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Ardissone A, Leonowicz-Bukała I, Struck-Peregończyk M. "Can Anyone Tell Me…". Online Health Communities in Diabetes Self-Management in Poland and Italy. HEALTH COMMUNICATION 2024:1-8. [PMID: 38687112 DOI: 10.1080/10410236.2024.2348842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
This paper contributes to the debate about the role of Online Health Communities (OHCs) in the healthcare system by concentrating on the kind of information sought and shared by their members. The paper focuses on OHCs for diabetes and discusses the main findings of a qualitative study conducted in Italy and Poland. The Uses and Gratifications approach informed the study, while content analysis was used to perform the analysis. The findings show that OHCs' role goes beyond information and emotional support, which relies on expertise by experience. Indeed, the lack of basic knowledge constituting the essential diabetes literacy for self-management was partially compensated by peer exchange in the OHCs. This raises at least two problems: quality and reliability of the information shared online, and consequences in terms of the equity that a healthcare system provides.
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Affiliation(s)
| | - Iwona Leonowicz-Bukała
- Faculty of Media and Social Communication, University of Information Technology and Management in Rzeszow
| | - Monika Struck-Peregończyk
- Faculty of Media and Social Communication, University of Information Technology and Management in Rzeszow
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Crosswell R, Norman K, Cassim S, Papa V, Keenan R, Paul R, Chepulis L. Are patients with type 2 diabetes in the Waikato District provided with adequate education and support in primary care to self-manage their condition? A qualitative study. J Prim Health Care 2024; 16:61-69. [PMID: 38546777 DOI: 10.1071/hc23141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/02/2024] [Indexed: 04/02/2024] Open
Abstract
Introduction In Aotearoa New Zealand (NZ), type 2 diabetes (T2D) is predominantly managed in primary care. Despite established guidelines, patients are often suboptimally managed, with inequitable health outcomes. To date, few NZ studies have evaluated the primary care management of T2D at the time of diagnosis. Aim This study aims to explore patients' the provision of education and delivery of care to patients at the time of diagnosis, which is a crucial time in the disease trajectory. Methods Participants were recruited from a Māori health provider in the Waikato District, and diagnosed with T2D after January 2020. Patients were texted a link to opt into a survey (larger study) and then registered interest by providing contact details for an interview (current study). Semi-structured interviews were conducted and were audio recorded, transcribed, and thematically analysed. Results In total, 11 participants aged 19-65 years completed the interviews (female n = 9 and male n = 20); the comprised Māori (n = 5), NZ European (n = 5) and Asian (n = 1) participants. Three overarching themes were identified, including: (1) ineffective provision of resources and education methods; (2) poor communication from healthcare practitioners; and (3) health system barriers. Discussion Evidently, there are difficulties in primary care diabetes mellitus diagnosis and management. Improvements could include locally relevant resources tailored to patients' experiences and cultural identities. Utilising whānau support and a non-clinical workforce, such as health navigators/kaiāwhina, will drastically address current workforce issues and assist patient self-management. This will allow improved diagnosis experiences and better health outcomes for patients and whānau.
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Affiliation(s)
- Rebekah Crosswell
- Waikato Medical Research Centre, University of Waikato, Te Huataki Waiora, School of Health, Private Bag 3105, Hamilton 3240, New Zealand
| | - Kimberley Norman
- Waikato Medical Research Centre, University of Waikato, Te Huataki Waiora, School of Health, Private Bag 3105, Hamilton 3240, New Zealand
| | - Shemana Cassim
- Waikato Medical Research Centre, University of Waikato, Te Huataki Waiora, School of Health, Private Bag 3105, Hamilton 3240, New Zealand; and School of Psychology, Massey University, Auckland, New Zealand
| | - Valentina Papa
- Department of Nursing, University of Waikato, Hamilton, New Zealand
| | - Rawiri Keenan
- Waikato Medical Research Centre, University of Waikato, Te Huataki Waiora, School of Health, Private Bag 3105, Hamilton 3240, New Zealand
| | - Ryan Paul
- Te Whatu Ora Waikato, Hamilton, New Zealand
| | - Lynne Chepulis
- Waikato Medical Research Centre, University of Waikato, Te Huataki Waiora, School of Health, Private Bag 3105, Hamilton 3240, New Zealand
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Costa IG, Camargo-Plazas P. The processes of engagement in information-seeking behavior for individuals with diabetes who developed diabetic foot ulcer: A constructivist grounded theory study. Digit Health 2023; 9:20552076231177155. [PMID: 37361440 PMCID: PMC10286200 DOI: 10.1177/20552076231177155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 05/04/2023] [Indexed: 06/28/2023] Open
Abstract
To describe the process of engagement in information seeking behavior for individuals with type 1 and type 2 diabetes. Methodology Constructivist grounded theory. The data was gathered through thirty semi-structured interviews of participants attending a wound care clinic in Southeast, Ontario, Canada. The waiting period taken to seek appropriate help varied from weeks to months. Results "The processes of engagement in information-seeking behavior about diabetes" are organized as follows: 1) discovering diabetes, 2) reactions to the diagnosis, and 3) engaging in self-directed learning. For most participants, the diagnosis of diabetes was unexpected and usually confirmed after a long period of experiencing a diversity of symptoms. The terms used mostly by participants were "I started to wonder" and "Something was wrong with me." After being diagnosed with diabetes, participants sought information to learn about it. Most of them engaged in self-directed learning to acquire knowledge about their illness. Conclusion Although the Internet is often used to seek information, healthcare providers and support network also played an important role in supporting participants information-seeking behavior learn about diabetes. The unique needs of people with diabetes must be taken into consideration during their diabetes care journey. These findings call for the need to provide education about diabetes from the time they are diagnosed and direct them to reliable resources of information.
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Affiliation(s)
- Idevania G Costa
- School of Nursing, Faculty of Health Science, Lakehead University, Thunder Bay, ON, Canada
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Joo WT. Educational gradient in social network changes at disease diagnosis. Soc Sci Med 2023; 317:115626. [PMID: 36586184 PMCID: PMC10039803 DOI: 10.1016/j.socscimed.2022.115626] [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] [Received: 08/01/2022] [Revised: 12/15/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022]
Abstract
This study examines the educational gradient in social network changes following the diagnosis of new chronic diseases. Using a representative sample of the US older population, the author shows that the network size and amount of health-related discussion with social network members increased only for older adults with a bachelor's degree. Tie-level analyses reveal that such increase is from the activation of health discussion with the existing social network members, but not from the changes in discussion partners. These results suggest that heterogeneous temporal dynamics in social networks may be one mechanism that shapes diverging health trajectories in later life.
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Affiliation(s)
- Won-Tak Joo
- Department of Demography, University of California, Berkeley, 328 Social Sciences Building, Berkeley, CA, 94720, USA.
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5
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Abdel-Rahman N, Manor O, Valinsky L, Mosenzon O, Calderon-Margalit R, Roberman S. What is important for people with type 2 diabetes? A focus group study to identify relevant aspects for Patient-Reported Outcome Measures in diabetes care. PLoS One 2022; 17:e0277424. [PMCID: PMC9662717 DOI: 10.1371/journal.pone.0277424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background
Patient-Reported Outcome Measures (PROMs) aim to evaluate the quality of care based on the perspectives of patients rather than clinical indicators. Qualitative research is needed to identify these perspectives in people with type 2 diabetes.
Objective
To identify, for the first time in Israel, aspects valuable for people with type 2 diabetes that can be relevant for PROMs in diabetes care.
Methods
A qualitative study included three focus groups totalling 19 people with type 2 diabetes. Inclusion criteria were: (1)type 2 diabetes, (2)diabetes duration of at least six months, and (3)adults aged 45–80 years. Purposive sampling enabled recruitment of heterogeneous participants. Also, two experts’ panels with healthcare providers involved in diabetes care (n = 23) were conducted to provide triangulation of information (more testimony about what is valuable for people with type 2 diabetes). Discussions were recorded, transcribed and thematically analysed.
Results
Four domains were deemed valuable for people with type 2 diabetes: (1)challenges of living with diabetes, including reduced physical function, healthy lifestyle struggles, sexual dysfunction, and financial burden, (2)mental health issues, including depression, distress, anxiety, frustration, and loneliness, (3)self-management ability, including management of lifestyle modifications and treatment, knowledge about the disease and treatment, and (4)patient-clinician relationships, including the devotion of clinicians, trust in clinicians and treatment, shared decision-making, and multidisciplinary care under one roof. Experts favour using PROMs in diabetes routine care and even acknowledged their necessity to improve the treatment process. However, only some of the domains raised by people with type 2 diabetes were identified by the experts.
Conclusions
There are content gaps between perspectives of people with type 2 diabetes and their healthcare providers. PROMs are essential in addressing issues largely not addressed in routine diabetes care. We recommend that researchers and healthcare providers, who intend to utilize PROMs for diabetes care, consider the aforementioned domains.
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Affiliation(s)
- Nura Abdel-Rahman
- Braun School of Public Health, Hebrew University of Jerusalem Hadassah Medical School, Jerusalem, Israel
| | - Orly Manor
- Braun School of Public Health, Hebrew University of Jerusalem Hadassah Medical School, Jerusalem, Israel
| | | | - Ofri Mosenzon
- Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ronit Calderon-Margalit
- Braun School of Public Health, Hebrew University of Jerusalem Hadassah Medical School, Jerusalem, Israel
- * E-mail:
| | - Sveta Roberman
- Braun School of Public Health, Hebrew University of Jerusalem Hadassah Medical School, Jerusalem, Israel
- Gordon Academic College of Education, Haifa, Israel
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Ferrey A, Moore L, Jolly JK. 'It was like being hit with a brick': a qualitative study on the effect of clinicians' delivery of a diagnosis of eye disease for patients in primary and secondary care. BMJ Open 2022; 12:e059970. [PMID: 35863827 PMCID: PMC9315907 DOI: 10.1136/bmjopen-2021-059970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To explore patients' experiences of getting a diagnosis of eye disease, the psychological impact of this and how this could be improved. DESIGN An exploratory qualitative interview study using a narrative approach and inductive methods. SETTING This study was conducted with patients who had attended ophthalmic appointments in primary and secondary care and in opticians located in the South of England. PARTICIPANTS 18 people diagnosed with eye disease in England. RESULTS Four themes were identified: the convoluted process of being diagnosed, the impact of clinicians' words, the search for information and reflections on what could be improved. The prolonged wait for a definitive diagnosis was a source of frustration and anxiety for many patients. Professionals' words and tone when delivering a diagnosis sometimes affected a patient's view of their diagnosis and their later ability to come to terms with it. Patients were desperate for information, but many felt they were not provided with sufficient information at the time of diagnosis and did not know whether to trust information found online. Participants felt the provision of a hospital liaison service and/or counselling could mitigate the impact on patients and families. CONCLUSIONS Interactions with clinicians can have a lasting impact on how a diagnosis is experienced and how well the patient is able to come to terms with their visual impairment. Receiving little or no information left patients feeling lost and unsupported. This led them to search for information from less reliable sources. Clinicians should consider how they communicate a diagnosis to patients, how and when they offer information about diagnosis and prognosis and where possible signpost patients to additional support systems and counselling services as early as possible.
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Affiliation(s)
- Anne Ferrey
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Lucy Moore
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jasleen Kaur Jolly
- Vision and Eye Research Institute, Anglia Ruskin University, Chelmsford, Essex, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Chavez-Tapia NC, Barrientos-Gutierrez T, Torres-Ibarra L, Sanchez-Jiménez B, Juarez-Hernandez E, Ramos-Ostos M, Alva-Lopez LF, Uribe M. Incremental levels of diagnostic information incentivize health-seeking in non-alcoholic fatty liver: a randomized clinical trial. Sci Rep 2022; 12:8272. [PMID: 35585153 PMCID: PMC9117664 DOI: 10.1038/s41598-022-12295-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 05/03/2022] [Indexed: 02/06/2023] Open
Abstract
Patients with chronic disorders like non-alcoholic fatty liver disease (NAFLD) face important challenges adhering to diagnostic and treatment tracks. As NAFLD increases, the need to incentivize health-seeking behaviors grows. No evidence-based interventions to address this gap exist. The aim of the study was to estimate the effect of providing increasing levels of diagnostic information on medical care-seeking in adults newly diagnosed with NAFLD. We randomly assigned adults with a sonographic diagnosis of NAFLD at a check-up unit in Mexico to one of five groups. All groups received medical consultation. A: no further interventions; B: received multimedia educational material (MEM); C: MEM + NAFLD-fibrosis-score (NFS); D: MEM + transient elastography (TE); E: MEM + NFS + TE. 1209 participants were randomized, follow-up rate 91%; 82% male, BMI 30.5 ± 4 kg/m2. There were no differences in the proportion of patients undergoing further diagnostic evaluation of liver fibrosis (A 0.4%, E 0.4%, P-for-trend = 0.269). Groups who received more information sought specialized medical care more frequently: A 22%, E 30% (P-for-trend = 0.047). A trend to receive treatment was also observed at higher levels of information: A 26.7%, E 36.3% (P-for-trend = 0.134). Increasing the amount of diagnostic information seemed to increase patient's health-seeking. Tailoring the communication of information obtained for diagnosis could help to increase health-seeking in chronic disease patients.Trial registration: NCT01874249 (full date of first registration 11-06-2013).
