheshti Medical University, Tehran, Iran
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Aronson R, Li A, Brown RE, Walker A, Lyons A, Orzech N. Optimizing Diabetes Self-management Using the Novel Skills, Confidence, and Preparedness Index (SCPI). Diabetes Care 2019; 42:1873-1878. [PMID: 31399439 DOI: 10.2337/dc19-0699] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/23/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The Skills, Confidence, and Preparedness Index (SCPI) is an electronic tool designed to assess three dimensions (knowledge, confidence, and preparedness) in a clinically relevant measure with immediate feedback to guide the individualization of patient education. This study sought to assess the validity and reliability of the final SCPI generation, its relevance to glycemia, and its responsiveness to patient education. RESEARCH DESIGN AND METHODS In Part 1, patients with type 1 and type 2 diabetes were recruited from specialist clinics over a 6-month period and completed the 23-item SCPI using a tablet. In Part 2, participants also underwent a diabetes self-management education (DSME) program. Baseline SCPI score was used to guide the DSME, and SCPI and glycemia were assessed at completion. RESULTS In total, 423 patients met inclusion criteria and 405 had evaluable data. SCPI scores were found to have a high degree of validity, internal consistency, and test-retest reliability, with no floor or ceiling effects. Scoring was negatively correlated with HbA1c (type 1 diabetes: r = -0.26, P = 0.001; type 2 diabetes: r = -0.20, P = 0.004). In 51 participants who underwent a DSME intervention (6.4 ± 0.6 visits over a mean ± SD 3.4 ± 0.8 months), mean HbA1c improvement was 1.2 ± 0.2% (13.1 ± 2.2 mmol/mol, P < 0.0001). Total SCPI score and each subscore improved in parallel. CONCLUSIONS The SCPI tool is a quick and easy-to-use measurement of three domains: skills, confidence, and preparedness. The instant scoring and feedback and its relationship to glycemic control should improve the efficiency and quality of individualizing care in the diabetes clinic.
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Affiliation(s)
| | - Aihua Li
- LMC Diabetes & Endocrinology, Toronto, Ontario, Canada
| | - Ruth E Brown
- LMC Diabetes & Endocrinology, Toronto, Ontario, Canada
| | | | - Ashley Lyons
- LMC Diabetes & Endocrinology, Toronto, Ontario, Canada
| | - Naomi Orzech
- LMC Diabetes & Endocrinology, Toronto, Ontario, Canada
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Metwally AM, Soliman M, Abdelmohsen AM, Kandeel WA, Saber M, Elmosalami DM, Asem N, Fathy AM. Effect of Counteracting Lifestyle Barriers through Health Education in Egyptian Type 2 Diabetic Patients. Open Access Maced J Med Sci 2019; 7:2886-2894. [PMID: 31844454 PMCID: PMC6901843 DOI: 10.3889/oamjms.2019.624] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Egypt is among the world top 10 countries in diabetes prevalence. It is the first country among the MENA region. Healthy lifestyle education and support help people with diabetes to improve health outcomes. Many physical and psychological barriers can hinder patients from following a healthy lifestyle. AIM This study aimed to examine the effect of lifestyle modification educational sessions in helping Egyptian patients to overcome main barriers of diabetes self-management through improving nutritional behaviours, physical activity, medication compliance, and blood glucose monitoring. METHODS A cohort study included 205 patients with type 2 diabetes. Baseline assessment of patients' lifestyle behaviours and barriers using personal diabetes questionnaire of Louisville University, with both anthropometric and blood glucose assessment. Interventional lifestyle health education was provided weekly through multiple integrated techniques, followed by a post-intervention assessment to evaluate the effect of the health education sessions. Statistical analysis was done to identify any statistically significant difference before and after the health education intervention. RESULTS There was a significant improvement of the post-education mean scores of the studied behaviours when compared with the pre-education scores of the participants' behaviours (p < 0.001). There was also a significant reduction in the barriers facing patients to diabetes self-management including nutritional barriers (P < 0.001), medication compliance barriers (P < 0.001) with a percent change (43%), physical activity barriers (p < 0.001), and blood glucose monitoring (p < 0.001) with a percent change (44%).There was a statistically significant positive correlation between improvement of medication compliance (P = 0.027), blood glucose monitoring(P = 0.045), and glycated haemoglobin of the study participants. CONCLUSION lifestyle modification education of type 2 diabetic patients can overcome the main barriers of following a healthy lifestyle and improve their anthropometric measures and blood glucose level.
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Affiliation(s)
- Ammal Mokhtar Metwally
- Department of Community Medicine Research, Medical Division, National Research Centre, Giza, Egypt
| | - Mona Soliman
- Department of Public Health & Community Medicine, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Aida M. Abdelmohsen
- Department of Community Medicine Research, Medical Division, National Research Centre, Giza, Egypt
| | - Wafaa A. Kandeel
- Biological Anthropology Department, Medical Division, National Research Centre, Giza, Egypt
- Theodor Bilharz Research Institute, Giza, Egypt
| | - Maha Saber
- Department of Complementary Medicine Research, Medical Division, National Research Centre, Giza, Egypt
- Medical Research Centre of Excellence (MRCE), Giza, Egypt
| | - Dalia Mohamed Elmosalami
- Department of Community Medicine Research, Medical Division, National Research Centre, Giza, Egypt
| | - Noha Asem
- Department of Public Health & Community Medicine, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Asmaa Mohamed Fathy
- Department of Community Medicine Research, Medical Division, National Research Centre, Giza, Egypt
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Jalilian H, Pezeshki MZ, Janati A, Najafipour F, Sarbakhsh P, Zarnaq RK. Readiness for weight change and its association with diet knowledge and skills, diet decision making and diet and exercise barriers in patients with type 2 diabetes. Diabetes Metab Syndr 2019; 13:2889-2895. [PMID: 31425953 DOI: 10.1016/j.dsx.2019.07.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 07/29/2019] [Indexed: 12/30/2022]
Abstract
AIMS this study aimed to investigate stages of weight change in type 2 diabetics and its associations with diet knowledge and skills, diet decision making, diet and exercise barriers. MATERIALS AND METHODS This was a cross-sectional study of 1139 patients with type 2 diabetes aged>18 years in East Azerbaijan, Iran. Data were collected using the Personal Diabetes Questionnaire (PDQ) and were analyzed using SPSS software (version 22) and descriptive statistics, Chi-square and one-way ANOVA tests. RESULTS 48.1% of the patients were in the pre-contemplation stage. 7.5%, 14.6% and 29.8% of patients were in the stages of contemplation, preparation and action, respectively. Patients with a higher score in diet knowledge and skills and diet decision making were more likely to be involved in the action stage of weight loss process, while those who had more eating problems and exercise barriers were less likely to be involved in the action stage of weight loss. CONCLUSION The results of this study showed that a substantial percentage of patients are at the pre-contemplation stage, so proper measures are needed to inform patients about the consequences of obesity and overweight. It is also necessary to focus on people with poor incomes and education status and those living in rural areas. Improve diet knowledge and skills and diet decision making and the reduction of barriers to exercise can help patients to take action to lose weight.
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Affiliation(s)
- Habib Jalilian
- Iranian Center of Excellence in Health Management, Department of Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran; Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Mohammad Zakarya Pezeshki
- Social Determinants of Health Research Center, Department of Community and Family Medicine, Tabriz Medical School, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Ali Janati
- Iranian Center of Excellence in Health Management, Department of Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Farzad Najafipour
- Endocrine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Parvin Sarbakhsh
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Rahim Khodayari Zarnaq
- Iranian Center of Excellence in Health Management, Department of Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran; Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.
