1
|
Chowdhury HA, Harrison CL, Siddiquea BN, Tissera S, Afroz A, Ali L, Joham AE, Billah B. The effectiveness of diabetes self-management education intervention on glycaemic control and cardiometabolic risk in adults with type 2 diabetes in low- and middle-income countries: A systematic review and meta-analysis. PLoS One 2024; 19:e0297328. [PMID: 38306363 PMCID: PMC10836683 DOI: 10.1371/journal.pone.0297328] [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: 07/11/2023] [Accepted: 01/01/2024] [Indexed: 02/04/2024] Open
Abstract
Diabetes mellitus (DM) poses a significant challenge to public health. Effective diabetes self-management education (DSME) interventions may play a pivotal role in the care of people with type 2 diabetes mellitus (T2DM) in low- and middle-income countries (LMICs). A specific up-to-date systematic review is needed to assess the effect of DSME interventions on glycaemic control, cardiometabolic risk, self-management behaviours, and psychosocial well-being among T2DM across LMICs. The MEDLINE, Embase, CINAHL, Global Health, and Cochrane databases were searched on 02 August 2022 and then updated on 10 November 2023 for published randomised controlled trials (RCTs) and quasi-experimental studies. The quality of the studies was assessed, and a random-effect model was used to estimate the pooled effect of diabetes DSME intervention. Heterogeneity (I2) was tested, and subgroup analyses were performed. Egger's regression test and funnel plots were used to examine publication bias. The risk of bias of the included studies was assessed using the Cochrane risk-of-bias tool for randomized trial (RoB 2). The overall assessment of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach. A total of 5893 articles were retrieved, and 44 studies (n = 11838) from 21 LMICs met the inclusion criteria. Compared with standard care, pooled analysis showed that DSME effectively reduced the HbA1c level by 0.64% (95% CI: 0.45% to 0.83%) and 1.27% (95% CI: -0.63% to 3.17%) for RCTs and quasi-experimental design studies, respectively. Further, the findings showed an improvement in cardiometabolic risk reduction, diabetes self-management behaviours, and psychosocial well-being. This review suggests that ongoing support alongside individualised face-to-face intervention delivery is favourable for improving overall T2DM management in LMICs, with a special emphasis on countries in the lowest income group.
Collapse
Affiliation(s)
- Hasina Akhter Chowdhury
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh
| | - Cheryce L. Harrison
- Monash Centre for Health Research and Implementation–MCHRI, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Bodrun Naher Siddiquea
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sanuki Tissera
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Afsana Afroz
- Department of Biochemistry and Pharmacology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Liaquat Ali
- Pothikrit Institute of Health Studies (PIHS), Dhaka, Bangladesh
| | - Anju E. Joham
- Monash Centre for Health Research and Implementation–MCHRI, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Departments of Endocrinology and Diabetes, Monash Health, Melbourne, Australia
| | - Baki Billah
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| |
Collapse
|
2
|
Kong JX, Zhu L, Wang HM, Li Y, Guo AY, Gao C, Miao YY, Wang T, Lu XY, Zhu HH, Patrick DL. Effectiveness of the Chronic Care Model in Type 2 Diabetes Management in a Community Health Service Center in China: A Group Randomized Experimental Study. J Diabetes Res 2019; 2019:6516581. [PMID: 30719455 PMCID: PMC6335771 DOI: 10.1155/2019/6516581] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/17/2018] [Accepted: 11/20/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The Chronic Care Model, based on core elements of team-centered care in chronic diseases, has widely been accepted. This study was aimed at evaluating the effectiveness of the Chronic Care Model in type 2 diabetes management. METHODS A group randomized experimental study was conducted. Twelve communities of the Zhaohui Community Health Service Center in Hangzhou, China, were randomly assigned into an intervention group (n = 6) receiving the Chronic Care Model-based intervention and a control group (n = 6) receiving conventional care. A total of three hundred patients, twenty-five for each community, aged ≥18 years with type 2 diabetes for at least 1-year duration, were recruited. Data of health behaviors, clinical outcomes, and health-related quality of life (Short-Form 36-item questionnaire) were collected before and after a 9-month intervention and analyzed using descriptive statistics, t-test, chi-square test, binary logistic regression, and linear mixed regression. A total of 258 patients (134 in intervention and 124 in control) who completed the baseline and follow-up evaluations and the entire intervention were included in the final analyses. RESULTS Health behaviors such as drinking habit (OR = 0.07, 95% CI: 0.01, 0.75), physical activity (OR = 2.92, 95% CI: 1.18, 7.25), and diet habit (OR = 4.30, 95% CI: 1.49, 12.43) were improved. The intervention group had a remarkable reduction in glycated hemoglobin (from 7.17% to 6.60%, P < 0.001). The quality of life score changes of the role limitation due to physical problems (mean = 9.97, 95% CI: 3.33, 16.60), social functioning (mean = 6.50, 95% CI: 2.37, 10.64), role limitation due to emotional problems (mean = 8.06, 95% CI: 2.15, 13.96), and physical component summary score (mean = 3.31, 95% CI: 1.22, 5.39) were improved in the intervention group compared to the control group. CONCLUSION The Chronic Care Model-based intervention helped improve some health behaviors, clinical outcomes, and quality of life of type 2 diabetes patients in China in a short term.