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Affiliation(s)
- Norberto C Chavez-Tapia
- Obesity and Digestive Diseases Unit and Translational Research Unit, Medica Sur Clinic and Foundation, Puente de Piedra 150 Col. Toriello Guerra Tlalpan, 14050, Mexico City, Mexico.
| | | | - Leticia Torres-Ibarra
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Beatriz Sanchez-Jiménez
- Gastroenterology Department, Centro Medico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Eva Juarez-Hernandez
- Translational Research Unit, Medica Sur Clinic and Foundation, Mexico City, Mexico
| | - Martha Ramos-Ostos
- Integral Diagnosis and Treatment Center, Medica Sur Clinic and Foundation, Mexico City, Mexico
| | - Luis F Alva-Lopez
- Radiology and Medical Imaging Unit, Medica Sur Clinic and Foundation, Mexico City, Mexico
| | - Misael Uribe
- Obesity and Digestive Diseases Unit and Translational Research Unit, Medica Sur Clinic and Foundation, Puente de Piedra 150 Col. Toriello Guerra Tlalpan, 14050, Mexico City, Mexico
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8
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Anokye R, Jackson B, Dimmock J, Dickson JM, Blekkenhorst LC, Hodgson JM, Lewis JR, Stanley M. Psychological distress and quality of life following provision of vascular imaging results of the coronary and carotid arteries to asymptomatic adults: a scoping review protocol. F1000Res 2022; 9:1376. [PMID: 35035903 PMCID: PMC8733827 DOI: 10.12688/f1000research.27432.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Non-invasive screening for atherosclerosis or asymptomatic cardiovascular disease of the coronary and carotid arteries is commonly undertaken, and research has been focussed on how results from these screenings lead to behaviour change. However, no review has focused on the effects of these results on psychological distress and health-related quality of life (HRQoL). This protocol will outline how a scoping review will be conducted to map all available evidence on psychological distress and/or HRQoL outcomes following the provision of vascular imaging results of the coronary and carotid arteries. Methods: Arksey and O’Malley’s (2005) framework subsequently enhanced by Levac et al. (2010) and Peters et al (2015, 2017) will guide the scoping review. Databases such as MEDLINE (Clarivate), APA PsychINFO, EMBASE, Social Work Abstracts, Psychology and Behavioural Sciences Collection, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) will be searched using MeSH terms such as "Coronary stenosis", "Carotid Stenosis", "Psychological Distress" and "Quality of Life" and related terms. Two investigators will screen title and abstract and all articles meeting inclusion criteria will be extracted. Data on authors, publication year, country of origin, aims/purpose, methodology, intervention, outcome measures as well as key findings that relate to the scoping review questions will be extracted for each included study. The findings will be presented using tables and thematic narrative synthesis. The scoping review will not produce a pooled estimate of the impact of vascular imaging results on psychological distress and HRQoL but will present information from the included studies related to psychological distress and HRQoL. Conclusion: The review will highlight and address gaps in knowledge and provide direction for future investigations.
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Affiliation(s)
- Reindolf Anokye
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, 6027, Australia
| | - Ben Jackson
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Crawley, Western Australia, 6009, Australia.,Telethon Kids Institute, Perth, Western Australia, Australia
| | - James Dimmock
- Department of Psychology, James Cook University, Townsville, Queensland, 4811, Australia
| | - Joanne M Dickson
- School of Arts and Humanities (Psychology Discipline), Edith Cowan University, Joondalup, Western Australia, 6027, Australia.,Department of Psychological Science, University of Liverpool, Liverpool, L69 7ZX, UK
| | - Lauren C Blekkenhorst
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, 6027, Australia.,Medical School, University of Western Australia, Crawley, Western Australia, 6009, Australia
| | - Jonathan M Hodgson
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, 6027, Australia.,Medical School, University of Western Australia, Crawley, Western Australia, 6009, Australia
| | - Joshua R Lewis
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, 6027, Australia.,Medical School, University of Western Australia, Crawley, Western Australia, 6009, Australia.,School of Public Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, 2000, Australia
| | - Mandy Stanley
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, 6027, Australia
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Sallay V, Klinovszky A, Csuka SI, Buzás N, Papp-Zipernovszky O. Striving for autonomy in everyday diabetes self-management-qualitative exploration via grounded theory approach. BMJ Open 2021; 11:e058885. [PMID: 34952888 PMCID: PMC9066350 DOI: 10.1136/bmjopen-2021-058885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The rapid worldwide increase in the incidence of diabetes significantly influences the lives of individuals, families and communities. Diabetes self-management requires personal autonomy and the presence of a supportive social environment. These attributes can considerably ameliorate the outcomes of the chronic condition. However, little is known about individual variations in overcoming the illness-related challenges and in the achievement of autonomy in daily activities. This paper seeks to bridge this knowledge gap. DESIGN This qualitative study used the grounded theory approach. Semi-structured interviews were conducted, and the data collection and data analysis probed participant experiences of autonomy through the self-management of their daily socio-physical environments. SETTING Participants were recruited from the outpatient ward of a university clinic in Hungary. PARTICIPANTS The study was conducted with 26 adult patients with type 2 diabetes mellitus (15 females and 11 males aged between 26 and 80 years; M=62.6 years; SD=13.1). The inclusion criteria were: T2D diagnosis at least 1 year before the beginning of the study; prescribed insulin injection therapy; aged over 18 years; native Hungarian speaker and not diagnosed with dementia or any form of cognitive impairment. RESULTS The study established three principal aspects of the active construction of personal autonomy in diabetes self-management: coping strategies vis-à-vis threats posed by the symptoms and the treatment of the disease; autonomous ways of creating protective space and time and relationship processes that support everyday experiences of self-directedness. CONCLUSIONS The results of this study confirm the validity of the self-determination theory in diabetes self-management. They also imply that pathways towards constructing everyday experiences of self-directedness in participants lead through self-acceptance, supporting family relationships and a doctor-patient relationship characterised by partnership. The tentative empirical model of pathways towards patients' experience of self-directedness can serve as a framework for future research, patient-centred clinical practice, and education.
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Affiliation(s)
- Viola Sallay
- Institute of Psychology, University of Szeged, Szeged, Hungary
| | - Andrea Klinovszky
- Department of Health Economics, University of Szeged, Szeged, Hungary
| | - Sára Imola Csuka
- Károly Rácz Doctoral School, Semmelweis University, Budapest, Hungary
- Institute for the Psychology of Special Needs, Eötvös Loránd University, Budapest, Hungary
| | - Norbert Buzás
- Department of Health Economics, University of Szeged, Szeged, Hungary
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10
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Duke N. Type 2 diabetes self-management: spirituality, coping and responsibility. J Res Nurs 2021; 26:743-760. [PMID: 35251282 PMCID: PMC8894753 DOI: 10.1177/17449871211026958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background In England, although The National Institute of Health and Care Excellence recommends that patients’ religious beliefs should be incorporated into individual healthcare plans, these components are often neglected in diabetes management care plans. A literature review identified a paucity of research regarding how the spirituality of British people may influence their approach to their self-management of type 2 diabetes (T2D). Aims To explore how the spirituality of a small group of adults with T2D, living in England, influenced their coping strategies and self-management of diet and exercise. Methods Biographic Narrative Interpretive Method of two interviews per participant and thematic analysis for data interrogation ( n = 8). Data as glycated haemoglobin, living situation, age, length of time since T2D diagnosis, body mass index and diabetic medicines contextualised the interview data. Results Participants’ spirituality, health beliefs, coping and sense of responsibility for T2D self-management overlapped in complex layers. Three themes were generated: (a) spirituality influences expectations in life; (b) beliefs influence coping styles of diabetes self-management; and (c) responsibility influences diabetes self-management. A model was created to assist nurses in addressing these components. Conclusion Nurses should consider how patients’ self-management of T2D may be influenced by their spirituality, health beliefs, coping and sense of responsibility.
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Affiliation(s)
- Natasha Duke
- Independent Consultant, School of Health Sciences, University of Southampton, UK
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11
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Gallardo-Rincón H, Montoya A, Saucedo-Martínez R, Mújica-Rosales R, Suárez-Idueta L, Martínez-Juárez LA, Razo C, Lozano R, Tapia-Conyer R. Integrated Measurement for Early Detection (MIDO) as a digital strategy for timely assessment of non-communicable disease profiles and factors associated with unawareness and control: a retrospective observational study in primary healthcare facilities in Mexico. BMJ Open 2021; 11:e049836. [PMID: 34475175 PMCID: PMC8413929 DOI: 10.1136/bmjopen-2021-049836] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES The Carlos Slim Foundation implemented the Integrated Measurement for Early Detection (MIDO), a screening strategy for non-communicable diseases (NCDs) in Mexico as part of CASALUD, a portfolio of digital health services focusing on healthcare delivery and prevention/management of NCDs. We investigated the disease profile of the screened population and evaluated MIDO's contribution to the continuum of care of the main NCDs. DESIGN Using data from MIDO and the chronic diseases information system, we quantified the proportion of the population screened and diagnosed with NCDs, and measured care linkage/retention and level of control achieved. We analysed comorbidity patterns and estimated prevalence of predisease stages. Finally, we estimated characteristics associated with unawareness and control of NCDs, and examined efficacy of the CASALUD model in improving NCD control. SETTING Public primary health centres in 27/32 Mexican states. PARTICIPANTS Individuals aged ≥20 years lacking healthcare access. RESULTS From 2014 to 2018, 743 000 individuals were screened using MIDO. A predisease or disease condition was detected in ≥70% of the population who were unaware of their NCD status. The screening identified 38 417 new cases of type 2 diabetes, 53 133 new cases of hypertension and 208 627 individuals with obesity. Dyslipidaemia was found in 77.3% of individuals with available blood samples. Comorbidities were highly prevalent, especially in people with obesity. Only 5.47% (n=17 774) of individuals were linked with their corresponding primary health centre. Factors associated with unawareness of and uncontrolled NCDs were sex, age, and social determinants, for example, rural/urban environment, access to healthcare service, and education level. Patients with type 2 diabetes treated at clinics under the CASALUD model were more likely to achieve disease control (OR: 1.32, 95% CI: 1.09 to 1.61). CONCLUSION Patient-centred screening strategies such as MIDO are urgently needed to improve screening, access, retention and control for patients with NCDs.
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Affiliation(s)
- Héctor Gallardo-Rincón
- Health Sciences University Center (CUCS-UdeG), University of Guadalajara, Guadalajara, Jalisco, México
| | | | | | | | | | | | - Christian Razo
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Rafael Lozano
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Roberto Tapia-Conyer
- Carlos Slim Foundation, México City, Mexico
- School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
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Gopalan A, Blatchins MA, Altschuler A, Mishra P, Fakhouri I, Grant RW. Disclosure of New Type 2 Diabetes Diagnoses to Younger Adults: a Qualitative Study. J Gen Intern Med 2021; 36:1622-1628. [PMID: 33501523 PMCID: PMC7837080 DOI: 10.1007/s11606-020-06481-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 12/15/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Adults diagnosed with type 2 diabetes at a younger age are at increased risk for poor outcomes. Yet, little is known about the early experiences of these individuals, starting with communication of the diagnosis. Addressing this knowledge gap is important as this initial interaction may shape subsequent disease-related perceptions and self-management. OBJECTIVE We examined diagnosis disclosure experiences and initial reactions among younger adults with newly diagnosed type 2 diabetes. PARTICIPANTS Purposive sample of adult members of Kaiser Permanente Northern California, an integrated healthcare delivery system, diagnosed with type 2 diabetes before age 45 years. APPROACH We conducted six focus groups between November 2017 and May 2018. Transcribed audio recordings were coded by two coders using thematic analysis. KEY RESULTS Participants (n = 41) were 38.4 (± 5.8) years of age; 10 self-identified as Latinx, 12 as Black, 12 as White, and 7 as multiple or other races. We identified variation in diagnosis disclosure experiences, centered on four key domains: (1) participants' sense of preparedness for diagnosis (ranging from expectant to surprised); (2) disclosure setting (including in-person, via phone, via secure message, or via review of results online); (3) perceived provider tone (from nonchalant, to overly fear-centered, to supportive); and (4) participants' emotional reactions to receiving the diagnosis (including acceptance, denial, guilt, and/or fear, rooted in personal and family experience). CONCLUSIONS For younger adults, the experience of receiving a diabetes diagnosis varies greatly. Given the long-term consequences of inadequately managed diabetes and the need for early disease control, effective initial disclosure represents an opportunity to optimize initial care. Our results suggest several opportunities to improve the type 2 diabetes disclosure experience: (1) providing pre-test counseling, (2) identifying patient-preferred settings for receiving the news, and (3) developing initial care strategies that acknowledge and address the emotional distress triggered by this life-altering, chronic disease diagnosis.
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Affiliation(s)
- Anjali Gopalan
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA.
| | - Maruta A Blatchins
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Andrea Altschuler
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Pranita Mishra
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Issa Fakhouri
- Kaiser Permanente Northern California Stockton Medical Offices, Stockton, CA, USA
| | - Richard W Grant
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
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13
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Namdar A, Karimi M, Vahidi M, Jouybari L, Emami Z, Ranjbar H. Shocked to happy: Experiences of Iranian diabetics in reaction to the bad news of the diagnosis. ACTA FACULTATIS MEDICAE NAISSENSIS 2021. [DOI: 10.5937/afmnai38-28720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Diagnosis of a chronic disease like type 2 diabetes mellitus (T2DM) is frequently shocking for patients, which influences their lives. Getting aware of bad news such as obtaining a chronic illness diagnosis is a sensitive issue in patients' lives. Conversely, reactions to the reception of a diagnosis of diabetes are often varied for a few reasons. To manage the diseases through care planning, the identification and modification of the causes of various reactions are necessary. The aim of the present survey was to investigate the reaction of diabetics to the reception of diabetes diagnosis and its possible reasons. In this qualitative study, in-depth interviews were used. Furthermore, traditional content analysis of semi-structured interviews was conducted using a qualitative strategy with 20 individuals with type 2 diabetes. The purposeful sampling approach was employed for recruiting the participants. Eleven male and nine female participants having type 2 diabetes had been transferred to the diabetes association of Iran for receiving consulting assistance in the areas of nutrition, psychology, and health care. Four categories of reactions have arisen from the investigation including behavioral, emotional, contextual, and cognitive reactions. Reactions to the prognosis of diabetes may be different for some reasons. The findings of the present investigation may be employed by health care providers to obtain a more comprehensive understanding of unusual and usual reactions, their causes, and the context in the early years after the diagnosis and planning care programs for disease management.