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Jalilian H, Pezeshki MZ, Janati A, Najafipour F, Imani A, Zozani MA, Khodayari Zarnaq R. Readiness for diet change and its association with diet knowledge and skills, diet decision making and diet barriers in type 2 diabetic patients. Diabetes Metab Syndr 2019; 13:2933-2938. [PMID: 31425959 DOI: 10.1016/j.dsx.2019.07.065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 07/30/2019] [Indexed: 11/26/2022]
Abstract
AIMS to investigate stages of change for dietary in type 2 diabetics and its associations with diet knowledge and skills, diet decision making and diet barriers. MATERIALS AND METHODS This was a cross-sectional study which was conducted on 1139 diabetics aged>18 years in East Azerbaijan, Iran. Data were collected through a Personal Diabetes Questionnaire (PDQ) and analyzed through SPSS version 22 software using descriptive statistics, Chi-square and one-way ANOVA tests. Tukey's HSD post hoc tests were applied to illustrate ANOVA findings. RESULTS 59.3% of patients do not follow a diet plan to control their blood glucose. 44.7%, 5.5%, 13%, and 36.8% of patients, respectively, were in the stages of pre-contemplation, contemplation, preparation and action. Patients who had shorter disease duration and those whose current treatment was lifestyle change were more likely within the action stage. Also, patients who had a higher score in diet knowledge and skills and diet decision making and those who had a lower score in diet barriers were more likely in the action stage of change. CONCLUSION Based on the results of this study, a considerable proportion of diabetic patients were in the pre-contemplation stage. Diet knowledge and skills, diet decision making and diet barriers were factors contributing to diet readiness to change. Therefore, taking necessary measures to increase diet knowledge, skills and diet decision-making and a reduction in diet barriers can help people with type 2 diabetes to change diet.
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Affiliation(s)
- Habib Jalilian
- Iranian Center of Excellence in Health Management, Department of Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran; Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Mohammad Zakarya Pezeshki
- Social Determinants of Health Research Center, Department of Community and Family Medicine, Tabriz Medical School, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Ali Janati
- Iranian Center of Excellence in Health Management, Department of Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Farzad Najafipour
- Endocrine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Ali Imani
- Iranian Center of Excellence in Health Management, Department of Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Morteza Arab Zozani
- Iranian Center of Excellence in Health Management, Department of Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Rahim Khodayari Zarnaq
- Iranian Center of Excellence in Health Management, Department of Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran; Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.
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Caro-Bautista J, Espinar-Toledo M, Villa-Estrada F, Lupiáñez-Pérez I, Kaknani-Uttumchandani S, García-Mayor S, Salas-Samper F, Morales-Asencio JM. Development and Psychometric Validation of an Instrument to Identify Barriers to Self-Care Among Spanish Patients With Type 2 Diabetes on the Basis of Theory of Planned Behavior. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:1033-1041. [PMID: 31511180 DOI: 10.1016/j.jval.2019.04.1921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 03/09/2019] [Accepted: 04/02/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Several instruments are available to evaluate barriers to self-care in people with type 2 diabetes, but with significant psychometric weaknesses and poor theoretical background. OBJECTIVES To develop and psychometrically validate a questionnaire to identify barriers to self-care in this population on the basis of the theory of planned behavior. METHODS The study was carried out in 15 primary healthcare centers belonging to the Public Health Care System in Andalusia (Spain). After content validity was confirmed, an initial pilot study was undertaken (n = 54) and the model was evaluated in 2 samples of 205 subjects each to test its configural and metric invariance by confirmatory factor analysis. Internal consistency, test-retest reliability, criterion validity, and interpretability were carried out following COSMIN standards. RESULTS A 4-factor instrument (intention, subjective norms, perceived control, and attitudes) with 15 items was obtained with a good fit: goodness-of-fit index = 0.92, comparative fit index = 0.93, and root mean square error of approximation = 0.043 (90% confidence interval 0.034-0.052). Cronbach α was 0.78, and test-retest reliability was adequate (intraclass correlation coefficient 0.73; P < .0001). The instrument revealed an adequate criterion validity depending on the treatment complexity and level of metabolic control. Thus, participants with poor self-care scores were more likely to suffer from diabetes-related complications (odds ratio 1.91; 95% confidence interval 1.15-3.1). CONCLUSIONS A theory-driven instrument is suitable for its use with Spanish people with type 2 diabetes to assess their self-care needs and make tailored recommendations for lifestyle modifications on the basis of their behavioral determinants.
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Affiliation(s)
- Jorge Caro-Bautista
- Health Care Centre "El Limonar", District of Primary Health Care of Málaga, Andalusian Public Health System, Málaga, Spain; Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.
| | - Milagrosa Espinar-Toledo
- Health Care Centre "Rincón de la Victoria", District of Primary Health Care of Málaga, Andalusian Public Health System, Málaga, Spain
| | - Francisca Villa-Estrada
- Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain; Health Care Centre "Miraflores de los Ángeles", District of Primary Health Care of Málaga, Andalusian Public Health System, Málaga, Spain
| | - Inmaculada Lupiáñez-Pérez
- Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain; Health Care Centre "Carlinda", District of Primary Health Care of Málaga, Andalusian Public Health System, Málaga, Spain
| | - Shakira Kaknani-Uttumchandani
- Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain; Department of Nursing and Podiatry, Universidad de Málaga, Málaga, Spain
| | - Silvia García-Mayor
- Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain; Department of Nursing and Podiatry, Universidad de Málaga, Málaga, Spain
| | - Felipe Salas-Samper
- Health Care Centre "La Carihuela", District of Primary Health Care of Costa del Sol, Andalusian Public Health System, Málaga, Spain
| | - José-Miguel Morales-Asencio
- Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain; Department of Nursing and Podiatry, Universidad de Málaga, Málaga, Spain
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Nelson LA, Ackerman MT, Greevy RA, Wallston KA, Mayberry LS. Beyond Race Disparities: Accounting for Socioeconomic Status in Diabetes Self-Care. Am J Prev Med 2019; 57:111-116. [PMID: 31130463 PMCID: PMC6589128 DOI: 10.1016/j.amepre.2019.02.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/11/2019] [Accepted: 02/12/2019] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Among patients with type 2 diabetes, racial disparities are prevalent across a variety of outcomes; however, inconsistent disparities in determinants of outcomes warrants exploring the impact of other, related factors. This study sought to examine whether disparities in health literacy, numeracy, self-care behaviors, and HbA1c persisted between non-Hispanic blacks and non-Hispanic whites after applying a robust adjustment for socioeconomic status (SES). METHODS From 2016 to 2018, adult patients with type 2 diabetes (N=444) were recruited from primary care clinics. Participants self-reported demographics; indicators of SES (i.e., income, education, health insurance, housing status, and financial strain); subjective health literacy and numeracy; and self-care behaviors. Participants also completed an HbA1c test. In 2018, differences were examined between non-Hispanic blacks and non-Hispanic whites in health literacy, numeracy, self-care, and HbA1c, first unadjusted and then adjusted using propensity score weighting. RESULTS In unadjusted analyses, compared with non-Hispanic whites, non-Hispanic blacks had lower health literacy (p=0.039) and numeracy (p<0.001); less medication adherence (p=0.009); use of information for dietary decisions (p=0.013); and problem eating behaviors (p<0.001; i.e., non-Hispanic blacks reported fewer problems); and higher HbA1c levels (p=0.005). After adjusting for all SES indicators, only the reverse disparity in problem eating behaviors (p=0.016) and the disparity in HbA1c (p=0.011) remained. CONCLUSIONS Findings highlight the importance of considering SES when examining disparities in health-related skills and behaviors. Moving beyond education and income to inclusion of more comprehensive markers of SES can improve understanding of how SES may contribute to disparities and the ability to appropriately target factors leading to inequality.
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Affiliation(s)
- Lyndsay A Nelson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael T Ackerman
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert A Greevy
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kenneth A Wallston
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee; Center for Diabetes Translation Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lindsay S Mayberry
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, Tennessee; Center for Diabetes Translation Research, Vanderbilt University Medical Center, Nashville, Tennessee.
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Ortega-Avila AB, Cervera-Garvi P, Ramos-Petersen L, Chicharro-Luna E, Gijon-Nogueron G. Patient-Reported Outcome Measures for Patients with Diabetes Mellitus Associated with Foot and Ankle Pathologies: A Systematic Review. J Clin Med 2019; 8:jcm8020146. [PMID: 30691204 PMCID: PMC6407033 DOI: 10.3390/jcm8020146] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 01/21/2019] [Accepted: 01/24/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Diabetes mellitus (DM) is a chronic and complex disease, which is a major cause of morbidity and mortality and affects all age groups. It commonly produces secondary effects on the foot, often making daily activities impossible. Patient-reported outcome measures (PROMs) provide a standardised method of obtaining patients’ outlooks on their functional status and wellbeing. Although many instruments have been proposed for obtaining data on persons with DM whose feet are affected by the disease, in many cases the psychometric properties of the instrument have yet to be established. The principal objective of our review was to identify PROMs specific for patients with DM affecting the foot and ankle and to evaluate the psychometric properties and methodological quality of these instruments. Methods: In this systematic review, we investigate studies (published in English or Spanish) based on the use of one or more PROMs specific to foot and ankle pathologies for patients with DM (type I or II). To do so, the databases PubMed, Scopus, CINAHL, PEDro and Google Scholar were searched for studies that analysed psychometric or clinimetric properties in this respect. These were assessed according to Terwee or COSMIN criteria. Results: Of the 1016 studies identified in the initial search, only 11 were finally included in the qualitative review. Analysis according to Terwee and COSMIN criteria showed that the Foot Health Status Questionnaire (FHSQ) presented the greatest number of positive values. Conclusions: The FHSQ is the highest-quality PROM currently available for the foot and ankle, for patients with DM.