Collapse
Affiliation(s)
- Jing-Xia Kong
- Department of Social Medicine and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
- Department of Investment and Insurance, Zhejiang Financial College, Hangzhou, Zhejiang Province, China
| | - Lin Zhu
- Department of Social Medicine, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Hong-Mei Wang
- Department of Social Medicine and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Ying Li
- Department of Social Medicine, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - An-Ying Guo
- Department of Social Medicine, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Chao Gao
- Department of Social Medicine, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Yan-Yao Miao
- Department of Social Medicine, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Ting Wang
- Department of Social Medicine, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Xiao-Yang Lu
- Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Hong-Hong Zhu
- Preventive Medicine Institute, Louisiana, MO 63353, USA
| | - Donald L. Patrick
- Department of Health Services, University of Washington, H670 Health Sciences Building, Box 357660, Seattle, WA 98195-7660, USA
| |
Collapse
|
3
|
Shin KS, Lee E. Relationships of health literacy to self‐care behaviors in people with diabetes aged 60 and above: Empowerment as a mediator. J Adv Nurs 2018; 74:2363-2372. [DOI: 10.1111/jan.13738] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 04/16/2018] [Accepted: 06/06/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Kyung Suk Shin
- Graduate School of Public Health Ajou University Suwon Korea
| | - Eun‐Hyun Lee
- Graduate School of Public Health Ajou University Suwon Korea
| |
Collapse
|
4
|
Al-Arifi MN, Al-Omar HA. Impact of a multidisciplinary intensive education program on type 2 diabetes mellitus patients' glycemic control and cardiovascular risk factors. Saudi Med J 2018; 39:705-710. [PMID: 29968894 PMCID: PMC6146253 DOI: 10.15537/smj.2018.7.22194] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 04/23/2018] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To evaluate the impact of a multidisciplinary intensive education program (MIEP) on type 2 diabetes mellitus (T2DM) patients' outcomes. METHODS A retrospective study was used to evaluate the impact of MIEP on T2DM patients' outcomes for between May 2016 and May 2017. Data were collected from the diabetes education clinic in King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia where patients were referred from diabetes outpatient clinics to the diabetes education clinic to receive MIEP. In terms of measuring the clinical outcomes of the T2DM patients, glycemic control, blood pressure, weight, and lipid profiles were assessed before MIEP at 3, 6, and 12 months. Results: A total of 174 patients with T2DM fulfilled study inclusion criteria. The results indicate improved glycemic control where patients' HbA1c and blood sugar levels were significantly reduced 3, 6, and 12 months after MIEP compared to the baseline (p less than 0.005). Moreover, blood pressure improved after education; a significant improvement was observed in the mean systolic blood pressure (SBP) from baseline to 12 months (p=0.036), and in the mean diastolic blood pressure (DBP) after 12 months (p=0.016). Additionally, the study found significant differences in total cholesterol and low-density lipoprotein (LDL) cholesterol 6 months after the intervention (p=0.014, p=0.02, respectively). Conclusion: Implementing an MIEP for T2DM patients can improve their clinical outcomes, which consequently may delay the disease's long-term complications.