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Kumar S, Kumar G, Velu S, Pardhan S, Sivaprasad S, Ruamviboonsuk P, Raman R. Patient and provider perspectives on barriers to screening for diabetic retinopathy: an exploratory study from southern India. BMJ Open 2020; 10:e037277. [PMID: 33303431 PMCID: PMC7733174 DOI: 10.1136/bmjopen-2020-037277] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE Diabetic retinopathy is one of the leading causes of visual impairment after cataract and uncorrected refractive error. It has major public health implications globally, especially in countries such as India where the prevalence of diabetes is high. With timely screening and intervention, the disease progression to blindness can be prevented, but several barriers exist. As compliance to diabetic retinopathy screening in people with diabetes is very poor in India, this study was conducted to explore understanding of and barriers to diabetic retinopathy screening from the perspectives of patients and healthcare providers. METHODS Using qualitative methods, 15 consenting adult patients with diabetes were selected purposively from those attending a large tertiary care private eye hospital in southern India. Eight semistructured interviews were carried out with healthcare providers working in large private hospitals. All interviews were audiotaped, transcribed verbatim and analysed using the framework analytical approach. RESULTS Four themes that best explained the data were recognising and living with diabetes, care-seeking practices, awareness about diabetic retinopathy and barriers to diabetic retinopathy screening. Findings showed that patients were aware of diabetes but understanding of diabetic retinopathy and its complications was poor. Absence of symptoms, difficulties in doctor-patient interactions and tedious nature of follow-up care were some major deterrents to care seeking reported by patients. Difficulties in communicating information about diabetic retinopathy to less literate patients, heavy work pressure and silent progression of the disease were major barriers to patients coming for follow-up care as reported by healthcare providers. CONCLUSIONS Enhancing patient understanding through friendly doctor-patient interactions will promote trust in the doctor. The use of an integrated treatment approach including education by counsellors, setting up of patient support groups, telescreening approaches and use of conversation maps may prove more effective in the long run.
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Affiliation(s)
| | - Geetha Kumar
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India
| | - Saranya Velu
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India
| | - Shahina Pardhan
- Vision and Eye Research Unit (VERU), School of Medicine, Anglia Ruskin University, Cambridge, UK
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India
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15
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Berry E, Davies M, Dempster M. Exploring the perceptions of emotional distress among couples living with Type 2 diabetes and among diabetes healthcare providers, and consideration of support needs. Diabet Med 2020; 37:1669-1678. [PMID: 31206755 DOI: 10.1111/dme.14052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2019] [Indexed: 11/29/2022]
Abstract
AIMS To compare the emotional distress experienced by people with Type 2 diabetes with the perceptions of their partners, and to explore the perceptions of healthcare providers and how these differ from the perceptions and experiences of couples living with Type 2 diabetes regarding their support needs. METHODS A purposive sample of people with Type 2 diabetes and their partners was recruited through Diabetes UK media outlets and support groups, while healthcare providers were recruited through hospital and diabetes education teams. Inductive thematic analysis was conducted. RESULTS Seven people with Type 2 diabetes and six partners took part in separate semi-structured interviews and seven healthcare providers took part in focus groups. Themes emerged regarding unique psychological struggles for people with Type 2 diabetes: 'sense of restriction'; 'disempowerment'; and 'acceptance of diabetes'. For partners the themes of 'feeling responsible' and 'need for greater involvement' emerged. Common themes arising from people with Type 2 diabetes, partners and healthcare providers highlighted diabetes-related stresses: 'self-care struggles' and 'perceived need for appropriate psychological support'. A key theme drawn from healthcare providers was 'perceived professional barriers to psychological support', which captures concerns related to providing emotional support in clinical practice. CONCLUSIONS People with Type 2 diabetes, partners, and healthcare providers share a common understanding of the emotional stresses of living with Type 2 diabetes, but also experience diabetes differently depending on their role and responsibilities. All face barriers that need to be considered to ensure that emotional support in diabetes is meaningful and feasible in routine practice.
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Affiliation(s)
- E Berry
- School of Psychology, Queen's University Belfast, Belfast, UK
| | - M Davies
- Clinical Psychology Department, Belfast Health and Social Care Trust, Belfast, UK
| | - M Dempster
- School of Psychology, Queen's University Belfast, Belfast, UK
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Morgan TL, Semenchuk BN, Ceccarelli L, Kullman SM, Neilson CJ, Kehler DS, Duhamel TA, Strachan SM. Self-Compassion, Adaptive Reactions and Health Behaviours Among Adults With Prediabetes and Type 1, Type 2 and Gestational Diabetes: A Scoping Review. Can J Diabetes 2020; 44:555-565.e2. [PMID: 32680775 DOI: 10.1016/j.jcjd.2020.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 12/21/2022]
Abstract
Engaging in health-promoting behaviours has health benefits for people with prediabetes or diabetes. People experience negative affect after diagnoses, which can impede self-regulation of health behaviours. Self-compassion, extending care to oneself in difficult times, can mitigate negative affect and promote self-regulation. This scoping review explored the relationship between self-compassion and adaptive affect, self-regulation and engagement in health-promoting/management behaviours among people with prediabetes or diabetes. We conducted a scoping literature search from 6 databases for studies and conference abstracts. Randomized controlled trials and cross-sectional, longitudinal, observational and qualitative designs focused on self-compassion were included. Eligible studies included adults with diabetes (prediabetes, type 1, type 2 and gestational), measured self-compassion using a validated Self-Compassion Scale (quantitative) or included the 3 components (qualitative) and investigated: negative affect, health promoting/management behaviours and/or self-regulation. After deduplication, 5,338 quantitative and 953 qualitative abstracts, and 18 conference proceedings were screened leaving 35 articles. Full-text screening retained 11 eligible studies (6 cross-sectional studies, 2 randomized controlled trials, 2 longitudinal studies and 1 qualitative study). Higher self-compassion was associated with decreased negative affect in 9 studies and was positively associated with well-being in 1 cross-sectional study. Self-compassion led to decreased negative affect and improved blood glucose in 2 interventions. Five studies found positive associations between self-compassion and health-promoting/management behaviours. One qualitative study found self-compassion to benefit affective reactions, health-promoting behaviours and self-regulation. This review shows that self-compassion is linked to adaptive behavioural and affective responding among people with prediabetes and diabetes, and the need for more research on self-compassion and self-regulation in these populations.
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Affiliation(s)
- Tamara L Morgan
- School of Kinesiology and Health Studies, Faculty of Arts and Science, Queen's University, Kingston, Ontario, Canada.
| | - Brittany N Semenchuk
- Faculty of Kinesiology & Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Laura Ceccarelli
- Faculty of Kinesiology & Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sasha M Kullman
- Faculty of Kinesiology & Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Christine J Neilson
- University of Manitoba Libraries, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dustin Scott Kehler
- School of Physiotherapy, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Todd A Duhamel
- Faculty of Kinesiology & Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada; Institute of Cardiovascular Sciences, St. Boniface Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada
| | - Shaelyn M Strachan
- Faculty of Kinesiology & Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada
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Ledford CJW, Fisher CL, Cafferty LA, Jackson JT, Crawford PF, Seehusen DA. How patients make sense of a diabetes diagnosis: An application of Weick's model of organizing. Diabetes Res Clin Pract 2020; 162:108117. [PMID: 32179127 DOI: 10.1016/j.diabres.2020.108117] [Citation(s) in RCA: 3] [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: 11/21/2019] [Revised: 02/27/2020] [Accepted: 03/06/2020] [Indexed: 11/22/2022]
Abstract
AIMS To identify communication cycles patients use to make sense of a diabetes diagnosis and barriers patients encounter in their sensemaking process. METHODS Researchers conducted interviews with 33 participants with type 2 diabetes mellitus or prediabetes at medical centers in Georgia and Nevada. A thematic analysis using the constant comparative method identified communication cycles. RESULTS Patients reported engaging three communication cycles to make sense of the diagnosis: (1) interacting with healthcare clinicians; (2) seeking information online; and (3) taking a nutrition/diabetes management class. Patients reported system-level barriers that impact sensemaking: (1) lack of consistent or routine care; and (2) lack of access to resources. CONCLUSION Results here reinforce the theoretical proposition that receiving a diagnosis is an equivocal process that requires patients to make sense of new information through communication cycles. Patients in this sample repeatedly described communication cycles to interpret this new information rather than relying on assembly rules. Clinicians can promote patient understanding of diabetes and self-management by taking time to explain the diagnosis, maintaining consistent care, providing guidance to online sources, and ensuring patients have access to diabetes education.
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Affiliation(s)
- Christy J W Ledford
- Military Primary Care Research Network, Uniformed Services University of the Health Sciences, Department of Family Medicine, 4301 Jones Bridge Road, Bethesda, MD, USA
| | - Carla L Fisher
- University of Florida, College of Journalism and Communications, P.O. Box 118400, Gainesville, FL, USA
| | - Lauren A Cafferty
- Henry M. Jackson Foundation, 6720A Rockledge Dr. Bethesda, MD, USA; Henry M. Jackson Foundation, 6720A Rockledge Dr. Bethesda, MD, USA
| | - Jeremy T Jackson
- Henry M. Jackson Foundation, 6720A Rockledge Dr. Bethesda, MD, USA; Henry M. Jackson Foundation, 6720A Rockledge Dr. Bethesda, MD, USA.
| | - Paul F Crawford
- Henry M. Jackson Foundation, 6720A Rockledge Dr. Bethesda, MD, USA; Nellis Family Medicine Residency, 4700 Las Vegas Boulevard North, Las Vegas, NV, USA
| | - Dean A Seehusen
- Augusta University, Department of Family Medicine, 1120 15th Street, Augusta, GA, USA
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Hart RI, Cameron DA, Cowie FJ, Harden J, Heaney NB, Rankin D, Jesudason AB, Lawton J. The challenges of making informed decisions about treatment and trial participation following a cancer diagnosis: a qualitative study involving adolescents and young adults with cancer and their caregivers. BMC Health Serv Res 2020; 20:25. [PMID: 31914994 PMCID: PMC6950988 DOI: 10.1186/s12913-019-4851-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 12/19/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Limited attention has been paid to adolescents and young adults' (AYA's) experiences in the aftermath of a cancer diagnosis, despite this being a time when potentially life-changing decisions are made. We explored AYA's and caregivers' experiences of, and views about, making treatment and trial participation decisions following a cancer diagnosis, in order to understand, and help facilitate, informed treatment decision-making in this age group. METHODS Interviews were undertaken with 18 AYA diagnosed, or re-diagnosed, with cancer when aged 16-24 years, and 15 parents/caregivers. Analysis focused on the identification and description of explanatory themes. RESULTS Most AYA described being extremely unwell by the time of diagnosis and, consequently, experiencing difficulties processing the news. Distress and acceleration in clinical activity following diagnosis could further impede the absorption of treatment-relevant information. After referral to a specialist cancer unit, many AYA described quickly transitioning to a calm and pragmatic mind-set, and wanting to commence treatment at the earliest opportunity. Most reported seeing information about short-term side-effects of treatment as having limited relevance to their recovery-focused outlook at that time. AYA seldom indicated wanting to make choices about front-line treatment, with most preferring to defer decisions to health professionals. Even when charged with decisions about trial participation, AYA reported welcoming a strong health professional steer. Parents/caregivers attempted to compensate for AYA's limited engagement with treatment-relevant information. However, in seeking to ensure AYA received the best treatment, these individuals had conflicting priorities and information needs. CONCLUSION Our study highlights the challenging context in which AYA are confronted with decisions about front-line treatment, and reveals how their responses make it hard to ensure their decisions are fully informed. It raises questions about the direct value, to AYA, of approaches that aim to promote decision-making by improving understanding and recall of information, though such approaches may be of value to caregivers. In seeking to improve information-giving and involvement in treatment-related decision-making at diagnosis, care should be taken not to delegitimize the preference of many AYA for a directive approach from trusted clinicians.
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Affiliation(s)
- Ruth I Hart
- Usher Institute, Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - David A Cameron
- NHS Research Scotland Cancer Lead and Cancer Research UK Edinburgh Centre, MRC Institute of Genetics & Molecular Medicine, The University of Edinburgh, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XR, UK
| | - Fiona J Cowie
- Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - Jeni Harden
- Usher Institute, Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Nicholas B Heaney
- Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - David Rankin
- Usher Institute, Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Angela B Jesudason
- Royal Hospital for Sick Children, Department of Paediatric Haematology and Oncology, Sciennes Road, Edinburgh, EH9 1LF, UK
| | - Julia Lawton
- Usher Institute, Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK.
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Stagg SD, Belcher H. Living with autism without knowing: receiving a diagnosis in later life. Health Psychol Behav Med 2019; 7:348-361. [PMID: 34040855 PMCID: PMC8114403 DOI: 10.1080/21642850.2019.1684920] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 10/12/2019] [Indexed: 01/30/2023] Open
Abstract
Increasingly adults over the age of 50 are receiving a diagnosis of autism spectrum condition. Growing up in a time when autism was poorly recognised, these adults have lived unknowingly with the condition and face readjustment. This paper reports the first study to investigate this population. Nine adults over the age of 50, who had recently been diagnosed with ASC, were interviewed, and thematic analysis was used to analyse the transcripts. Results showed that the participants had received treatment for anxiety and depression. They reported ASC behaviours in their childhood and growing up they felt isolated and alien. Receiving a diagnosis was seen as a positive step and allowed for a reconfiguration of self and an appreciation of individual needs. Given the positive aspects of receiving a late diagnosis, more work is needed to identify older adults with undiagnosed ASC.