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Affiliation(s)
- Ana Belen Ortega-Avila
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Penalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain.
| | - Pablo Cervera-Garvi
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Penalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain.
| | - Laura Ramos-Petersen
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Penalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain.
| | - Esther Chicharro-Luna
- Department of Behavioral Sciences and Health, Miguel Hernández University, San Juan de Alicante, 03550 Alicante, Spain.
| | - Gabriel Gijon-Nogueron
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Penalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain.
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain.
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Ebadi A, Ausili D, Albatineh AN, Salarvand S, Ghanei Ghashlagh R. Psychometric Evaluation of the Farsi Version of the Self-Care of Diabetes Inventory in Iranian Patients with Diabetes. Diabetes Metab Syndr Obes 2019; 12:2775-2784. [PMID: 31920357 PMCID: PMC6941697 DOI: 10.2147/dmso.s235436] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 12/13/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Lifelong self-care is important in particular for patients with diabetes, because preventing diabetes complications can help maintain the quality of life and independence of diabetic patients. Currently, there are 16 self-care tools, the majority of which focus on one part of self-care. Therefore, the aim of this study was to evaluate the psychometric properties of the Farsi Self-Care of Diabetes Inventory (F-SCODI) in Iran. METHODS A cross-sectional study was performed on 400 diabetic patients who were selected by convenience sampling to complete the F-SCODI. In this regard, construct validity was assessed using exploratory factor analysis. Additionally, the internal consistency of the F-SCODI was evaluated by McDonald's omega coefficient and Cronbach's alpha; whereas its stability was assessed by a test re-test approach. RESULTS In total, four factors were extracted (activity-nutritional behavior, smoking avoidance behavior, illness-related behaviors, and health-promoting behaviors) in the dimension of self-care maintenance, three factors (symptom monitoring, symptom assessment, and symptom recognition) in the dimension of self-care monitoring, two factors (autonomous self-care and consultative self-care) in the self-care management dimension, and two factors (task-specific self-care confidence and persistence self-care) in the dimension of confidence. In this regard, the overall consistencies of the four dimensions were 0.809, 0.767, 0.590, and 0.886, respectively. CONCLUSION This study indicated that the Farsi version of SCODI had acceptable internal consistency and reliability as well as content and construct validity. Given the acceptable psychometric properties, this tool can be used in future studies in Iranian patients with diabetes.
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Affiliation(s)
- Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Davide Ausili
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Ahmed N Albatineh
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Shahin Salarvand
- Social Determinant of Health Research Center, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Reza Ghanei Ghashlagh
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
- Correspondence: Reza Ghanei Ghashlagh Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Pasdaran Ave, Sanandaj6618634683, IranTel +98 9144050284Fax +98 36237511 Email
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Cheng LJ, Wu VX, Dawkes S, Lim ST, Wang W. Factors influencing diet barriers among outpatients with poorly-controlled type 2 diabetes: A descriptive correlational study. Nurs Health Sci 2018; 21:102-111. [PMID: 30264523 DOI: 10.1111/nhs.12569] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 07/06/2018] [Accepted: 07/27/2018] [Indexed: 01/06/2023]
Abstract
The aim of the present descriptive correlational study was to investigate diet barriers and their influencing factors among outpatients with poorly-controlled type 2 diabetes in Singapore. One hundred and ten patients with poorly-controlled type 2 diabetes were recruited from a tertiary hospital in Singapore. The Personal Diabetes Questionnaire and Appraisal of Diabetes Scale were used to measure the study variables. Our participants reported that the most common diet barriers were eating out, followed by food cravings. Eating problems and negative diabetes appraisal were identified as significant predictors of diet barriers. The findings laid the groundwork with preliminary findings for the development of culturally-tailored and patient-centered education programs to enhance eating behaviors and promote positive appraisal.
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Affiliation(s)
- Ling Jie Cheng
- Department of Nursing, Khoo Teck Puat Hospital, Yishun Health Campus, National Healthcare Group, Singapore
| | - Vivien Xi Wu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Susan Dawkes
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, Scotland
| | - Suan Tee Lim
- National University Hospital, National University Health System, Singapore
| | - Wenru Wang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Nelson LA, Wallston KA, Kripalani S, Greevy RA, Elasy TA, Bergner EM, Gentry CK, Mayberry LS. Mobile Phone Support for Diabetes Self-Care Among Diverse Adults: Protocol for a Three-Arm Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e92. [PMID: 29636319 PMCID: PMC5915673 DOI: 10.2196/resprot.9443] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 01/19/2018] [Accepted: 02/08/2018] [Indexed: 01/03/2023] Open
Abstract
Background Nonadherence to self-care is common among patients with type 2 diabetes (T2D) and often leads to severe complications. Moreover, patients with T2D who have low socioeconomic status and are racial/ethnic minorities disproportionately experience barriers to adherence and poor outcomes. Basic phone technology (text messages and phone calls) provides a practical medium for delivering content to address patients’ barriers to adherence; however, trials are needed to explore long-term and sustainable effects of mobile phone interventions among diverse patients. Objective The aim of this study is to evaluate the effects of mobile phone–based diabetes support interventions on self-care and hemoglobin A1c (HbA1c) among adults with T2D using a 3-arm, 15-month randomized controlled trial with a Type 1 hybrid effectiveness-implementation approach. The intervention arms are (1) Rapid Encouragement/Education And Communications for Health (REACH) and (2) REACH + Family-focused Add-on for Motivating Self-care (FAMS). Methods We recruited primary care patients with T2D (N=512) from Federally Qualified Health Centers and an academic medical center, prioritizing recruitment of publicly insured and minority patients from the latter. Eligible patients were prescribed daily diabetes medication and owned a cell phone with text messaging capability. We excluded patients whose most recent HbA1c result within 12 months was <6.8% to support detection of intervention effects on HbA1c. Participants were randomly assigned to REACH only, REACH + FAMS, or the control condition. REACH provides text messages tailored to address patient-specific barriers to medication adherence based on the Information-Motivation-Behavioral skills model, whereas FAMS provides monthly phone coaching with related text message content focused on family and friend barriers to diet and exercise adherence. We collect HbA1c and self-reported survey data at baseline and at 3, 6, and 12 months, and again at 15 months to assess sustained changes. We will use generalized estimating equation models to test the effects of REACH (either intervention arm) on HbA1c relative to the control group, the potential additive effects of FAMS, and effects of either intervention on adherence to self-care behaviors and diabetes self-efficacy. Results The trial is ongoing; recruitment closed December 2017. We plan to perform analyses on 6-month outcomes for FAMS in July 2018, and project to have 15-month data for REACH analyses in April 2019. Conclusions Our study will be one of the first to evaluate a long-term, theory-based text messaging intervention to promote self-care adherence among racially/ethnically and socioeconomically diverse adults with T2D. Moreover, our study will assess the feasibility of a family-focused intervention delivered via mobile phones and compare the effects of text messaging alone versus text messaging plus phone coaching. Findings will advance our understanding of how interventions delivered by phone can benefit diverse patients with chronic conditions. Trial Registration ClinicalTrials.gov NCT02409329; https://clinicaltrials.gov/ct2/show/NCT02409329 (Archived by WebCite at http://www.webcitation.org/6yHkg9SSl); NCT02481596; https://clinicaltrials.gov/ct2/show/NCT02481596 (Archived by WebCite at http://www.webcitation.org/6yHkj9XD4)
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Affiliation(s)
- Lyndsay A Nelson
- Center for Health Behavior and Health Education, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Kenneth A Wallston
- Center for Diabetes Translation Research, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,School of Nursing, Vanderbilt University, Nashville, TN, United States.,Center for Effective Health Communication, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Sunil Kripalani
- Center for Effective Health Communication, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Center for Clinical Quality and Implementation Research, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Robert A Greevy
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Tom A Elasy
- Center for Health Behavior and Health Education, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Center for Diabetes Translation Research, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Erin M Bergner
- Center for Health Behavior and Health Education, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Chad K Gentry
- Department of Pharmacy, College of Pharmacy and Health Sciences, Lipscomb University, Nashville, TN, United States
| | - Lindsay S Mayberry
- Center for Health Behavior and Health Education, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Center for Diabetes Translation Research, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Center for Effective Health Communication, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
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Packer TL, Fracini A, Audulv Å, Alizadeh N, van Gaal BGI, Warner G, Kephart G. What we know about the purpose, theoretical foundation, scope and dimensionality of existing self-management measurement tools: A scoping review. PATIENT EDUCATION AND COUNSELING 2018; 101:579-595. [PMID: 29239734 DOI: 10.1016/j.pec.2017.10.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 10/10/2017] [Accepted: 10/21/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To identify self-report, self-management measures for adults with chronic conditions, and describe their purpose, theoretical foundation, dimensionality (multi versus uni), and scope (generic versus condition specific). METHODS A search of four databases (8479 articles) resulted in a scoping review of 28 self-management measures. RESULTS Although authors identified tools as measures of self-management, wide variation in constructs measured, purpose, and theoretical foundations existed. Subscales on 13 multidimensional tools collectively measure domains of self-management relevant to clients, however no one tool's subscales cover all domains. CONCLUSIONS Viewing self-management as a complex, multidimensional whole, demonstrated that existing measures assess different, related aspects of self-management. Activities and social roles, though important to patients, are rarely measured. Measures with capacity to quantify and distinguish aspects of self-management may promote tailored patient care. PRACTICE IMPLICATIONS In selecting tools for research or assessment, the reason for development, definitions, and theories underpinning the measure should be scrutinized. Our ability to measure self-management must be rigorously mapped to provide comprehensive and system-wide care for clients with chronic conditions. Viewing self-management as a complex whole will help practitioners to understand the patient perspective and their contribution in supporting each individual patient.