Collapse
Affiliation(s)
- Mohamed N Al-Arifi
- College of Pharmacy, Clinical Pharmacy Department, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
| | | |
Collapse
|
5
|
Abstract
AIMS AND OBJECTIVES To examine and critique various models guiding the care and education of people with diabetes, to develop more helpful and effective approaches to care. The focus is on relationships and communication between patients and healthcare providers. BACKGROUND Many patients are not adhering to the recommended treatments, hence it seems that effective diabetes care is difficult to achieve, particularly for patients of lower socio-economic status, who are disproportionately afflicted. The results are usually devastating, and lead to serious health complications that incisively diminish quality of life for patients with diabetes, frustrate healthcare providers and increase healthcare costs. DESIGN Critical review. METHOD This paper represents a critical review of various approaches to diabetes care and education. A CINAHL search with relevant key words was carried out and selected exemplary research studies and articles describing and/or evaluating the various approaches to diabetes care and management were examined. Particular attention was paid to how the paradigmatic underpinnings of these approaches construct patient - healthcare provider relationships. CONCLUSION The literature revealed that the traditional top-down approaches to care were largely ineffective, while collaborative approaches, based in respect and taking the whole persons and their unique situations into account, were found to be central to good care. Further, an integration of the different kinds of knowledge contained in the various approaches can complement and extend one another. RELEVANCE TO CLINICAL PRACTICE Avoiding devastating complications by improving the management of diabetes and overall quality of life of patients is a worthwhile goal. Therefore expanding diabetes care beyond the traditional bio-medical model to develop more effective approaches to care is of interest to all healthcare professionals working in this area.
Collapse
Affiliation(s)
- Isolde Daiski
- Associate Professor, School of Nursing, York University, Toronto, Canada
| |
Collapse
|
6
|
Rassart J, Luyckx K, Oris L, Goethals E, Moons P, Weets I. Coping with type 1 diabetes through emerging adulthood: Longitudinal associations with perceived control and haemoglobin A1c. Psychol Health 2016; 31:622-35. [DOI: 10.1080/08870446.2016.1144753] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
7
|
The Relationship of Health Locus of Control and Health-Related Quality of Life in the Chronic Phase After Traumatic Brain Injury. J Head Trauma Rehabil 2015; 30:424-31. [DOI: 10.1097/htr.0000000000000128] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
8
|
Cander S, Gul OO, Gul CB, Keles SB, Yavas S, Ersoy C. The Impact of Patient Education on Anthropometric, Lipidemic, and Glycemic Parameters Among Patients With Poorly Controlled Type II Diabetes Mellitus: A 3-Month Prospective Single-Center Turkish Study. Workplace Health Saf 2014; 62:500-7. [PMID: 25199169 DOI: 10.3928/21650799-20140826-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 07/25/2014] [Indexed: 11/20/2022]
Abstract
This study evaluated the impact of patient education on adherence to a diabetes care plan (e.g., anthropometric, lipidemic, and glycemic parameters) among adults with type II diabetes mellitus without adequate glycemic control. A total of 61 ambulatory adults with type II diabetes mellitus (mean age: 53.6 ± 8.2 years, 70.5% female) were evaluated for anthropometrics, duration of diabetes mellitus, type of anti-diabetic treatment, blood biochemistry, and glycemic parameters in this 3-month prospective observational single-center study. During the course of the study, participants demonstrated a significant decrease in body weight and fat percentage and HbA1c (p < .001 for each). None of the factors evaluated was a significant determinant for glycemic parameters. These findings revealed that adults with type II diabetes mellitus who received education on adherence to routine self-monitoring of blood glucose, standard diabetic diet, and an exercise program delivered by certified diabetes educators had better glycemic control and significant decrease in body weight and fat percentage over a 3-month monitoring period.