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Affiliation(s)
- Steven D. Stagg
- Department of Psychology, Anglia Ruskin University, Cambridge, United Kingdom
| | - Hannah Belcher
- Department of Psychology, Anglia Ruskin University, Cambridge, United Kingdom
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20
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Side effects and practices to improve management of type 2 diabetes mellitus from the viewpoint of patient experience and health care management. A narrative review. ACTA ACUST UNITED AC 2019; 66:596-610. [PMID: 31409576 DOI: 10.1016/j.endinu.2019.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 05/27/2019] [Accepted: 05/28/2019] [Indexed: 01/22/2023]
Abstract
INTRODUCTION There is an alarming increase in the number of patients with type 2 diabetes mellitus. This increase is causing personal, family, social, economic, and political problems. The aim of this article is to review the side effects of treatments, the complications suffered by patients, and the practices to improve management of this disease from the viewpoint of the experience of patients and health care management. MATERIAL AND METHODS A narrative review was conducted of studies on type 2 diabetes mellitus published in English and Spanish indexed in PubMed, Science Direct, Cinahl, MedLine, Psychology and Behavioral Sciences Collection, and Google academic. A total of 1,118 articles were found, 42 of which referred to the objectives of the review and met the inclusion criteria. RESULTS The side effects and complications experienced by patients and their perception that they do not receive adequate information, together with poor satisfaction, lead to non-adherence to treatment, which impairs patient health and increases health care costs. The proposals in the reviewed studies guide the actions to improve treatment adherence and, thus, quality of life of patients, to decrease side effects and mortality and, therefore, the costs associated to type 2 diabetes mellitus through: 1) quick and easy access to medical care, 2) quality health education, and 3) participation of patients in the decisions about their treatment and in self-management of their disease to make minimum changes in their lifestyles.
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21
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Pikkemaat M, Boström KB, Strandberg EL. "I have got diabetes!" - interviews of patients newly diagnosed with type 2 diabetes. BMC Endocr Disord 2019; 19:53. [PMID: 31126267 PMCID: PMC6534850 DOI: 10.1186/s12902-019-0380-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 05/15/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND To be diagnosed with type 2 diabetes is a challenge for every patient. There are previous studies on patients' experience in general but not addressing the increased cardiovascular risk and multifactorial treatment. The aim of this study was to explore the thoughts, experiences and reactions of newly diagnosed patients with diabetes to this diagnosis and to the risk of developing complications. METHODS Ten adults (7 men/3 women, aged 50-79) diagnosed with type 2 diabetes within the last 12 months were interviewed at a primary health care center in Sweden. An interview guide was used in the semi-structured interviews that were transcribed verbatim. The analysis was qualitative and inspired by systematic text condensation (Malterud). The text was read several times and meaning units were identified. Related meaning units were sorted into codes and related codes into categories during several meetings between the authors. Finally, the categories were merged and formed themes. RESULTS We defined three main themes: Reaction to diagnosis, Life changes and Concerns about the future. Most patients reacted to the diagnosis without intensive feelings. Lifestyle changes were mainly accepted but hard to achieve. The patients' major concerns for the future were the consequences for daily life (being able to drive and read) and concerns for relatives rather than anxieties regarding medical issues such as laboratory tests. There were considerable differences in how much patients wanted to know about their future risks. CONCLUSIONS The results of this study might help to focus doctor-patient communication on issues highlighted by the patients and on the importance of individualizing information and recommendations for each patient.
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Affiliation(s)
- M Pikkemaat
- Husensjö Health Care Center, Skaragatan 102, S-25363, Helsingborg, Sweden.
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden.
| | - K Bengtsson Boström
- R&D Center Skaraborg Primary Care, Skövde, Sweden
- Department of Public Health and Community Medicine, Primary Health Care, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - E L Strandberg
- Department of Clinical Sciences Malmö, Family Medicine, Lund University, Malmö, Sweden
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Abstract
Objective: This qualitative study sought to identify and describe patients' variant perceptions of disease severity after receiving a type 2 diabetes (T2DM) or prediabetes (preDM) diagnosis. Design: Researchers interviewed 29 patients from two US medical centers to ascertain perceptions of severity. We used the constant comparative method from a grounded theory approach to identify themes from patients' perspectives that inform their disease severity. This approach was used to help translate research to practice and ultimately identify intervention strategies informed by authentic experiences of preDM and T2DM patients. Results: Perceptions of disease severity fell into two groups: high and low severity. Patients diagnosed with T2DM and preDM emerged in both groups and were comparative in terms of sample size, gender, and ethnic diversity. Several factors contributed to patients' beliefs, including what they were told about the disease, observations from experiences within their own social network, and information from formal diabetes classes and their own research. The two perspectives diverged when patients described how their belief was informed by three thematic properties or personal factors: (i) fears; (ii) clinician communication; and (iii) social comparisons. Conclusions: Beliefs about severity are influenced by patients' fears, interactions with clinicians, and experiences within their social networks. These findings show that when interacting with patients with T2DM or preDM, clinicians should elicit patient perceptions of disease severity so they may then tailor the discussion to address these perceptions and help patients grasp the severity of these conditions.
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Edelman S, Belton A, Down S, Alzaid A, Capehorn M, Gamerman V, Nagel F, Lee J, Emmerson J, Polonsky WH. Physician-patient communication at prescription of an additional oral drug for type 2 diabetes and its links to patient outcomes - New findings from the global IntroDia® study. Diabetes Res Clin Pract 2019; 149:89-97. [PMID: 30685350 DOI: 10.1016/j.diabres.2019.01.020] [Citation(s) in RCA: 8] [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: 07/30/2018] [Revised: 12/05/2018] [Accepted: 01/15/2019] [Indexed: 11/29/2022]
Abstract
AIMS To investigate experiences of people with type 2 diabetes (T2DM) at the clinic visit when an additional oral antidiabetes drug (OAD) is prescribed, and how this affects their quality of life, self-management and key outcomes. METHODS We surveyed adults with T2DM from a large multinational study of patient-physician communication during early T2DM treatment (IntroDia®). We examined their experiences when an additional OAD is prescribed ("add-on") after initial OAD monotherapy, focusing on 24 key conversational elements, overall patient-perceived communication quality (PPCQ), and associations with current patient-reported outcomes. The links between PPCQ and people's efforts to delay add-on therapy were also assessed. RESULTS 4235 people with T2DM prescribed an additional OAD, or a combination of two, were analysed. Exploratory factor analyses of the conversational elements during add-on yielded three coherent, meaningful factors: Encouraging (Cronbach's α = 0.62), Collaborative (α = 0.81), and Discouraging (α = 0.81). PPCQ was positively associated with Encouraging (β = +1.252, p < 0.001) and Collaborative (β = +1.206, p < 0.001), but negatively associated with Discouraging (β = -0.895, p < 0.001). Better PPCQ at add-on was associated with less diabetes distress, greater well-being and better self-care at the present time. Approximately 20% of people bargained (two-thirds successfully) with their physician to delay additional medication. Non-bargaining individuals reported significantly better mean PPCQ, diabetes distress, well-being and self-care than those who bargained. CONCLUSIONS Encouraging and patient-inclusive conversations at add-on moments may improve patient well-being and self-care outcomes. People with T2DM who attempted to delay additional medication reported poorer PPCQ and outcomes.
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Affiliation(s)
- Steven Edelman
- Division of Endocrinology and Metabolism, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Veterans Affairs Medical Center, 3350 La Jolla Village Dr, San Diego, CA 92161, USA.
| | - Anne Belton
- The Michener Institute of Education at UHN, 222 St. Patrick Street, Toronto, Ontario M5T 1V4, Canada.
| | - Susan Down
- Somerset Partnership NHS Foundation Trust, 2nd Floor, Mallard Court, Express Park, Bristol Road, Bridgwater, Somerset TA6 4RN, United Kingdom.
| | - Aus Alzaid
- Prince Sultan Military Medical City, PO Box 7897, Riyadh 11159, Saudi Arabia.
| | - Matthew Capehorn
- Rotherham Institute for Obesity, and Clifton Medical Centre, Doncaster Gate, Rotherham, South Yorkshire S65 1DA, United Kingdom.
| | - Victoria Gamerman
- Boehringer Ingelheim Pharmaceuticals, Inc., 900 Ridgebury Road, PO Box 368, Ridgefield, CT 06877, USA.
| | - Friederike Nagel
- Boehringer Ingelheim GmbH, Binger Straße 173, D-55216 Ingelheim am Rhein, Germany.
| | - Jisoo Lee
- Boehringer Ingelheim International GmbH, Binger Straße 173, D-55216 Ingelheim am Rhein, Germany.
| | - James Emmerson
- Boehringer Ingelheim International GmbH, Binger Straße 173, D-55216 Ingelheim am Rhein, Germany.
| | - William H Polonsky
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Behavioral Diabetes Institute, 5405 Oberlin Drive, Suite 100, San Diego, CA 92121, USA.
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Down S, Alzaid A, Polonsky WH, Belton A, Edelman S, Gamerman V, Nagel F, Lee J, Emmerson J, Capehorn M. Physician experiences when discussing the need for additional oral medication with type 2 diabetes patients: Insights from the cross-national IntroDia® study. Diabetes Res Clin Pract 2019; 148:179-188. [PMID: 30641173 DOI: 10.1016/j.diabres.2019.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 12/05/2018] [Accepted: 01/04/2019] [Indexed: 12/30/2022]
Abstract
AIMS Physician-patient communication when discussing the need for additional oral medication for type 2 diabetes (add-on) may affect the self-care of people with this condition. We aimed to investigate physicians' recalled experiences of the add-on consultation. METHODS We conducted a cross-sectional survey of physicians treating people with type 2 diabetes in 26 countries, as part of a large cross-national study of physician-patient communication during early treatment of type 2 diabetes (IntroDia®). The survey battery included novel questions about physician experiences at add-on and the Jefferson Scale of Physician Empathy. RESULTS Of 9247 eligible physicians, 6753 responded (73.0% response rate). Most (82%) agreed that physician-patient discussions at add-on strongly influence patients' disease acceptance and treatment adherence. Half the physicians reported ≥1 challenge in most or all add-on conversations, with a significant inverse relationship between frequency of challenges and Jefferson Scale of Physician Empathy score (standardised β coefficient: -0.313; p < 0.001). Physicians estimated that only around half their patients with type 2 diabetes follow their self-care advice. Exploratory factor analysis of physician beliefs about why their patients did not follow recommendations yielded two distinct dimensions: psychosocial barriers (e.g. depressed mood) and personal failings of the patient (e.g. not enough willpower) (r = 0.37, p < 0.001). CONCLUSIONS Physicians' empathy and beliefs about their patients may play a significant role in their success with the add-on conversation and, consequently, promotion of patient engagement and self-care. Although the study was limited by its retrospective, cross-sectional nature, the findings from IntroDia® may inform efforts to improve diabetes care.
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Affiliation(s)
- Susan Down
- Somerset Partnership NHS Foundation Trust, Parkgate House, East Reach, Taunton, Somerset TA1 3ES, United Kingdom.
| | - Aus Alzaid
- Prince Sultan Military Medical City, PO Box 7897, Riyadh 11159, Saudi Arabia.
| | - William H Polonsky
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Behavioral Diabetes Institute, 5405 Oberlin Drive, Suite 100, San Diego, CA 92121, USA.
| | - Anne Belton
- The Michener Institute of Education at UHN, 222 St. Patrick Street, Toronto, Ontario M5T 1V4, Canada.
| | - Steven Edelman
- Division of Endocrinology and Metabolism, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Veterans Affairs Medical Center, 3350 La Jolla Village Dr, San Diego, CA 92161, USA.
| | - Victoria Gamerman
- Boehringer Ingelheim Pharmaceuticals, Inc., 900 Ridgebury Road, PO Box 368, Ridgefield, CT 06877, USA.
| | - Friederike Nagel
- Boehringer Ingelheim GmbH, Binger Straße 173, D-55216 Ingelheim am Rhein, Germany.
| | - Jisoo Lee
- Boehringer Ingelheim International GmbH, Binger Straße 173, D-55216 Ingelheim am Rhein, Germany.
| | - James Emmerson
- Boehringer Ingelheim International GmbH, Binger Straße 173, D-55216 Ingelheim am Rhein, Germany.
| | - Matthew Capehorn
- Rotherham Institute for Obesity, and Clifton Medical Centre, Doncaster Gate, Rotherham, South Yorkshire S65 1DA, United Kingdom.
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Dimova ED, Ward A, Swanson V, Evans JMM. Patients' Illness Perceptions of Type 2 Diabetes: A Scoping Review. Curr Diabetes Rev 2019; 15:15-30. [PMID: 29283073 DOI: 10.2174/1573399814666171227214845] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 12/14/2017] [Accepted: 12/14/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND People's personal perceptions, or illness representations, of type 2 diabetes can act as barriers to successful self-management. INTRODUCTION Understanding patients' subjective perceptions of type 2 diabetes can aid the design of evidence-based care and appropriate educational programmes. This scoping review provides a narrative account of previous knowledge of patients' illness representations of type 2 diabetes. METHODS Quantitative and qualitative studies that explored patients' illness representations of type 2 diabetes, as defined by Leventhal's Common Sense Model, were included. RESULTS Thirty four studies were identified for this review, but only 14 studies were carried out in a general population of people with diabetes. Illness representations varied across study populations. While it is clear that the perceptions of ethnic minorities and marginalised groups are embedded in their historical and cultural backgrounds, it is also important to understand the views of the wider population. CONCLUSION The review highlights the need for self-management interventions to reflect the target population's representations of type 2 diabetes in order to inform interventions and clinical practice.