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Affiliation(s)
- Tanya L Packer
- School of Occupational Therapy, Dalhousie University, Halifax, Canada; Radboud University Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands; Faculty of Health and Social Studies, Han University of Applied Sciences, Nijmegen, The Netherlands.
| | - America Fracini
- School of Occupational Therapy, Dalhousie University, Halifax, Canada.
| | - Åsa Audulv
- Department of Nursing Science, Mid Sweden University, Sundsvall, Sweden.
| | - Neda Alizadeh
- School of Occupational Therapy, Dalhousie University, Halifax, Canada.
| | - Betsie G I van Gaal
- Radboud University Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands; Faculty of Health and Social Studies, Han University of Applied Sciences, Nijmegen, The Netherlands.
| | - Grace Warner
- School of Occupational Therapy, Dalhousie University, Halifax, Canada.
| | - George Kephart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
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Aronson R, Brown RE, Jiandani D, Walker A, Orzech N, Mbuagbaw L. Assessment of self-management in patients with diabetes using the novel LMC Skills, Confidence and Preparedness Index (SCPI). Diabetes Res Clin Pract 2018; 137:128-136. [PMID: 29097289 DOI: 10.1016/j.diabres.2017.10.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 10/16/2017] [Accepted: 10/26/2017] [Indexed: 10/18/2022]
Abstract
AIMS The LMC Skills, Confidence & Preparedness Index (SCPI) is an electronic tool designed to meet ISOQOL standards and (a) assess three dimensions: knowledge, confidence and preparedness; (b) provide a clinically meaningful measure; (c) provide immediate feedback to the healthcare provider. Internal consistency and external validity have been previously reported in a refractory diabetes cohort. This larger evaluation, broader in glycemic control, sought to assess clinical relevance to glycemia. METHODS Participants with type 1 and type 2 diabetes were recruited from LMC Diabetes and Endocrinology specialist clinics, from April to October 2016. Participants completed the SCPI using a tablet. Demographic and laboratory data were extracted from the LMC Diabetes Patient Registry. RESULTS In total, 529 patients met inclusion criteria and were included in psychometric analyses; 518 patients with established diabetes (>6 months) were assessed for SCPI - glycemia correlations. SCPI scores were found to have a high degree of validity, internal consistency, and test-retest reliability. Most importantly, the tool showed good external validity in its relation to glycemic control, both in tertile analysis, demonstrating a threshold effect consistent with a 'moderate' degree of poor control; and in overall correlation with HbA1c for the total SCPI score and two subscales (Skills and Confidence). CONCLUSIONS The SCPI tool is a quick (25 items), easy to use measure of three domains - knowledge, confidence and preparedness. The instant scoring and specific feedback, as well as the relationship to glycemic control should provide significant value in the patient assessment in the diabetes clinic.
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Affiliation(s)
- Ronnie Aronson
- LMC Diabetes & Endocrinology, 1929 Bayview Ave., Toronto, ON M4G 3E8, Canada.
| | - Ruth E Brown
- LMC Diabetes & Endocrinology, 1929 Bayview Ave., Toronto, ON M4G 3E8, Canada.
| | - Dishay Jiandani
- LMC Diabetes & Endocrinology, 1929 Bayview Ave., Toronto, ON M4G 3E8, Canada.
| | - Ashleigh Walker
- LMC Diabetes & Endocrinology, 1929 Bayview Ave., Toronto, ON M4G 3E8, Canada.
| | - Naomi Orzech
- LMC Diabetes & Endocrinology, 1929 Bayview Ave., Toronto, ON M4G 3E8, Canada.
| | - Lawrence Mbuagbaw
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada; Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare-Hamilton, 100 West 5th Street, Hamilton, ON L9C 0E3, Canada; Centre for the Development of Best Practices in Health, Yaoundé Central Hospital, Yaoundé, Cameroon.
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Karimy M, Koohestani HR, Araban M. The association between attitude, self-efficacy, and social support and adherence to diabetes self-care behavior. Diabetol Metab Syndr 2018; 10:86. [PMID: 30534204 PMCID: PMC6260748 DOI: 10.1186/s13098-018-0386-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 11/12/2018] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Diabetes is a chronic illness which requires lifelong self-care behaviors. The objective of the present research was to investigate the association of self-efficacy, attitude and social support with adherence to diabetes self-care behavior. MATERIALS AND METHODS In this cross-sectional study conducted in 2017, 403 diabetic patients of Zarandieh, Iran participated. They were evaluated by valid and reliable questionnaires comprised of items on diabetes self-care, self-efficacy in dealing with problems, social support and attitude towards self-care. Data were analyzed using SPSS 18 applying t test, ANOVA, and multiple regression analysis. RESULTS The results indicated that patients with higher self-care scores had better self-efficacy, social support, and attitude towards self-care. Moreover, self-efficacy, social support, and attitude towards self-care variables accounted for 39.5% of the total variance of self-care behavior. Furthermore, social support (β = 0.87), self-efficacy (β = 0.52), and attitude towards self-care (β = 0.42) were respectively the most important predictors of self-care behaviors. CONCLUSION Social support, self-efficacy and attitude towards self-care behaviors were associated with self-care behaviors in patient with diabetes. They might suggest that educational programs specifically target these factors.