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Affiliation(s)
- Elena D Dimova
- Faculty of Health Sciences and Sport, University of Stirling, FK9 4LA, Scotland, United Kingdom
| | - Ashleigh Ward
- Faculty of Health Sciences and Sport, University of Stirling, FK9 4LA, Scotland, United Kingdom
| | - Vivien Swanson
- Faculty of Natural Sciences, University of Stirling, FK9 4LA, Scotland, United Kingdom
| | - Josie M M Evans
- Faculty of Health Sciences and Sport, University of Stirling, FK9 4LA, Scotland, United Kingdom
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Strachan SM, Bean C, Jung ME. 'I'm on the train and I can't stop it': Western Canadians' reactions to prediabetes and the role of self-compassion. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:979-987. [PMID: 30074658 DOI: 10.1111/hsc.12628] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 06/29/2018] [Accepted: 07/03/2018] [Indexed: 06/08/2023]
Abstract
Prediabetes, a condition characterised by impaired glucose regulation, is on the rise worldwide. This condition puts people at risk for cardiovascular disease, and 50% of people with prediabetes will develop type 2 diabetes (T2D). People with prediabetes can reduce their risk of developing T2D through lifestyle changes such as regular physical activity and healthy eating. However, the experience of health risks can be associated with negative reactions that can undermine people's ability to self-regulate the health behaviours that would reduce such risk. Self-compassion, or treating oneself kindly in the face of challenge, is known to help people manage negative emotions and facilitate self-regulation. Therefore, self-compassion may be helpful for people with prediabetes who have to manage their health behaviours in the context of a health threat. The purpose of this study was to explore how people, from a small Canadian city who learn that they have prediabetes, react emotionally to their prediabetes diagnosis. We also explored participants' receptivity to applying self-compassion in the context of their prediabetes. Twenty-one adults, recently notified by their doctors as having HbA1c scores indicative of prediabetes (Mage = 57.76, SD = 5.43), engaged in a semi-structured interview between June 2017 and January 2018. Inductive thematic analysis was used to analyse the data and four themes emerged. Participants' reactions to learning that they had prediabetes were characterised by (a) distress and concern, (b) downplay of T2D risks, (c) guilt and shame, and participants were receptive to (d) self-compassion as a beneficial approach to take in relation to their prediabetes. Findings suggest that people experience negative reactions to their prediabetes diagnosis yet are receptive to self-compassion, which could mitigate these reactions. These findings can inform lifestyle behaviour change programmes for individuals living with prediabetes by providing a better understanding of their perspectives of disease diagnosis.
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Affiliation(s)
- Shaelyn M Strachan
- Faculty of Kinesiology and Recreation Management, Winnipeg, Manitoba, Canada
| | - Corliss Bean
- Faculty of Health and Social Development, The University of British Columbia, Kelowna, British Columbia, Canada
| | - Mary E Jung
- Faculty of Health and Social Development, The University of British Columbia, Kelowna, British Columbia, Canada
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Murray E, Ross J, Pal K, Li J, Dack C, Stevenson F, Sweeting M, Parrott S, Barnard M, Yardley L, Michie S, May C, Patterson D, Alkhaldi G, Fisher B, Farmer A, O’Donnell O. A web-based self-management programme for people with type 2 diabetes: the HeLP-Diabetes research programme including RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2018. [DOI: 10.3310/pgfar06050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background
In the UK, 6% of the UK population have diabetes mellitus, 90% of whom have type 2 diabetes mellitus (T2DM). Diabetes mellitus accounts for 10% of NHS expenditure (£14B annually). Good self-management may improve health outcomes. NHS policy is to refer all people with T2DM to structured education, on diagnosis, to improve their self-management skills, with annual reinforcement thereafter. However, uptake remains low (5.6% in 2014–15). Almost all structured education is group based, which may not suit people who work, who have family or other caring commitments or who simply do not like group-based formats. Moreover, patient needs vary with time and a single education session at diagnosis is unlikely to meet these evolving needs. A web-based programme may increase uptake.
Objectives
Our aim was to develop, evaluate and implement a web-based self-management programme for people with T2DM at any stage of their illness journey, with the goal of improving access to, and uptake of, self-management support, thereby improving health outcomes in a cost-effective manner. Specific objectives were to (1) develop an evidence-based theoretically informed programme that was acceptable to patients and health-care professionals (HCPs) and that could be readily implemented within routine NHS care, (2) determine the clinical effectiveness and cost-effectiveness of the programme compared with usual care and (3) determine how best to integrate the programme into routine care.
Design
There were five linked work packages (WPs). WP A determined patient requirements and WP B determined HCP requirements for the self-management programme. WP C developed and user-tested the Healthy Living for People with type 2 Diabetes (HeLP-Diabetes) programme. WP D was an individually randomised controlled trial in primary care with a health economic analysis. WP E used a mixed-methods and case-study design to study the potential for implementing the HeLP-Diabetes programme within routine NHS practice.
Setting
English primary care.
Participants
People with T2DM (WPs A, D and E) or HCPs caring for people with T2DM (WPs B, C and E).
Intervention
The HeLP-Diabetes programme; an evidence-based theoretically informed web-based self-management programme for people with T2DM at all stages of their illness journey, developed using participatory design principles.
Main outcome measures
WPs A and B provided data on user ‘wants and needs’, including factors that would improve the uptake and accessibility of the HeLP-Diabetes programme. The outcome for WP C was the HeLP-Diabetes programme itself. The trial (WP D) had two outcomes measures: glycated haemoglobin (HbA1c) level and diabetes mellitus-related distress, as measured with the Problem Areas in Diabetes (PAID) scale. The implementation outcomes (WP E) were the adoption and uptake at clinical commissioning group, general practice and patient levels and the identification of key barriers and facilitators.
Results
Data from WPs A and B supported our holistic approach and addressed all areas of self-management (medical, emotional and role management). HCPs voiced concerns about linkage with the electronic medical records (EMRs) and supporting patients to use the programme. The HeLP-Diabetes programme was developed and user-tested in WP C. The trial (WP D) recruited to target (n = 374), achieved follow-up rates of over 80% and the intention-to-treat analysis showed that there was an additional improvement in HbA1c levels at 12 months in the intervention group [mean difference –0.24%, 95% confidence interval (CI) –0.44% to –0.049%]. There was no difference in overall PAID score levels (mean difference –1.5 points, 95% CI –3.9 to 0.9 points). The within-trial health economic analysis found that incremental costs were lower in the intervention group than in the control group (mean difference –£111, 95% CI –£384 to £136) and the quality-adjusted life-years (QALYs) were higher (mean difference 0.02 QALYs, 95% CI 0.000 to 0.044 QALYs), meaning that the HeLP-Diabetes programme group dominated the control group. In WP E, we found that the HeLP-Diabetes programme could be successfully implemented in primary care. General practices that supported people in registering for the HeLP-Diabetes programme had better uptake and registered patients from a wider demographic than those relying on patient self-registration. Some HCPs were reluctant to do this, as they did not see it as part of their professional role.
Limitations
We were unable to link the HeLP-Diabetes programme with the EMRs or to determine the effects of the HeLP-Diabetes programme on users in the implementation study.
Conclusions
The HeLP-Diabetes programme is an effective self-management support programme that is implementable in primary care.
Future work
The HeLP-Diabetes research team will explore the following in future work: research to determine how to improve patient uptake of self-management support; develop and evaluate a structured digital educational pathway for newly diagnosed people; develop and evaluate a digital T2DM prevention programme; and the national implementation of the HeLP-Diabetes programme.
Trial registration
Research Ethics Committee reference number 10/H0722/86 for WPs A–C; Research Ethics Committee reference number 12/LO/1571 and UK Clinical Research Network/National Institute for Health Research (NIHR) Portfolio 13563 for WP D; and Research Ethics Committee 13/EM/0033 for WP E. In addition, for WP D, the study was registered with the International Standard Randomised Controlled Trial Register as reference number ISRCTN02123133.
Funding details
This project was funded by the NIHR Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 6, No. 5. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Jamie Ross
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Kingshuk Pal
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Jinshuo Li
- Department of Health Sciences, University of York, Heslington, York, UK
| | - Charlotte Dack
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Fiona Stevenson
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Michael Sweeting
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, Heslington, York, UK
| | - Maria Barnard
- Whittington Hospital, Whittington Health NHS Trust, London, UK
| | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, UK
| | - Susan Michie
- Centre for Behaviour Change, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Carl May
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - David Patterson
- Whittington Hospital, Whittington Health NHS Trust, London, UK
| | - Ghadah Alkhaldi
- Research Department of Primary Care and Population Health, University College London, London, UK
- Community Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Brian Fisher
- Patient Access to Electronic Records Systems Ltd (PAERS), Evergreen Life, Manchester, UK
| | - Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Orla O’Donnell
- Research Department of Primary Care and Population Health, University College London, London, UK
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Cleal B, Panton UH, Willaing I, Holt R. Incidence of filled antidepressant prescriptions among people with newly diagnosed diabetes and its interaction with occupational status within the working population of Denmark 1996-2010. Prim Care Diabetes 2018; 12:305-311. [PMID: 29409730 DOI: 10.1016/j.pcd.2018.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/21/2017] [Accepted: 01/01/2018] [Indexed: 02/09/2023]
Abstract
AIMS People with diabetes have heightened levels of depressive symptoms, but less is known about the development of these symptoms in relation to diabetes duration. In this study, we examined the use of prescribed antidepressants in the first five years after diagnosis of diabetes among the working-age population in Denmark. METHODS All Danish adults aged 18-54 years, diagnosed with diabetes in the study period were included. Diabetes status and purchase of prescription antidepressants were obtained from validated population registers. Data analysis focused on filled antidepressant prescriptions at ≤1 and ≤5years from diagnosis with diabetes. RESULTS 35,677 people diagnosed with diabetes were included in the study. At ≤1 year post-diagnosis, 2.6% had filled antidepressant prescriptions. At ≤5years, this figure rose to 10.4%. Overall, both female gender and lower socioeconomic status were associated with higher incidence of filled antidepressant prescriptions. Diabetes duration modified the degree of differences between men and women and socioeconomic strata. CONCLUSION Diagnosis with diabetes immediately impacts mental wellbeing, with higher rates of filled antidepressant prescriptions in the first year after diagnosis. People of working age diagnosed with diabetes face specific challenges and addressing such challenges would enhance patient experiences. Focus on mental health in the clinical encounter with people newly diagnosed with diabetes is warranted and important.
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Affiliation(s)
- Bryan Cleal
- Health Promotion Research, Steno Diabetes Center Copenhagen, Niels Steensens Vej 6, Gentofte DK-2820, Denmark.
| | | | - Ingrid Willaing
- Health Promotion Research, Steno Diabetes Center Copenhagen, Niels Steensens Vej 6, Gentofte DK-2820, Denmark
| | - Richard Holt
- Human Development and Health Academic Unit, Faculty of Medicine, The Institute of Developmental Sciences (IDS Building), MP887, University of Southampton, Southampton General Hospital, Hampshire, United Kingdom
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Gardsten C, Blomqvist K, Rask M, Larsson Å, Lindberg A, Olsson G. Challenges in everyday life among recently diagnosed and more experienced adults with type 2 diabetes: A multistage focus group study. J Clin Nurs 2018; 27:3666-3678. [PMID: 29495094 DOI: 10.1111/jocn.14330] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2018] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To identify perceived challenges related to self-management among recently diagnosed adults and those with longer experience of type 2 diabetes as a foundation for the future development of a person-centred information and communication technology service. BACKGROUND Learning self-management of type 2 diabetes includes mastering the skills required to complete complex emotional and physical tasks. A service developed with the participation of stakeholders may be an alternative way to meet rising needs for self-management. DESIGN Qualitative descriptive design influenced by a participatory approach. METHODS Multistage focus group interviews among one group of recently diagnosed (≤3 years, n = 4) adults and one group with longer experience (≥5 years, n = 7) of type 2 diabetes. RESULTS Challenges in self-management in everyday life with type 2 diabetes were identified: understanding; developing skills and abilities; and mobilising personal strengths. Both groups described challenges in understanding the causes of fluctuating blood glucose and in developing and mobilising skills for choosing healthful food and eating regularly. The recently diagnosed group was more challenged by learning to accept the diagnosis and becoming motivated to change habits while the experienced group was mainly challenged by issues about complications and medications. CONCLUSION Adults with diabetes have different needs for support during different phases of the disease. From a person-centred perspective, it would be desirable to meet individual needs for self-management on peoples' own terms through a technological service that could reach and connect to a large number of people. RELEVANCE TO CLINICAL PRACTICE Diabetes nurses need to address the knowledge needs of patients with diabetes and support them in developing self-management skills. Consistent with person-centred care, practitioners should also encourage patients' abilities to mobilise their own personal strengths to maintain self-management.
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Affiliation(s)
- Cecilia Gardsten
- Faculty of Health Science, Research Platform for Collaboration for Health, Kristianstad University, Kristianstad, Sweden.,Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Kerstin Blomqvist
- Faculty of Health Science, Research Platform for Collaboration for Health, Kristianstad University, Kristianstad, Sweden
| | - Mikael Rask
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Åse Larsson
- Primary Healthcare, Region Skåne, Hässleholm, Sweden
| | - Agneta Lindberg
- Department of Medicine, Hässleholm Hospital Organization, Hässleholm, Sweden
| | - Gith Olsson
- Department of Medicine, Hässleholm Hospital Organization, Hässleholm, Sweden
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Hoffmann J, Haastert B, Brüne M, Kaltheuner M, Begun A, Chernyak N, Icks A. How do patients with diabetes report their comorbidities? Comparison with administrative data. Clin Epidemiol 2018; 10:499-509. [PMID: 29750054 PMCID: PMC5933335 DOI: 10.2147/clep.s135872] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
AIMS Patients with diabetes are probably often unaware of their comorbidities. We estimated agreement between self-reported comorbidities and administrative data. METHODS In a random sample of 464 diabetes patients, data from a questionnaire asking about the presence of 14 comorbidities closely related to diabetes were individually linked with statutory health insurance data. RESULTS Specificities were >97%, except cardiac insufficiency (94.5%), eye diseases (93.8%), peripheral arterial disease (92.6%), hypertension (90.9%), and peripheral neuropathy (85.8%). Sensitivities were <60%, except amputation (100%), hypertension (83.1%), and myocardial infarction (67.2%). A few positive predictive values were >90% (hypertension, myocardial infarction, and eye disease), and six were below 70%. Six negative predictive values were >90%, and two <70% (hypertension and eye disease). Total agreement was between 42.7% (eye disease) and 100% (dialysis and amputation). Overall, substantial agreement was observed for three morbidities (kappa 0.61-0.80: hypertension, myocardial infarction, and amputation). Moderate agreement (kappa 0.41-0.60) was estimated for angina pectoris, heart failure, stroke, peripheral neuropathy, and kidney disease. Factors associated with agreement were the number of comorbidities, diabetes duration, age, sex, and education. CONCLUSIONS Myocardial infarction and amputation were well reported by patients as comorbidities; eye diseases and foot ulceration rather poorly, particularly in older, male, or less educated patients. Patient information needs improving.