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Affiliation(s)
- Mahmood Karimy
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Hamid Reza Koohestani
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Marzieh Araban
- Social Determinants of Health Research Center, Public Health School, Ahvaz Jundishapur University of Medical Sciences, 61375-15751 Ahvaz, Iran
- Department of Health Education and Promotion, Public Health School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Soltanian AR, Borzouei S, Afkhami-Ardekan M. Design, developing and validation a questionnaire to assess general population awareness about type II diabetes disease and its complications. Diabetes Metab Syndr 2017; 11 Suppl 1:S39-S43. [PMID: 27612396 DOI: 10.1016/j.dsx.2016.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 09/03/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Timely prevention of type 2 diabetes decrease socio-economic burden of disease in a society. To measure people's knowledge, the existence of valid and accurate tool such as questionnaires is very important. In the study we tried to make a comprehensive questionnaire to measure knowledge of apparently healthy individuals. MATERIAL AND METHODS In this study a questionnaire to assess general population awareness about type II diabetes disease and its complications was Design, developing and validation based on 10 experts' panel and statistical inferences. RESULTS Initially 67 questions designed and according to the experts' panel 16 questions were removed and 11 questions were edited. Finally, content validity of 51 questions has been approved by the experts' panel. According to Lawshe's score if CVRs were at least 0.8, items will be has content validity. The results show that both internal consistency and intra-class-correlation were good (>0.75). Cronbach's alpha and ICC were 0.84 and 0.82, respectively for all questions. To confirm structure of conceptual model, confirmatory factor analysis and Amos software was used. Goodness of Fit Index was RMSEA=0.027, GFI=0.95, AGFI=0.91, CFI=0.97; and showed that the hypothesized model is approved. CONCLUSION In general, we can say that the questionnaire is approximately comprehensive and complete. It is suggested that to assess awareness of diabetes type 2 in seven dominants (e.g. fundamentals, common symptoms, early and late complications, diet, control methods, and source of information of DMT2) this questionnaire should be used in general population.
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Affiliation(s)
- Ali Reza Soltanian
- Department of Biostatistics and Modeling of Noncommunicable Diseases Research Center, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Shiva Borzouei
- Department of Internal Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Mohammad Afkhami-Ardekan
- Department of Endocrinology, Yazd Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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Psychometric evaluation of the short version of the Personal Diabetes Questionnaire to assess dietary behaviors and exercise in patients with type 2 diabetes. Eat Behav 2017; 26:182-188. [PMID: 28456108 PMCID: PMC5715467 DOI: 10.1016/j.eatbeh.2017.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 03/31/2017] [Accepted: 04/03/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Patients with diabetes and of lower socioeconomic status have difficulty adhering to dietary recommendations. Practical and effective tools assessing self-management behaviors are needed to help evaluate interventions tailored to the needs of individual patients or population groups. This study examined the psychometric properties of a short 11-item version of the Personal Diabetes Questionnaire scale (PDQ-11) using data from the Public-Private Partnership to Improve Diabetes Education trial. METHODS Patients (n=411) with type 2 diabetes from ten safety net primary care clinics in the Mid-Cumberland Region of Tennessee completed the PDQ-11, the Summary of Diabetes Self-Care Activities (SDSCA), the Perceived Diabetes Self-Management Scale (PDSMS), and the Adherence to Refills and Medications Scale (ARMS). Statistical analyses were conducted to explore the subscale structure of the PDQ-11, and the internal consistency and validity of its subscales. RESULTS Exploratory factor analysis of the PDQ-11 revealed four components (Cronbach's α=0.50 to 0.81): Eating Behavior Problems; Use of Information for Dietary Decision Making; Calorie Restriction; and Activity and Exercise. Eating Behavior Problems and Use of Information for Dietary Decision Making had the strongest associations with the diet subscales of the SDSCA and were also correlated with the PDSMS and the ARMS scores (all ps<0.001). Different PDQ-11 subscales were correlated with BMI (Calorie Restriction Activity and Exercise) and blood pressure (Eating Behavior Problems). CONCLUSIONS The PDQ-11 is a useful measure of dietary behaviors in patients with type 2 diabetes; its use may help providers tailor individual nutrition intervention strategies to patients.
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Heerman WJ, Jackson N, Hargreaves M, Mulvaney SA, Schlundt D, Wallston KA, Rothman RL. Clusters of Healthy and Unhealthy Eating Behaviors Are Associated With Body Mass Index Among Adults. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2017; 49:415-421.e1. [PMID: 28363804 PMCID: PMC5747265 DOI: 10.1016/j.jneb.2017.02.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/31/2017] [Accepted: 02/05/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To identify eating styles from 6 eating behaviors and test their association with body mass index (BMI) among adults. DESIGN Cross-sectional analysis of self-report survey data. SETTING Twelve primary care and specialty clinics in 5 states. PARTICIPANTS Of 11,776 adult patients who consented to participate, 9,977 completed survey questions. VARIABLES MEASURED Frequency of eating healthy food, frequency of eating unhealthy food, breakfast frequency, frequency of snacking, overall diet quality, and problem eating behaviors. The primary dependent variable was BMI, calculated from self-reported height and weight data. ANALYSIS k-Means cluster analysis of eating behaviors was used to determine eating styles. A categorical variable representing each eating style cluster was entered in a multivariate linear regression predicting BMI, controlling for covariates. RESULTS Four eating styles were identified and defined by healthy vs unhealthy diet patterns and engagement in problem eating behaviors. Each group had significantly higher average BMI than the healthy eating style: healthy with problem eating behaviors (β = 1.9; P < .001), unhealthy (β = 2.5; P < .001), and unhealthy with problem eating behaviors (β = 5.1; P < .001). CONCLUSIONS AND IMPLICATIONS Future attempts to improve eating styles should address not only the consumption of healthy foods but also snacking behaviors and the emotional component of eating.
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Affiliation(s)
- William J Heerman
- General Pediatrics, Vanderbilt University Medical Center, Nashville, TN; Department of Internal Medicine and Public Health, Vanderbilt University, Nashville, TN; Center for Health Services Research, Vanderbilt University, Nashville, TN.
| | - Natalie Jackson
- Department of Internal Medicine and Public Health, Vanderbilt University, Nashville, TN; Center for Health Services Research, Vanderbilt University, Nashville, TN
| | | | - Shelagh A Mulvaney
- Department of Internal Medicine and Public Health, Vanderbilt University, Nashville, TN; School of Nursing, Vanderbilt University, Nashville, TN; Department of Biomedical Informatics, Vanderbilt University, Nashville, TN
| | - David Schlundt
- Center for Health Services Research, Vanderbilt University, Nashville, TN
| | | | - Russell L Rothman
- Department of Internal Medicine and Public Health, Vanderbilt University, Nashville, TN; Center for Health Services Research, Vanderbilt University, Nashville, TN
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Shu PS, Chan YM, Huang SL. Higher body mass index and lower intake of dairy products predict poor glycaemic control among Type 2 Diabetes patients in Malaysia. PLoS One 2017; 12:e0172231. [PMID: 28234927 PMCID: PMC5325472 DOI: 10.1371/journal.pone.0172231] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 02/01/2017] [Indexed: 01/08/2023] Open
Abstract
This cross-sectional study was designed to determine factors contributing to glyceamic control in order to provide better understanding of diabetes management among Type 2 Diabetes patients. A pre-tested structured questionnaire was used to obtain information on socio-demographic and medical history. As a proxy measure for glycaemic control, glycosylated haemoglobin (HbA1c) was obtained as secondary data from the medical reports. Perceived self-care barrier on diabetes management, diet knowledge and skills, and diet quality were assessed using pretested instruments. With a response rate of 80.3%, 155 subjects were recruited for the study. Mean HbA1c level of the subjects was 9.02 ± 2.25% with more than 70% not able to achieve acceptable level in accordance to WHO recommendation. Diet quality of the subjects was unsatisfactory especially for vegetables, fruits, fish and legumes as well as from the milk and dairy products group. Higher body mass index (BMI), poorer medication compliance, lower diet knowledge and skill scores and lower intake of milk and dairy products contributed significantly on poor glycaemic control. In conclusion, while perceived self-care barriers and diet quality failed to predict HbA1c, good knowledge and skill ability, together with appropriate BMI and adequate intake of dairy products should be emphasized to optimize glycaemic control among type 2 diabetes patients.