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Affiliation(s)
- Jonas Hoffmann
- Institute of Health Services Research and Health Economics, German Diabetes Center, Düsseldorf, Germany
| | | | - Manuela Brüne
- Institute of Health Services Research and Health Economics, German Diabetes Center, Düsseldorf, Germany
| | | | - Alexander Begun
- Institute of Health Services Research and Health Economics, German Diabetes Center, Düsseldorf, Germany
| | - Nadja Chernyak
- Faculty of Medicine, Centre for Health and Society, Institute of Health Services Research and Health Economics, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Andrea Icks
- Institute of Health Services Research and Health Economics, German Diabetes Center, Düsseldorf, Germany
- Faculty of Medicine, Centre for Health and Society, Institute of Health Services Research and Health Economics, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research, Ingolstädter Neuherberg, Germany
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Biernatzki L, Kuske S, Genz J, Ritschel M, Stephan A, Bächle C, Droste S, Grobosch S, Ernstmann N, Chernyak N, Icks A. Information needs in people with diabetes mellitus: a systematic review. Syst Rev 2018; 7:27. [PMID: 29444711 PMCID: PMC5813383 DOI: 10.1186/s13643-018-0690-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 01/17/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The purpose of this study was to identify and analyse currently available knowledge on information needs of people with diabetes mellitus, also considering possible differences between subgroups and associated factors. METHODS Twelve databases including MEDLINE, EMBASE and the Cochrane Library were searched up until June 2015. Publications that addressed self-reported information needs of people with diabetes mellitus were included. Each study was assessed by using critical appraisal tools, e.g. from the UK National Institute for Health and Care Excellence. Extraction and content analysis were performed systematically. RESULTS In total, 1993 publications were identified and 26 were finally included. Nine main categories of information needs were identified, including 'treatment-process', 'course of disease', 'abnormalities of glucose metabolism' and 'diabetes through the life cycle'. Differences between patient subgroups, such as type of diabetes or age, were sparsely analysed. Some studies analysed associations between information needs and factors such as participation preferences or information seeking. They found, for example, that information needs on social support or life tasks were associated with information seeking in Internet forums. CONCLUSION Information needs in people with diabetes mellitus, appear to be high, yet poorly investigated. Research is needed regarding differences between diverse diabetes populations, including gender aspects or changes in information needs during the disease course. SYSTEMATIC REVIEW REGISTRATION The review protocol has been registered at Prospero ( CRD42015029610 ).
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Affiliation(s)
- Lisa Biernatzki
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Silke Kuske
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University, Moorenstraße 5, 40225 Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research, at Heinrich Heine University Düsseldorf, Auf’m Hennekamp 65, 40225 Düsseldorf, Germany
| | - Jutta Genz
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research, at Heinrich Heine University Düsseldorf, Auf’m Hennekamp 65, 40225 Düsseldorf, Germany
| | - Michaela Ritschel
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University, Moorenstraße 5, 40225 Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research, at Heinrich Heine University Düsseldorf, Auf’m Hennekamp 65, 40225 Düsseldorf, Germany
| | - Astrid Stephan
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Christina Bächle
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University, Moorenstraße 5, 40225 Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research, at Heinrich Heine University Düsseldorf, Auf’m Hennekamp 65, 40225 Düsseldorf, Germany
| | - Sigrid Droste
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Sandra Grobosch
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University, Moorenstraße 5, 40225 Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research, at Heinrich Heine University Düsseldorf, Auf’m Hennekamp 65, 40225 Düsseldorf, Germany
| | - Nicole Ernstmann
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Nadja Chernyak
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University, Moorenstraße 5, 40225 Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research, at Heinrich Heine University Düsseldorf, Auf’m Hennekamp 65, 40225 Düsseldorf, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University, Moorenstraße 5, 40225 Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research, at Heinrich Heine University Düsseldorf, Auf’m Hennekamp 65, 40225 Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
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Sebire SJ, Toumpakari Z, Turner KM, Cooper AR, Page AS, Malpass A, Andrews RC. "I've made this my lifestyle now": a prospective qualitative study of motivation for lifestyle change among people with newly diagnosed type two diabetes mellitus. BMC Public Health 2018; 18:204. [PMID: 29386030 PMCID: PMC5793401 DOI: 10.1186/s12889-018-5114-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 01/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diagnosis with Type 2 Diabetes is an opportunity for individuals to change their physical activity and dietary behaviours. Diabetes treatment guidelines recommend theory-based, patient-centred care and advocate the provision of support for patient motivation but the motivational experiences of people newly diagnosed with diabetes have not been well studied. Framed in self-determination theory, this study aimed to qualitatively explore how this patient group articulate and experience different types of motivation when attempting lifestyle change. METHODS A secondary analysis of semi-structured interview data collected with 30 (n female = 18, n male = 12) adults who had been newly diagnosed with type two diabetes and were participants in the Early ACTID trial was undertaken. Deductive directed content analysis was performed using NVivo V10 and researcher triangulation to identify and describe patient experiences and narratives that reflected the motivation types outlined in self-determination theory and if/how these changed over time. RESULTS The findings revealed the diversity in motivation quality both between and within individuals over time and that patients with newly-diagnosed diabetes have multifaceted often competing motivations for lifestyle behaviour change. Applying self-determination theory, we identified that many participants reported relatively dominant controlled motivation to comply with lifestyle recommendations, avoid their non-compliance being "found out" or supress guilt following lapses in behaviour change attempts. Such narratives were accompanied by experiences of frustrating slow behaviour change progress. More autonomous motivation was expressed as something often achieved over time and reflected goals to improve health, quality of life or family time. Motivational internalisation was evident and some participants had integrated their behaviour change to a new way of life which they found resilient to common barriers. CONCLUSIONS Motivation for lifestyle change following diagnosis with type two diabetes is complex and can be relatively low in self-determination. To achieve the patient empowerment aspirations of current national health care plans, intervention developers, and clinicians would do well to consider the quality not just quantity of their patients' motivation. TRIAL REGISTRATION ISRCTN ISRCTN92162869 . Retrospectively registered.
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Affiliation(s)
- Simon J. Sebire
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ UK
| | - Zoi Toumpakari
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ UK
| | - Katrina M. Turner
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Ashley R. Cooper
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Angie S. Page
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Alice Malpass
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Robert C. Andrews
- Institute of Biomedical and Clinical Sciences, University of Exeter Medical School, Medical Research, RILD Level 3, Barrack Road, Exeter, Devon EX2 5DW UK
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Al Hamid AM, Ghaleb M, Aljadhey H, Aslanpour Z. Factors contributing to medicine-related problems in adult patients with diabetes and/or cardiovascular diseases in Saudi Arabia: a qualitative study. BMJ Open 2017; 7:e017664. [PMID: 29133322 PMCID: PMC5695315 DOI: 10.1136/bmjopen-2017-017664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 08/09/2017] [Accepted: 08/16/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To investigate the factors contributing to medicine-related problems (MRPs) among patients with cardiovascular diseases (CVDs) and/or diabetes in Saudi Arabia. DESIGN Qualitative semistructured interviews were conducted. Interviews were audio recorded then transcribed into Microsoft Word. The transcribed interviews were then imported into the qualitative analysis software NVivo where thematic analysis was applied. Thematic synthesis was achieved by coding and developing subthemes/themes from the findings of the interviews. SETTING Five healthcare centres in Najran, Saudi Arabia. PARTICIPANTS 25 adult patients with diabetes and/or CVDs. RESULTS The study cohort included 16 men and 9 women with a median age of 61.8 years (40-85 years). Diabetes was the main condition encountered among 23 patients and CVDs were reported among 18 patients. Perceived factors leading to MRPs were of four types and related to: patient-, healthcare system-, clinical (condition-) and medicine-related factors. Patient-related factors were related to living situation, religious practices, diet/exercise and patients' behaviour towards the condition and medicines. Healthcare system-related factors comprised sources and availability of medicines, ease of access to healthcare system and patient satisfaction with healthcare providers. Clinical (condition-) related factors associated with both the knowledge and control over condition, and effects of the condition among medicines intake. Medicine-related factors included lack of knowledge about medicines and medicine use. CONCLUSIONS The results of this study uncovered many factors associated with MRPs among patients with CVDs and diabetes in Saudi Arabia, especially in reference to lifestyle and medicine use. Improving communication with healthcare professional alongside the introduction of national clinical guidance would mitigate the unwanted health complications related to medicine use.
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Affiliation(s)
- Abdullah Mahdi Al Hamid
- Department of Pharmacy, Pharmacology and Postgraduate Medicine, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Maisoon Ghaleb
- Department of Pharmacy, Pharmacology and Postgraduate Medicine, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Hisham Aljadhey
- College of Pharmacy, King Saud University, Riyadh, Riyadh, Saudi Arabia
| | - Zoe Aslanpour
- Department of Pharmacy, Pharmacology and Postgraduate Medicine, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Hertfordshire, UK
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Capehorn M, Polonsky WH, Edelman S, Belton A, Down S, Gamerman V, Nagel F, Lee J, Alzaid A. Challenges faced by physicians when discussing the Type 2 diabetes diagnosis with patients: insights from a cross-national study (IntroDia ® ). Diabet Med 2017; 34:1100-1107. [PMID: 28370335 DOI: 10.1111/dme.13357] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2017] [Indexed: 12/30/2022]
Abstract
AIMS To investigate physicians' recalled experiences of their conversations with patients at diagnosis of Type 2 diabetes, because physician-patient communication at that time may influence the patient's subsequent self-care and outcomes. METHODS As part of a large cross-national study of physician-patient communication during early treatment of Type 2 diabetes (IntroDia® ), we conducted a cross-sectional survey of physicians treating people with Type 2 diabetes in 26 countries across Africa, Asia, Europe, Latin America, the Middle East, North America and Oceania. The survey battery was designed to evaluate physician experiences during diagnosis conversations as well as physician empathy (measured using the Jefferson Scale of Physician Empathy). RESULTS A total of 6753 of 9247 eligible physicians completed the IntroDia® survey (response rate 73.0%). Most respondents (87.5%) agreed that the conversation at diagnosis of Type 2 diabetes impacts the patient's acceptance of the condition and self-care. However, almost all physicians (98.9%) reported challenges during this conversation. Exploratory factor analysis revealed two related yet distinct types of challenges (r = 0.64, P < 0.0001) associated with either patients (eight challenges, α = 0.87) or the situation itself at diagnosis (four challenges, α = 0.72). There was a significant inverse association between physician empathy and overall challenge burden, as well as between empathy and each of the two types of challenges (all P < 0.0001). Study limitations include reliance on accurate physician recall and inability to assign causality to observed associations. CONCLUSIONS Globally, most physicians indicated that conversations with patients at diagnosis of Type 2 diabetes strongly influence patient self-care. Higher physician empathy was associated with fewer challenges during the diagnosis conversation.
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Affiliation(s)
- M Capehorn
- Rotherham Institute for Obesity, Rotherham, UK
- Clifton Medical Centre, Rotherham, UK
| | - W H Polonsky
- Department of Psychiatry, University of California San Diego, San Diego, USA
- Behavioral Diabetes Institute, San Diego, USA
| | - S Edelman
- Division of Endocrinology and Metabolism, University of California San Diego, San Diego, USA
- Veterans Affairs Medical Center, San Diego, USA
| | - A Belton
- International Diabetes Federation, Brussels, Belgium
- The Michener Institute of Education at UHN, Toronto, Ontario, Canada
| | - S Down
- Somerset Partnership NHS Foundation Trust, Bridgwater, UK
| | - V Gamerman
- Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, USA
| | - F Nagel
- Boehringer Ingelheim GmbH, Ingelheim, Germany
| | - J Lee
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - A Alzaid
- Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Laursen DH, Christensen KB, Christensen U, Frølich A. Assessment of short and long-term outcomes of diabetes patient education using the health education impact questionnaire (HeiQ). BMC Res Notes 2017; 10:213. [PMID: 28619041 PMCID: PMC5471707 DOI: 10.1186/s13104-017-2536-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 06/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Type 2 diabetes is a progressive chronic illness that will affect more than 500 million people worldwide by 2030. It is a significant cause of morbidity and mortality. Finding the right care management for diabetes patients is necessary to effectively address the growing population of affected individuals and escalating costs. Patient education is one option for improving patient self-management. However, there are large discrepancies in the outcomes of such programs and long-term data are lacking. We assessed the short and long-term outcomes of diabetes patient education using the health education impact questionnaire (HeiQ). METHODS We conducted a observational cohort study of 83 type 2 diabetes patients participating in patient education programs in Denmark. The seven-scale HeiQ was completed by telephone interview at baseline and 2 weeks (76 participants, 93%) and 12 months (66, 80%) after the patient education ended. Changes over time were assessed using mean values and standard deviation at each time point and Cohen effect sizes. RESULTS Patients reported improvements 2 weeks after the program ended in 4 of 7 constructs: skills and technique acquisition (ES = 0.59), self-monitoring and insight (ES = 0.52), constructive attitudes and approaches (ES = 0.43) and social integration and support (ES = 0.27). After 12 months, patients reported improvements in 3 of 7 constructs: skills and technique acquisition (ES = 0.66), constructive attitudes and approaches (ES = 0.43), and emotional wellbeing (ES = 0.44). Skills and technique showed the largest short- and long-term effect size. No significant changes were found in health-related activity or positive and active engagement in life over time. CONCLUSION After 12 months, diabetes patients who participated in patient education demonstrated increased self-management skills, improved acceptance of their chronic illness and decreased negative emotional response to their disease. Applying HeiQ as an outcome measure yielded new knowledge as to what patients with diabetes can obtain by participating in a patient education.