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Affiliation(s)
- Ping Soon Shu
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Yoke Mun Chan
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Selangor, Malaysia
- * E-mail:
| | - Soo Lee Huang
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
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Frandes M, Deiac AV, Timar B, Lungeanu D. Instrument for assessing mobile technology acceptability in diabetes self-management: a validation and reliability study. Patient Prefer Adherence 2017; 11:259-269. [PMID: 28243069 PMCID: PMC5317318 DOI: 10.2147/ppa.s127922] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Nowadays, mobile technologies are part of everyday life, but the lack of instruments to assess their acceptability for the management of chronic diseases makes their actual adoption for this purpose slow. OBJECTIVE The objective of this study was to develop a survey instrument for assessing patients' attitude toward and intention to use mobile technology for diabetes mellitus (DM) self-management, as well as to identify sociodemographic characteristics and quality of life factors that affect them. METHODS We first conducted the documentation and instrument design phases, which were subsequently followed by the pilot study and instrument validation. Afterward, the instrument was administered 103 patients (median age: 37 years; range: 18-65 years) diagnosed with type 1 or type 2 DM, who accepted to participate in the study. The reliability and construct validity were assessed by computing Cronbach's alpha and using factor analysis, respectively. RESULTS The instrument included statements about the actual use of electronic devices for DM management, interaction between patient and physician, attitude toward using mobile technology, and quality of life evaluation. Cronbach's alpha was 0.9 for attitude toward using mobile technology and 0.97 for attitude toward using mobile device applications for DM self-management. Younger patients (Spearman's ρ=-0.429; P<0.001) with better glycemic control (Spearman's ρ=-0.322; P<0.001) and higher education level (Kendall's τ=0.51; P<0.001) had significantly more favorable attitude toward using mobile assistive applications for DM control. Moreover, patients with a higher quality of life presented a significantly more positive attitude toward using modern technology (Spearman's ρ=0.466; P<0.001). CONCLUSION The instrument showed good reliability and internal consistency, making it suitable for measuring the acceptability of mobile technology for DM self-management. Additionally, we found that even if most of the patients showed positive attitude toward mobile applications, only a moderate level of intention to indeed use them was observed. Moreover, the study indicated that barriers were truthfulness and easiness to use.
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Affiliation(s)
- Mirela Frandes
- Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy of Timisoara
| | - Anca V Deiac
- Department of Mathematics, Polytechnic University of Timisoara
| | - Bogdan Timar
- Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy of Timisoara
- Third Medical Clinic, Emergency Hospital of Timisoara, Timisoara, Romania
- Correspondence: Bogdan Timar, Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy of Timisoara, 2 Eftimie Murgu, 300041 Timisoara, Romania, Tel +40 741 528 093, Fax +40 256 462 856, Email
| | - Diana Lungeanu
- Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy of Timisoara
- Department of Mathematics, Polytechnic University of Timisoara
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Cheng L, Leung DYP, Wu YN, Sit JWH, Yang MY, Li XM. Psychometric Properties of the Modified Personal Diabetes Questionnaire Among Chinese Patients With Type 2 Diabetes. Eval Health Prof 2016; 41:3-24. [PMID: 27649714 DOI: 10.1177/0163278716664393] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This study examined the psychometric properties of the Chinese version of the Personal Diabetes Questionnaire (C-PDQ). The PDQ was translated into Chinese using a forward and backward translation approach. After being reviewed by an expert panel, the C-PDQ was administered to a convenience sample of 346 adults with Type 2 diabetes. The Chinese version of the Summary of Diabetes Self-Care Activities (C-SDSCA) was also administered. The results of the exploratory factor analysis revealed a one-factor structure for the Diet Knowledge, Decision-Making, and Eating Problems subscales and a two-factor structure for the barriers-related subscales. The criterion and convergent validity were supported by significant correlations of the subscales of the C-PDQ with the glycated hemoglobin values and the parallel subscales in the C-SDSCA, respectively. The C-PDQ subscales also showed acceptable internal consistency (α = .61-.89) and excellent test-retest reliability (intraclass correlation coefficients: .73-.96). The results provide preliminary support for the reliability and validity of the C-PDQ. This comprehensive, patient-centered instrument could be useful to identify the needs, concerns, and priorities of Chinese patients with type 2 diabetes.
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Affiliation(s)
- Li Cheng
- 1 The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.,2 Faculty of Nursing, Health Science Center, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Doris Y P Leung
- 1 The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Yu-Ning Wu
- 3 Department of Endocrinology, The Ninth Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Janet W H Sit
- 1 The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Miao-Yan Yang
- 4 Department of Endocrinology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xiao-Mei Li
- 2 Faculty of Nursing, Health Science Center, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Heerman WJ, Wallston KA, Osborn CY, Bian A, Schlundt DG, Barto SD, Rothman RL. Food insecurity is associated with diabetes self-care behaviours and glycaemic control. Diabet Med 2016; 33:844-50. [PMID: 26314941 PMCID: PMC4769979 DOI: 10.1111/dme.12896] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2015] [Indexed: 11/29/2022]
Abstract
AIMS Food insecurity is the 'limited or uncertain availability of nutritionally adequate and safe foods'. Our objective was to examine the association between food insecurity, diabetes self-care and glycaemic control. METHODS We conducted a cross-sectional analysis of baseline data from adult patients with Type 2 diabetes who were enrolled in a randomized trial evaluating a health literacy-focused diabetes intervention in safety net primary care clinics in middle Tennessee. Food insecurity was assessed with three items from the U.S. Household Food Security Survey. Diabetes self-care behaviours were assessed with the Summary of Diabetes Self-Care Activities Scale, Personal Diabetes Questionnaire and Adherence to Refills and Medication Scale. Glycaemic control was assessed with HbA1c . RESULTS The sample consisted of 401 participants, 73% of whom reported some level of food insecurity. Food insecurity was significantly associated with self-care behaviours including less adherence to a general diet [Adjusted Odds Ratio (AOR) 0.9, P = 0.02], less physical activity (AOR 0.9, P = 0.04) and with a greater occurrence of medication non-adherence (AOR 1.2, P = 0.002) and calorie restriction (AOR 1.1, P = 0.02). Food insecurity was also associated with worse glycaemic control (adjusted β = 0.1, P = 0.03). None of the self-care behaviours were significantly associated with HbA1c , limiting the ability to test for self-care as a mechanism linking food insecurity to glycaemic control. CONCLUSIONS There was a high rate of food insecurity in a sample of patients with Type 2 diabetes who were of low socio-economic status. Food insecurity was associated with less adherence to recommended self-care behaviours and worse glycaemic control.
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Affiliation(s)
- W J Heerman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Center for Diabetes Translation Research, Center for Diabetes and Translational Research, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Center for Health Services Research, Nashville, TN, USA
| | - K A Wallston
- Vanderbilt Center for Health Services Research, Nashville, TN, USA
- School of Nursing, Nashville, TN, USA
| | - C Y Osborn
- Vanderbilt Center for Diabetes Translation Research, Center for Diabetes and Translational Research, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Center for Health Services Research, Nashville, TN, USA
- Department of Biomedical Informatics and the Center for Health Behavior and Health Education, Nashville, TN, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - A Bian
- Vanderbilt Center for Health Services Research, Nashville, TN, USA
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - D G Schlundt
- Vanderbilt Center for Diabetes Translation Research, Center for Diabetes and Translational Research, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Center for Health Services Research, Nashville, TN, USA
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - S D Barto
- Vanderbilt Center for Health Services Research, Nashville, TN, USA
| | - R L Rothman
- Vanderbilt Center for Diabetes Translation Research, Center for Diabetes and Translational Research, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Center for Health Services Research, Nashville, TN, USA
- Department of Biomedical Informatics and the Center for Health Behavior and Health Education, Nashville, TN, USA
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Cheng L, Sit JW, Leung DY, Li X. The Association Between Self-Management Barriers and Self-Efficacy in Chinese Patients with Type 2 Diabetes: The Mediating Role of Appraisal. Worldviews Evid Based Nurs 2016; 13:356-362. [DOI: 10.1111/wvn.12159] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2015] [Indexed: 01/15/2023]
Affiliation(s)
- Li Cheng
- Doctoral Student, The Nethersole School of Nursing, Faculty of Medicine; The Chinese University of Hong Kong; Shatin Hong Kong
| | - Janet W.H. Sit
- Associate Professor, The Nethersole School of Nursing, Faculty of Medicine; The Chinese University of Hong Kong; Shatin Hong Kong
| | - Doris Y.P. Leung
- Assistant Professor, The Nethersole School of Nursing, Faculty of Medicine; The Chinese University of Hong Kong; Hong Kong
| | - Xiaomei Li
- Professor, The School of Nursing, Faculty of Medicine; The Xi'an Jiaotong University; Xi'an China
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Cheng L, Leung DYP, Sit JWH, Li XM, Wu YN, Yang MY, Gao CX, Hui R. Factors associated with diet barriers in patients with poorly controlled type 2 diabetes. Patient Prefer Adherence 2016; 10:37-44. [PMID: 26834464 PMCID: PMC4716765 DOI: 10.2147/ppa.s94275] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The study was conducted to investigate the diet barriers perceived by patients with poorly controlled type 2 diabetes and examine the associations between diet barriers and sociodemographic characteristics, medical condition, and patient-centered variables. METHODS Secondary subgroup analyses were conducted based on the responses of 246 adults with poorly controlled type 2 diabetes from a multicenter, cross-sectional study. Diet barriers were captured by the Diet Barriers subscale of the Personal Diabetes Questionnaire. Participants also completed validated measures of diet knowledge, empowerment level, and appraisal of diabetes. Multiple regression techniques were used for model building, with a hierarchical block design to determine the separate contribution of sociodemographic characteristics, medical condition, and patient-centered variables to diet barriers. RESULTS Diet barriers were moderately evident (2.23±0.86) among Chinese patients with poorly controlled type 2 diabetes. The feeling of deprivation as a result of complying with a diet was the most recognized diet barrier (3.24±1.98), followed by "eating away from home" (2.79±1.82). Significantly higher levels of diet barriers were observed among those with lower levels of diet knowledge (β=-0.282, P<0.001) and empowerment (β=-0.190, P=0.015), and more negative appraisal (β=0.225, P=0.003). CONCLUSION Culturally tailored, patient-centered intervention programs that acknowledge individuals' preferences and allow for flexibility in diet management should be launched. Interventions programs that could enhance diet knowledge, promote positive appraisal, and improve empowerment level might effectively address diet barriers perceived by patients with poorly controlled type 2 diabetes.
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Affiliation(s)
- Li Cheng
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Ma Liu Shui, Shatin, New Territories, Hong Kong
- Correspondence: Li Cheng, The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Ma Liu Shui, Shatin, New Territories, 999077, Hong Kong, Tel +852 3943 9908, Fax +852 26035935, Email
| | - Doris Yin-ping Leung
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Ma Liu Shui, Shatin, New Territories, Hong Kong
| | - Janet Wing-hung Sit
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Ma Liu Shui, Shatin, New Territories, Hong Kong
| | - Xiao-mei Li
- The Department of Nursing, Faculty of Medicine, The Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Yu-ning Wu
- The Department of Endocrinology, The Ninth Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Miao-yan Yang
- The Department of Endocrinology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Cui-xia Gao
- The Department of Endocrinology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Rong Hui
- The Department of Endocrinology, Shaanxi Provincial People’s Hospital, Xi’an, People’s Republic of China
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Abstract
Objective. Previous studies have shown that receiving diabetes self-management education (DSME) is associated with increased care utilization. However, the relationship between DSME duration and care utilization patterns remains largely unexamined. Our purpose is to characterize DSME duration and examine the relationship between DSME duration and clinical- and self-care utilization patterns. Methods. The study sample included 1,446 adults who were ≥18 years of age, had diabetes, and had participated in the 2008 Florida Behavioral Risk Factor Surveillance System survey. Clinical- and self-care outcomes were derived using responses to the survey's diabetes module and were based on minimum standards of care established by the American Diabetes Association. The outcomes examined included self-monitoring of blood glucose at least once per day; receiving at least one eye exam, one foot exam, A1C tests, and an influenza vaccination in the past year; and ever receiving a pneumococcal vaccination. DSME duration was categorized as no DSME, >0 to <4 hours, 4-10 hours, and >10 hours. Results. After adjusting for sociodemographic variables, compared to those who did not receive DSME, those who had 4-10 or 10+ hours of DSME were more likely to receive two A1C tests (odds ratio [95% CI] 2.69 [1.30-5.58] and 2.63 [1.10-6.31], respectively) and have a pneumococcal vaccination (1.98 [1.03-3.80] and 1.92 [1.01-3.64], respectively). Those receiving 10+ hours of DSME were 2.2 times (95% CI 1.18-4.09) as likely to have an influenza vaccination. Conclusion. These data reveal a positive relationship between DSME duration and utilization of some diabetes clinical care services.
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Affiliation(s)
- Tammie M. Johnson
- University of North Florida, Department of Public Health, Brooks College of Health, Jacksonville, FL
| | - Jennifer Richards
- University of North Florida, Department of Public Health, Brooks College of Health, Jacksonville, FL
| | - James R. Churilla
- University of North Florida, Department of Clinical and Applied Movement Science, Brooks College of Health, Jacksonville, FL
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Knight H, Stetson B, Krishnasamy S, Mokshagundam SP. Diet self-management and readiness to change in underserved adults with type 2 diabetes. Prim Care Diabetes 2015; 9:219-225. [PMID: 25457433 DOI: 10.1016/j.pcd.2014.09.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 09/28/2014] [Indexed: 11/21/2022]
Abstract
AIM Dietary assessment in diabetes may be enhanced by considering patient-centered perspectives and barriers to change within IDF guidelines. Consideration of readiness to change (RTC) diet in underserved samples may guide future interventions in high risk populations. This study assesses the utility of a rapid assessment of RTC diet in a medically underserved sample. METHOD Participants were 253 Black (43.7%) and White (55.1%) American adults with type 2 diabetes [M age=57.93 (11.52); 60.5% female; 19% below the US poverty threshold]. Participants were recruited at medical clinics and completed validated self-report measures assessing diabetes knowledge, self-efficacy and dietary behaviors and barriers by RTC. RESULTS Stage-based comparisons identified significant differences in diabetes and dietary domains: participants in the Action stage endorsed fewer behavioral dietary barriers (p<.001), more frequent dietary problem-solving (p<.001), and greater diabetes self-efficacy (p<.001) than participants in the Contemplation and Preparation stages. Women were more likely to be in the Preparation stage and beyond (p<.05). CONCLUSIONS Findings highlight the clinical utility of a brief measure of RTC in understanding patient perspectives toward dietary behaviors in a medically underserved sample. The impact of gender on RTC diet warrants further exploration.
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Ward JEF, Stetson BA, Mokshagundam SPL. Patient perspectives on self-monitoring of blood glucose: perceived recommendations, behaviors and barriers in a clinic sample of adults with type 2 diabetes. J Diabetes Metab Disord 2015; 14:43. [PMID: 26137451 PMCID: PMC4486394 DOI: 10.1186/s40200-015-0172-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 05/10/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Patient-centered perspectives on self-monitoring of blood glucose (SBMG) were assessed in adults with type 2 diabetes using a self-regulation conceptual framework. METHODS Participants (N = 589; 53 % female) were adults with type 2 diabetes who were recruited during routine appointments at a diabetes outpatient clinic in the Southeastern/lower Midwestern region of the United States. RESULTS Participant's had varying perceptions regarding provider recommendations for SMBG (responder n = 380). Personal blood glucose testing patterns were also varied and reports frequently omitted (responder n = 296). Respondent's most frequent personal pattern was to test "occasionally, as needed," which did not differ by insulin use status, gender or age. In those not prescribed insulin, HbA1c reflected better control in those testing at least once per week (p = .040) or with a blood glucose goal (p = .018). 30.9 % endorsed at least monthly perceived encounters with SMBG barriers, with higher reports by women (p = .005) and younger (p = .006) participants. Poorer glycemic control was observed for participants with more frequently reported scheduling (p = .025, .041) and discouragement (p = .003) barriers. CONCLUSIONS Findings suggest that many may experience difficulty integrating SMBG into their lives and are unsure of recommendations and appropriate function. Research is needed to promote best practice recommendations for SMBG.
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Affiliation(s)
- Jennifer E F Ward
- Department of Psychological and Brain Sciences, 317 Life Sciences Building, University of Louisville, Louisville, KY 40292 USA
| | - Barbara A Stetson
- Department of Psychological and Brain Sciences, 317 Life Sciences Building, University of Louisville, Louisville, KY 40292 USA
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White RO, Eden S, Wallston KA, Kripalani S, Barto S, Shintani A, Rothman RL. Health communication, self-care, and treatment satisfaction among low-income diabetes patients in a public health setting. PATIENT EDUCATION AND COUNSELING 2015; 98:144-9. [PMID: 25468393 PMCID: PMC4282939 DOI: 10.1016/j.pec.2014.10.019] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 10/14/2014] [Accepted: 10/20/2014] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Diabetes patients with limited resources often experience suboptimal care. Less is known about the role of effective health communication (HC) in caring for low income diabetes patients. METHODS Ten health department clinics in TN participated in a trial evaluating a literacy-sensitive communication intervention. We assessed the quality of baseline HC and measured associations with diabetes outcomes. Assessments included: demographics, measures of HC, health literacy, self-care behaviors, self-efficacy, medication non-adherence, treatment satisfaction, and A1C. Unadjusted and adjusted multivariable regression models were used to test associations. RESULTS Participants (N=411) were 49.7±9.5 years, 61% female, uninsured (96%), with A1C 9.6±2.1. In unadjusted analyses, better communication, was associated with lower medication non-adherence (OR 0.40-0.68, all p<0.05), higher treatment satisfaction (OR 1.76-1.96, all p<0.01), portion size reduction (OR 1.43, p<0.05), diabetes self-efficacy (OR 1.41, p<0.05), and lower A1C (β=-0.06, p<0.01). In adjusted analyses, communication quality remained associated with lower medication non-adherence (AOR 0.39-0.68, all p<0.05), and higher treatment satisfaction (AOR 1.90-2.21, all p<0.001). CONCLUSIONS Better communication between low-income patients and providers was independently associated with lower medication non-adherence and higher treatment satisfaction. PRACTICE IMPLICATIONS Communication quality may be an important modifiable approach to improving diabetes care for vulnerable populations.