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Affiliation(s)
- Ditte Hjorth Laursen
- Research Unit of Chronic Conditions, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 20D, 2400, Copenhagen NV, Denmark.
| | - Karl Bang Christensen
- Department of Biostatistics, Institute of Public Health, University of Copenhagen, Øster Farimagsgade 5, Postboks 2099, 1014, Copenhagen K, Denmark
| | - Ulla Christensen
- Department of Social Medicine, Institute of Public Health, University of Copenhagen, Øster Farimagsgade 5, Postboks 2099, 1014, Copenhagen K, Denmark
| | - Anne Frølich
- Research Unit of Chronic Conditions, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 20D, 2400, Copenhagen NV, Denmark
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Polonsky WH, Capehorn M, Belton A, Down S, Alzaid A, Gamerman V, Nagel F, Lee J, Edelman S. Physician-patient communication at diagnosis of type 2 diabetes and its links to patient outcomes: New results from the global IntroDia® study. Diabetes Res Clin Pract 2017; 127:265-274. [PMID: 28407552 DOI: 10.1016/j.diabres.2017.03.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 03/16/2017] [Indexed: 12/31/2022]
Abstract
AIMS To investigate patient experiences during the diagnosis of type 2 diabetes mellitus (T2DM), focusing on how physician-patient communication at diagnosis influences patients' psychosocial stress and subsequent self-management and outcomes. METHODS We surveyed adults with T2DM in 26 countries in a large cross-national study of physician-patient communication during early T2DM treatment (IntroDia®). The self-report questionnaire assessed retrospectively patient experiences during diagnosis conversations (focusing on 43 possible conversational elements, and communication quality) and potential effects on patient-reported outcomes. RESULTS Data from 3628 people with T2DM who had been prescribed oral treatment at diagnosis were analysed. Exploratory factor analyses of the conversational elements yielded four coherent, meaningful factors: Encouraging (Cronbach's α=0.86); Collaborative (α=0.88); Recommending Other Resources (α=0.75); and Discouraging (α=0.72). Patient-perceived communication quality (PPCQ) at diagnosis was positively associated with Encouraging (β=+1.764, p<0.001) and Collaborative (β=+0.347, p<0.001), negatively associated with Discouraging (β=-1.181, p<0.001) and not associated with Recommending Other Resources (β=+0.087, p=0.096), using a stable path model. PPCQ was associated with less current diabetes distress, greater current well-being and better current self-care. Conversation elements comprising factors associated with better PPCQ (Encouraging and Collaborative) were recalled more frequently by patients than elements associated with poor PPCQ (Discouraging). CONCLUSIONS Better physician-patient communication at T2DM diagnosis may contribute to subsequent greater patient well-being and self-care, and may be enhanced by greater physician use of Collaborative and Encouraging conversation elements.
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Affiliation(s)
- William H Polonsky
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA; Behavioral Diabetes Institute, 5405 Oberlin Drive, Suite 100, San Diego, CA 92121, USA.
| | - Matthew Capehorn
- Rotherham Institute for Obesity, and Clifton Medical Centre, Doncaster Gate, Rotherham, South Yorkshire S65 1DA, United Kingdom
| | - Anne Belton
- The Michener Institute of Education at UHN, 222 St. Patrick Street, Toronto, Ontario M5T 1V4, Canada
| | - Susan Down
- Somerset Partnership NHS Foundation Trust, 2nd Floor, Mallard Court, Express Park, Bristol Road, Bridgwater TA6 4RN, United Kingdom
| | - Aus Alzaid
- Prince Sultan Military Medical City, PO Box 7897, Riyadh 11159, Saudi Arabia
| | - Victoria Gamerman
- Boehringer Ingelheim Pharmaceuticals, Inc., 900 Ridgebury Road, PO Box 368, Ridgefield, CT 06877, USA
| | - Friedericke Nagel
- Boehringer Ingelheim Pharma GmbH & Co. KG, Binger Straße 173, D-55216 Ingelheim am Rhein, Germany
| | - Jisoo Lee
- Boehringer Ingelheim Pharma GmbH & Co. KG, Binger Straße 173, D-55216 Ingelheim am Rhein, Germany
| | - Steven Edelman
- Division of Endocrinology and Metabolism, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Veterans Affairs Medical Center, 3350 La Jolla Village Dr, San Diego, CA 92161, USA
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Sapkota S, Brien JAE, Gwynn J, Flood V, Aslani P. Perceived impact of Nepalese food and food culture in diabetes. Appetite 2017; 113:376-386. [PMID: 28288801 DOI: 10.1016/j.appet.2017.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 01/31/2017] [Accepted: 03/07/2017] [Indexed: 01/17/2023]
Abstract
Consuming a healthy diet forms an important component of diabetes management; however, adhering to a healthy diet is challenging. Dietary behaviour is often guided by socio-cultural, environmental and emotional factors, and not necessarily by physical and nutritional needs. This study explored Nepalese patients' perceptions of the impact of diet, diet management requirement for diabetes and how Nepalese food culture in particular influenced diet management. Interviews were conducted with Nepalese participants with type 2 diabetes in Sydney and Kathmandu; and data was thematically analysed. Diet was recognized as a cause of, and a key treatment modality, in diabetes. Besides doctors, participants in Nepal received a large amount of dietary information from the community. Dietary changes formed a major component of lifestyle modifications adopted after diagnosis, and mostly consisted of removal of foods with added sugar and foods with high total sugar content from the diet, and a reduction in overall quantity of foods consumed. Perceived dietary restriction requirements created social and emotional discomfort to patients. Most participants perceived the Nepalese food culture as a barrier to effective diet management. Meals high in carbohydrates, limited food choices, and food preparation methods were identified as barriers, particularly in Nepal. In Australia, participants reported greater availability and easier access to appropriate food, and healthier cooking options. The socio-cultural aspects of food behaviour, mainly, food practices during social events were identified as significant barriers. Although diet was acknowledged as an important component of diabetes care, and most adopted changes in their diet post-diagnosis, effective and sustained changes were difficult to achieve. Future public health campaigns and education strategies should focus on improving diet knowledge, awareness of food options for diabetes, and effective dietary management.
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Affiliation(s)
- Sujata Sapkota
- Faculty of Pharmacy, The University of Sydney, NSW 2006, Australia.
| | - Jo-Anne E Brien
- Faculty of Pharmacy, The University of Sydney, NSW 2006, Australia; St. Vincent's Hospital, Clinical School, UNSW, NSW 2010, Australia.
| | - Josephine Gwynn
- St. Vincent's Hospital, Clinical School, UNSW, NSW 2010, Australia; Charles Perkins Center, The University of Sydney, NSW 2006, Australia; Faculty of Health Sciences, The University of Sydney, NSW 2006, Australia.
| | - Victoria Flood
- St. Vincent's Hospital, Clinical School, UNSW, NSW 2010, Australia; Charles Perkins Center, The University of Sydney, NSW 2006, Australia; Faculty of Health Sciences, The University of Sydney, NSW 2006, Australia.
| | - Parisa Aslani
- Faculty of Pharmacy, The University of Sydney, NSW 2006, Australia.
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Lindblad AJ, Cleave-Hogg D. Strategies for Teaching Self-Care with Type 2 Diabetes: Focus on Adult Development Theory. Can Pharm J (Ott) 2016. [DOI: 10.1177/171516350613900411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Adrienne J. Lindblad
- Adrienne Lindblad is the Acting Regional Pharmacy Clinical Coordinator with the David Thompson Health Region, in Red Deer, Alberta, and a PharmD candidate at the University of Toronto. Doreen Cleave-Hogg is the Educational Science Researcher, Centre for Research in Education, Faculty of Medicine, University of Toronto; Assistant Professor, Faculty of Pharmacy, University of Toronto; and Associate Director of Medical Education, Department of Anesthesiology, Canadian Simulation Centre, Sunnybrook Health
| | - Doreen Cleave-Hogg
- Adrienne Lindblad is the Acting Regional Pharmacy Clinical Coordinator with the David Thompson Health Region, in Red Deer, Alberta, and a PharmD candidate at the University of Toronto. Doreen Cleave-Hogg is the Educational Science Researcher, Centre for Research in Education, Faculty of Medicine, University of Toronto; Assistant Professor, Faculty of Pharmacy, University of Toronto; and Associate Director of Medical Education, Department of Anesthesiology, Canadian Simulation Centre, Sunnybrook Health
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Chernyak N, Stephan A, Bächle C, Genz J, Jülich F, Icks A. Assessment of information needs in diabetes: Development and evaluation of a questionnaire. Prim Care Diabetes 2016; 10:287-292. [PMID: 26777538 DOI: 10.1016/j.pcd.2015.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 09/22/2015] [Accepted: 11/30/2015] [Indexed: 11/16/2022]
Abstract
AIM To develop a questionnaire suitable for assessing the information needs of individuals with diabetes mellitus types 1 and 2 in diverse healthcare settings (e.g. primary care or long-term care) and at different time points during the course of the disease. METHODS The initial questionnaire was developed on the basis of literature search and analysis, reviewed by clinical experts, and evaluated in two focus groups. The revised version was pilot-tested on 39 individuals with diabetes type 2, type 1 and gestational diabetes. RESULTS The final questionnaire reveals the most important information needs in diabetes. A choice task, a rating task and open-ended questions are combined. First, participants have to choose three topics that interest them out of a list with 12 general topics and specify in their own words their particular information needs for the chosen topics. They are then asked how informed they feel with regard to all topics (4-point Likert-scale), and whether information is currently desired (yes/no). The questionnaire ends with an open-ended question asking for additional topics of interest. CONCLUSIONS Careful selection of topics and inclusion of open-ended questions seem to be essential prerequisites for the unbiased assessment of information needs. The questionnaire can be applied in surveys in order to examine patterns of information needs across various groups and changes during the course of the disease. Such knowledge would contribute to more patient-guided information, counselling and support.
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MESH Headings
- Choice Behavior
- Comprehension
- Consumer Health Information
- Diabetes Mellitus, Type 1/diagnosis
- Diabetes Mellitus, Type 1/physiopathology
- Diabetes Mellitus, Type 1/therapy
- Diabetes Mellitus, Type 2/diagnosis
- Diabetes Mellitus, Type 2/physiopathology
- Diabetes Mellitus, Type 2/therapy
- Diabetes, Gestational/diagnosis
- Diabetes, Gestational/physiopathology
- Diabetes, Gestational/therapy
- Female
- Focus Groups
- Health Knowledge, Attitudes, Practice
- Health Services Needs and Demand
- Humans
- Male
- Needs Assessment
- Patient Education as Topic
- Pilot Projects
- Pregnancy
- Qualitative Research
- Review Literature as Topic
- Surveys and Questionnaires
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Affiliation(s)
- N Chernyak
- Heinrich-Heine-University Duesseldorf, Faculty of Medicine, Department of Public Health, Mooren Straße 5, 40225, Duesseldorf, Germany.
| | - A Stephan
- Heinrich-Heine-University Duesseldorf, Faculty of Medicine, Department of Public Health, Mooren Straße 5, 40225, Duesseldorf, Germany.
| | - C Bächle
- German Diabetes Center at the Heinrich-Heine-University Duesseldorf, Institute for Biometrics and Epidemiology, Auf'm Hennekamp 65, 40225, Duesseldorf, Germany.
| | - J Genz
- German Diabetes Center at the Heinrich-Heine-University Duesseldorf, Institute for Biometrics and Epidemiology, Auf'm Hennekamp 65, 40225, Duesseldorf, Germany.
| | - F Jülich
- German Diabetes Center at the Heinrich-Heine-University Duesseldorf, Institute for Biometrics and Epidemiology, Auf'm Hennekamp 65, 40225, Duesseldorf, Germany.
| | - A Icks
- Heinrich-Heine-University Duesseldorf, Faculty of Medicine, Department of Public Health, Mooren Straße 5, 40225, Duesseldorf, Germany; German Diabetes Center at the Heinrich-Heine-University Duesseldorf, Institute for Biometrics and Epidemiology, Auf'm Hennekamp 65, 40225, Duesseldorf, Germany; German Center for Diabetes Research (DZD e.V.), Partner Düsseldorf, Düsseldorf, Germany.
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Peel E, Parry O, Douglas M, Lawton J. Taking the Biscuit? A Discursive Approach to Managing Diet in Type 2 Diabetes. J Health Psychol 2016; 10:779-91. [PMID: 16176956 DOI: 10.1177/1359105305057313] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Adopting and maintaining a healthy diet is pivotal to diabetic regimens. Behavioural research has focused on strategies to modify/maintain healthy behaviours; thus ‘compliance’ and ‘ noncompliance’ are operationalized by researchers. In contrast, discursive psychology focuses on the actions different accounts accomplish—in this case regarding diets. Using thematic discourse analysis, we examine dietary management talk in repeat-interviews with 40 newly diagnosed type 2 diabetes patients. Women in our study tended to construct dietary practices as an individual concern, while men presented food consumption as a family matter. Participants accounted for ‘cheating’ in complex ways that aim to accomplish, for instance, a compliant identity. Discursive psychology may facilitate fluidity in our understandings of dietary management, and challenge fixed notions of ‘compliant’ and ‘non-compliant’ diabetes patients.
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Affiliation(s)
- Elizabeth Peel
- Department of Psychology, Life and Health Sciences, Aston University, Birmingham, UK.