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Affiliation(s)
- Richard O White
- Division of Community Internal Medicine, Mayo Clinic, Jacksonville, USA; Department of Family Medicine, Mayo Clinic, Jacksonville, USA.
| | - Svetlana Eden
- Department of Biostatistics, Vanderbilt University, Nashville, USA
| | | | - Sunil Kripalani
- Department of Medicine, Vanderbilt University Medical Center, Nashville, USA; Institute for Medicine and Public Health, Vanderbilt University, Nashville, USA
| | - Shari Barto
- Institute for Medicine and Public Health, Vanderbilt University, Nashville, USA
| | - Ayumi Shintani
- Department of Biostatistics, Vanderbilt University, Nashville, USA
| | - Russell L Rothman
- Department of Medicine, Vanderbilt University Medical Center, Nashville, USA; Institute for Medicine and Public Health, Vanderbilt University, Nashville, USA
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Data collection challenges in community settings: insights from two field studies of patients with chronic disease. Qual Life Res 2014; 24:1043-55. [PMID: 25154464 DOI: 10.1007/s11136-014-0780-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2014] [Indexed: 01/16/2023]
Abstract
PURPOSE Collecting information about health and disease directly from patients can be fruitfully accomplished using contextual approaches, ones that combine more and less structured methods in home and community settings. This paper's purpose was to describe and illustrate a framework of the challenges of contextual data collection. METHODS A framework is presented based on prior work in community-based participatory research and organizational science, comprised of ten types of challenges across four broader categories. Illustrations of challenges and suggestions for addressing them are drawn from two mixed method, contextual studies of patients with chronic disease in two regions of the USA. RESULTS The first major category of challenges was concerned with the researcher-participant partnership, for example, the initial lack of mutual trust and understanding between researchers, patients, and family members. The second category concerned patient characteristics such as cognitive limitations and a busy personal schedule that created barriers to successful data collection. The third concerned research logistics and procedures such as recruitment, travel distances, and compensation. The fourth concerned scientific quality and interpretation, including issues of validity, reliability, and combining data from multiple sources. The two illustrative studies faced both common and diverse research challenges and used many different strategies to address them. CONCLUSION Collecting less structured data from patients and others in the community is potentially very productive but requires the anticipation, avoidance, or negotiation of various challenges. Future work is necessary to better understand these challenges across different methods and settings, as well as to test and identify strategies to address them.
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Caro-Bautista J, Martín-Santos FJ, Morales-Asencio JM. Systematic review of the psychometric properties and theoretical grounding of instruments evaluating self-care in people with type 2 diabetes mellitus. J Adv Nurs 2013; 70:1209-27. [PMID: 24237156 DOI: 10.1111/jan.12298] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2013] [Indexed: 01/17/2023]
Abstract
AIM To determine the psychometric properties and theoretical grounding of instruments that evaluate self-care behaviour or barriers in people with type 2 diabetes. BACKGROUND There are many instruments designed to evaluate self-care behaviour or barriers in this population, but knowledge about their psychometric validation processes is lacking. DESIGN Systematic review. DATA SOURCES We conducted a search for psychometric or validation studies published between January 1990-December 2012. We carried out searches in Pubmed, CINAHL, PsycINFO, ProQuolid, BibliPRO and Google SCHOLAR to identify instruments that evaluated self-care behaviours or barriers to diabetes self-care. REVIEW METHODS We conducted a systematic review with the following inclusion criteria: Psychometric or clinimetric validation studies that included patients with type 2 diabetes (exclusively or partially) and which analysed self-care behaviour or barriers to self-care and proxies like self-efficacy or empowerment, from a multidimensional approach. Language: Spanish or English. Two authors independently assessed the quality of the studies and extracted data using Terwee's proposed criteria: psychometrics properties, dimensionality, theoretical ground and population used for validation through each included instrument. RESULTS Sixteen instruments achieved the inclusion criteria for the review. We detected important methodological flaws in many of the selected instruments. Only the Self-management Profile for Type 2 Diabetes and Problem Areas in Diabetes Scale met half of Terwee's quality criteria. CONCLUSION There are no instruments for identifying self-care behaviours or barriers elaborated with a strong validation process. Further research should be carried out to provide patients, clinicians and researchers with valid and reliable instruments that are methodologically solid and theoretically grounded.
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Affiliation(s)
- Jorge Caro-Bautista
- District of Primary Health Care of Málaga, Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Spain
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Eton DT, Elraiyah TA, Yost KJ, Ridgeway JL, Johnson A, Egginton JS, Mullan RJ, Murad MH, Erwin PJ, Montori VM. A systematic review of patient-reported measures of burden of treatment in three chronic diseases. PATIENT-RELATED OUTCOME MEASURES 2013; 4:7-20. [PMID: 23833553 PMCID: PMC3699294 DOI: 10.2147/prom.s44694] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background Burden of treatment refers to the workload of health care and its impact on patient functioning and well-being. There are a number of patient-reported measures that assess burden of treatment in single diseases or in specific treatment contexts. A review of such measures could help identify content for a general measure of treatment burden that could be used with patients dealing with multiple chronic conditions. We reviewed the content and psychometric properties of patient-reported measures that assess aspects of treatment burden in three chronic diseases, ie, diabetes, chronic kidney disease, and heart failure. Methods We searched Ovid MEDLINE, Ovid EMBASE, Ovid PsycINFO, and EBSCO CINAHL through November 2011. Abstracts were independently reviewed by two people, with disagreements adjudicated by a third person. Retrieved articles were reviewed to confirm relevance, with patient-reported measures scrutinized to determine consistency with the definition of burden of treatment. Descriptive information and psychometric properties were extracted. Results A total of 5686 abstracts were identified from the database searches. After abstract review, 359 full-text articles were retrieved, of which 76 met our inclusion criteria. An additional 22 articles were identified from the references of included articles. From the 98 studies, 57 patient-reported measures of treatment burden (full measures or components within measures) were identified. Most were multi-item scales (89%) and assessed treatment burden in diabetes (82%). Only 15 measures were developed using direct patient input and had demonstrable evidence of reliability, scale structure, and multiple forms of validity; six of these demonstrated evidence of sensitivity to change. We identified 12 content domains common across measures and disease types. Conclusion Available measures of treatment burden in single diseases can inform derivation of a patient-centered measure of the construct in patients with multiple chronic conditions. Patients should take part in developing the measure to ensure salience and relevance.
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Affiliation(s)
- David T Eton
- Division of Heath Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
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Ahola AJ, Groop PH. Barriers to self-management of diabetes. Diabet Med 2013; 30:413-20. [PMID: 23278342 DOI: 10.1111/dme.12105] [Citation(s) in RCA: 172] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 10/31/2012] [Accepted: 12/18/2012] [Indexed: 12/27/2022]
Abstract
People with diabetes hold major responsibility for the day-to-day management of their chronic condition. The management that, amongst others, includes blood glucose monitoring, medication taking, diet and physical activity, aims at normalizing blood glucose levels. In many individuals, the level of glycaemia, however, frequently exceeds the recommendations. This observation, together with patients' and practitioners' reports, suggests that active self-management is suboptimal. Various reasons, both individual and environment related, contribute to the suboptimal concordance with treatment regimen. The aim of this review is to discuss some of the barriers to optimal diabetes self-management.
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Affiliation(s)
- A J Ahola
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Finland
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