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Ebrahimi H, Karimi Moonaghi H, Asghari Jafarabadi M, Namdar Areshtanab H, Jouybari L. Development and Preliminary Validation of Diabetes Adjustment Assessment Scale (DAAS): a New Measure of Adjustment with Type 2 Diabetes. J Caring Sci 2016; 5:145-52. [PMID: 27354978 PMCID: PMC4923838 DOI: 10.15171/jcs.2016.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 10/29/2015] [Indexed: 02/04/2023] Open
Abstract
Introduction: Several adjustment scales are available for
Diabetes, but, unfortunately most of them focused on the limited dimensions of diabetes
and are not specific for type 2 diabetes. The aim of this study was to develop a
multidimensional scale for Diabetes type 2 Adjustment Assessment and to test preliminary
validity, reliability and clinical utility of the scale for this population. Methods: In this methodological design study, the Diabetes
Adjustment Assessment Scale was developed and the psychometric properties of this scale
was assessed in patients with Type 2 diabetes. This study included internal consistency,
content validity and exploratory factor analysis. Results: 1000 patients with type 2 diabetes completed the
45-item Diabetes Adjustment Scale. After eliminating two item, the 43-item measure
demonstrated good internal consistency (Cronbach’s α= 0.75). Factor analysis identified
eight factors including; reshape (11 questions), seek to acceptance of illness (7
questions), normal life with the disease (6 questions), initial self-management (2
questions), comparing (4 questions), initial imaging of illness (4 questions), return to
resources(3 questions), and advanced self- management (6 questions). Conclusion: Considering that validity and reliability
indexes of the scale are reported in an appropriate level, it can be used as a valid and
reliable tool in measuring level of adjustment with type2 diabetes.
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Affiliation(s)
- Hossein Ebrahimi
- Department of Psychiatric Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Karimi Moonaghi
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Hossein Namdar Areshtanab
- Department of Psychiatric Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila Jouybari
- Department of Pediatric and Family Health Nursing, Faculty of Nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, Iran
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Perception et vécu émotionnel de la maladie et de ses traitements par des patients ayant un diabète de type 2 et en population générale. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/s1957-2557(16)30132-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Eborall HC, Virdee SK, Patel N, Redwood S, Greenfield SM, Stone MA. "And now for the good news..." the impact of negative and positive messages in self-management education for people with Type 2 diabetes: A qualitative study in an ethnically diverse population. Chronic Illn 2016; 12:3-17. [PMID: 25827572 DOI: 10.1177/1742395315577965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 02/25/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To explore the impact of Diabetes Education and Self Management for Ongoing and Newly Diagnosed (DESMOND) Foundation education, particularly from interviewees' narratives regarding recall of good and bad news messages and behaviour changes. METHODS In-depth, semi-structured interviews were conducted with a purposive sample (n=19) of people who had attended education sessions as part of a randomised controlled trial in two UK sites with ethnically diverse populations. Data collection and analysis were informed by the constant comparative approach and facilitated through charting. RESULTS Findings were similar in people from different ethnic backgrounds. Exploration of levels of recall of the sessions suggested that this was variable and sometimes very limited, but that interviewees had all assimilated some relevant learning. Key themes emerged relating to the way in which interviewees recalled and had been influenced by positive (good news) and negative (bad news) messages within the education sessions, including biomedical explanations. Both types of message appeared to have an important role in terms of motivation to change behaviour, but a notable observation was that none of the interviewees recalled receiving bad news messages when diagnosed. DISCUSSION Our findings have highlighted the importance of providing and combining both negative and positive messages within education designed to promote self-management behaviour change.
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Affiliation(s)
- Helen C Eborall
- Social Science Applied to Healthcare Improvement Research (SAPPHIRE) Group, University of Leicester, Leicester, UK
| | - Satnam K Virdee
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Naina Patel
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Sabi Redwood
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Margaret A Stone
- Diabetes Research Centre, University of Leicester, Leicester, UK
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Hofmann M, Dack C, Barker C, Murray E. The Impact of an Internet-Based Self-Management Intervention (HeLP-Diabetes) on the Psychological Well-Being of Adults with Type 2 Diabetes: A Mixed-Method Cohort Study. J Diabetes Res 2016; 2016:1476384. [PMID: 26682226 PMCID: PMC4670653 DOI: 10.1155/2016/1476384] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 04/09/2015] [Accepted: 04/29/2015] [Indexed: 11/17/2022] Open
Abstract
This mixed-method study assessed the impact of an internet-based, self-management intervention ("HeLP-Diabetes") on the psychological well-being of adults with type 2 diabetes. Nineteen participants were recruited from 3 general practices. Data were collected at baseline and at 6 weeks follow-up. Access to HeLP-Diabetes was associated with a significant decrease in participants' diabetes-related distress (Z = 2.04, p = 0.04, and d = 0.28). No significant differences were found in emotional distress or self-efficacy. The qualitative data found that participants reported improvements including increased self-efficacy and support, better management of low mood, greater diabetes awareness, and taking the condition more seriously. Participants also reported making improvements to their eating habits, exercise routine, and medical management. Some negative experiences associated with using the intervention were mentioned including feelings of guilt for not using the intervention as suggested or not making any behavioral changes, as well as technical and navigational frustrations with the intervention. Internet-based self-management interventions may have the potential to decrease diabetes-related distress in people with type 2 diabetes. The qualitative data also suggests internet interventions can positively impact both psychological and behavioural outcomes of adults with type 2 diabetes.
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Affiliation(s)
- Megan Hofmann
- Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London WC1E 6BT, UK
| | - Charlotte Dack
- Psychology Department, University of Bath, Claverton Down, Bath BA2 7AY, UK
- *Charlotte Dack:
| | - Chris Barker
- Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London WC1E 6BT, UK
| | - Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, Upper Floor 3, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, UK
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Wilkinson E, Waqar M, Sinclair A, Randhawa G. Meeting the Challenge of Diabetes in Ageing and Diverse Populations: A Review of the Literature from the UK. J Diabetes Res 2016; 2016:8030627. [PMID: 27830158 PMCID: PMC5086503 DOI: 10.1155/2016/8030627] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 09/12/2016] [Accepted: 09/20/2016] [Indexed: 01/22/2023] Open
Abstract
The impact of type 2 diabetes on ageing societies is great and populations across the globe are becoming more diverse. Complications of diabetes unequally affect particular groups in the UK older people, and people with a South Asian background are two population groups with increased risk whose numbers will grow in the future. We explored the evidence about diabetes care for older people with South Asian ethnicity to understand the contexts and mechanisms behind interventions to reduce inequalities. We used a realist approach to review the literature, mapped the main areas where relevant evidence exists, and explored the concepts and mechanisms which underpinned interventions. From this we constructed a theoretical framework for a programme of research and put forward suggestions for what our analysis might mean to providers, researchers, and policy makers. Broad themes of cultural competency; comorbidities and stratification; and access emerged as mid-level mechanisms which have individualised, culturally intelligent, and ethical care at their heart and through which inequalities can be addressed. These provide a theoretical framework for future research to advance knowledge about concordance; culturally meaningful measures of depression and cognitive impairment; and care planning in different contexts which support effective diabetes care for aging and diverse populations.
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Affiliation(s)
- Emma Wilkinson
- Institute for Health Research, University of Bedfordshire, Luton, UK
| | - Muhammad Waqar
- Institute for Health Research, University of Bedfordshire, Luton, UK
| | - Alan Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail, Droitwich, UK
| | - Gurch Randhawa
- Institute for Health Research, University of Bedfordshire, Luton, UK
- *Gurch Randhawa:
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Majeed-Ariss R, Jackson C, Knapp P, Cheater FM. British-Pakistani women's perspectives of diabetes self-management: the role of identity. J Clin Nurs 2015; 24:2571-80. [PMID: 26099049 DOI: 10.1111/jocn.12865] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2015] [Indexed: 12/26/2022]
Abstract
AIMS AND OBJECTIVES To explore the effects of type 2 diabetes on British-Pakistani women's identity and its relationship with self-management. BACKGROUND Type 2 diabetes is more prevalent and has worse outcomes among some ethnic minority groups. This may be due to poorer self-management and an inadequate match of health services to patient needs. The influence that type 2 diabetes has on British-Pakistani women's identity and subsequent self-management has received limited attention. DESIGN An explorative qualitative study. METHODS Face-to-face semi-structured English and Urdu language interviews were conducted with a purposively selected heterogeneous sample of 15 British-Pakistani women with type 2 diabetes. Transcripts were analysed thematically. RESULTS Four themes emerged: Perceived change in self emphasised how British-Pakistani women underwent a conscious adaptation of identity following diagnosis; Familiarity with ill health reflected women's adjustment to their changed identity over time; Diagnosis improves social support enabled women to accept changes within themselves and Supporting family is a barrier to self-management demonstrated how family roles were an aspect of women's identities that was resilient to change. The over-arching theme Role re-alignment enables successful self-management encapsulated how self-management was a continuous process where achievements needed to be sustained. Inter-generational differences were also noted: first generation women talked about challenges associated with ageing and co-morbidities; second generation women talked about familial and work roles competing with self-management. CONCLUSIONS The complex nature of British-Pakistani women's self-identification requires consideration when planning and delivering healthcare. RELEVANCE TO CLINICAL PRACTICE Culturally competent practice should recognise how generational status influences self-identity and diabetes self-management in ethnically diverse women. Health professionals should remain mindful of effective self-management occurring alongside, and being influenced by, other aspects of life.
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Affiliation(s)
| | - Cath Jackson
- School of Healthcare, University of Leeds, Leeds, UK.,York Trials Unit, Alcuin Research Centre, University of York, York, UK
| | - Peter Knapp
- Department of Health Sciences, University of York, UK
| | - Francine M Cheater
- School of Health Sciences, Faculty of Medicine & Health Sciences, University of East Anglia, Norwich Research Park, UK
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Dallosso HM, Bodicoat DH, Campbell M, Carey ME, Davies MJ, Eborall HC, Hadjiconstantinou M, Khunti K, Speight J, Heller S. Self-monitoring of blood glucose versus self-monitoring of urine glucose in adults with newly diagnosed Type 2 diabetes receiving structured education: a cluster randomized controlled trial. Diabet Med 2015; 32:414-22. [PMID: 25308625 DOI: 10.1111/dme.12598] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2014] [Indexed: 11/30/2022]
Abstract
AIMS To compare the effectiveness and acceptability of self-monitoring of blood glucose with self-monitoring of urine glucose in adults with newly diagnosed Type 2 diabetes. METHODS We conducted a multi-site cluster randomized controlled trial with practice-level randomization. Participants attended a structured group education programme, which included a module on self-monitoring using blood glucose or urine glucose monitoring. HbA1c and other biomedical measures as well as psychosocial data were collected at 6, 12 and 18 months. A total of 292 participants with Type 2 diabetes were recruited from 75 practices. RESULTS HbA1c levels were significantly lower at 18 months than at baseline in both the blood monitoring group [mean (se) -12 (2) mmol/mol; -1.1 (0.2) %] and the urine monitoring group [mean (se) -13 (2) mmol/mol; -1.2 (0.2)%], with no difference between groups [mean difference adjusted for cluster effect and baseline value = -1 mmol/mol (95% CI -3, 2); -0.1% (95% CI -0.3, 0.2)]. Similar improvements were observed for the other biomedical outcomes, with no differences between groups. Both groups showed improvements in total treatment satisfaction, generic well-being, and diabetes-specific well-being, and had a less threatening view of diabetes, with no differences between groups at 18 months. Approximately one in five participants in the urine monitoring arm switched to blood monitoring, while those in the blood monitoring arm rarely switched (18 vs 1% at 18 months; P < 0.001). CONCLUSIONS Participants with newly diagnosed Type 2 diabetes who attended structured education showed similar improvements in HbA1c levels at 18 months, regardless of whether they were assigned to blood or urine self-monitoring.
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Affiliation(s)
- H M Dallosso
- University Hospitals of Leicester, Leicester Diabetes Centre, Leicester, UK
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Jutterström L, Isaksson U, Sandström H, Hörnsten Å. Turning points in self-management of type 2 diabetes. ACTA ACUST UNITED AC 2015. [DOI: 10.1002/edn.205] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Affiliation(s)
- Jen Nash
- Chartered Psychologist with the British Psychological Society, Central & North West London NHS Trust; UK
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50
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Rankin D, Harden J, Waugh N, Noyes K, Barnard KD, Stephen J, Robertson KJ, Bath L, Robertson L, Lawton J. Pathways to diagnosis: a qualitative study of the experiences and emotional reactions of parents of children diagnosed with type 1 diabetes. Pediatr Diabetes 2014; 15:591-8. [PMID: 24552497 DOI: 10.1111/pedi.12124] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 12/16/2013] [Accepted: 01/08/2014] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The aim of this study was to explore from parents' perspectives the circumstances and events which led to their child being diagnosed with type 1 diabetes (T1D). The objective was to understand reasons for delays in seeking treatment and parents' emotional reactions to diagnosis so others can be better informed and supported in future. METHODS In-depth interviews with 54 parents of children (aged ≤12 yr) with T1D were conducted. Data analysis used an inductive, thematic approach. RESULTS Parents described a 'prompt' and a 'delayed' pathway to their child being diagnosed. Parents who considered the diagnosis to be 'prompt' reported how they, or other people, had recognized their child had developed symptoms of T1D which resulted in a rapid presentation to health care professionals. In contrast, parents who perceived their child's diagnosis to be 'delayed' did not recognize signs of T1D and attributed their child's deteriorating health to other conditions, being out of routines and/or their stage of development. These parents often only sought medical help when symptoms became extreme. All parents were distressed by their child's diagnosis; however, parents in the 'delayed' pathway expressed unresolved feelings of guilt, particularly when their child was diagnosed with diabetic ketoacidosis. DISCUSSION Parents' and other people's knowledge about T1D can affect the duration between onset of their child's symptoms and diagnosis. Campaigns to raise awareness should ensure that parents are made aware of symptoms and that T1D can develop during childhood. Health care professionals could discuss with parents the events preceding their child's diagnosis to better determine their emotional support needs.
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Affiliation(s)
- David Rankin
- Centre for Population Health Sciences, School of Molecular, Genetic and Population Health Sciences, University of Edinburgh Medical School, Edinburgh, UK
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