Collapse
|
9
|
Rassart J, Luyckx K, Klimstra TA, Moons P, Groven C, Weets I. Personality and Illness Adaptation in Adults with Type 1 Diabetes: The Intervening Role of Illness Coping and Perceptions. J Clin Psychol Med Settings 2014; 21:41-55. [DOI: 10.1007/s10880-014-9387-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
10
|
Celano CM, Beale EE, Moore SV, Wexler DJ, Huffman JC. Positive psychological characteristics in diabetes: a review. Curr Diab Rep 2013; 13:917-29. [PMID: 24048687 DOI: 10.1007/s11892-013-0430-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Positive psychological characteristics, such as optimism, self-efficacy, and resilience, have been increasingly associated with improved outcomes in medically ill individuals. However, there has been minimal systematic review of these characteristics and their associations with outcomes in people with diabetes. We aim to review these associations, their potential mediating mechanisms, and the evidence supporting interventions targeting these qualities. In people with diabetes, positive psychological characteristics are significantly associated with improved glycemic control, fewer complications, and reduced rates of mortality. Potential mechanisms mediating these associations include behavioral factors (e.g., improved treatment adherence), reduced inflammation, and improved neuroendocrine and autonomic functioning. Most psychosocial treatments in this population have focused on improving self-efficacy and resilience; such interventions may improve quality of life, well-being, and diabetes self-care. While untested in diabetes, interventions to boost other positive characteristics have been effective in other medically ill patients and may warrant further study in this cohort.
Collapse
|
11
|
Hernandez-Tejada MA, Campbell JA, Walker RJ, Smalls BL, Davis KS, Egede LE. Diabetes empowerment, medication adherence and self-care behaviors in adults with type 2 diabetes. Diabetes Technol Ther 2012; 14:630-4. [PMID: 22524548 PMCID: PMC3389377 DOI: 10.1089/dia.2011.0287] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Evidence suggests that empowerment is an important factor to address everyday aspects of dealing with a chronic disease. This study evaluated the effect of diabetes empowerment on medication adherence and self-care behaviors in adults with type 2 diabetes. SUBJECTS AND METHODS Data on 378 subjects with type 2 diabetes recruited from two primary care clinics in the southeastern United States were examined. Previously validated scales were used to measure diabetes empowerment, medication adherence, diabetes knowledge, and diabetes self-care behaviors (including diet, physical activity, blood sugar testing, and foot care). Multiple linear regression was used to assess the independent effect of diabetes empowerment on medication adherence and self-care behaviors controlling for relevant covariates. RESULTS Eighty-three percent were non-Hispanic blacks, 69% were women, 22% were 65 years or older, 68% were not married, 26% had less than high school education, 60% were unemployed, 39% were uninsured, and 47% had a yearly income <$10,000. Empowerment had significant correlations with medication adherence (r=0.17, P<0.003), diabetes knowledge (r=0.16, P=0.007), diet (r=0.24, P<0.001), exercise (r=0.25, P<0.001), blood sugar testing (r=0.12, P=0.043), and foot care (r=0.18, P=0.002). In the regression model, diabetes empowerment was significantly associated with medication adherence (β=-0.04, P=0.001), diabetes knowledge (β=0.09, P=0.012), diet (β=0.09, P<0.001), exercise (β=0.10, P<0.001), blood sugar testing (β=0.07, P=0.016), and foot care (β=0.08, P=0.001). CONCLUSIONS In this sample, diabetes empowerment was related to better diabetes knowledge, medication adherence and improved self-care behaviors. Emphasis on empowerment and self-efficacy is relevant to improve outcomes in the management of diabetes.
Collapse
Affiliation(s)
- Melba A. Hernandez-Tejada
- Center for Health Disparities Research, Medical University of South Carolina, Charleston, South Carolina
| | - Jennifer A. Campbell
- Center for Health Disparities Research, Medical University of South Carolina, Charleston, South Carolina
| | - Rebekah J. Walker
- Center for Health Disparities Research, Medical University of South Carolina, Charleston, South Carolina
| | - Brittany L. Smalls
- Center for Health Disparities Research, Medical University of South Carolina, Charleston, South Carolina
| | - Kimberly S. Davis
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Leonard E. Egede
- Center for Health Disparities Research, Medical University of South Carolina, Charleston, South Carolina
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
- Center for Disease Prevention and Health Interventions for Diverse Populations, Charleston VA REAP, Ralph H. Johnson VA Medical Center, Charleston, South Carolina
| |
Collapse
|
12
|
Luyckx K, Moons P, Weets I. Self-classification as an adult in patients with type 1 diabetes: relationships with glycemic control and illness coping. PATIENT EDUCATION AND COUNSELING 2011; 85:245-250. [PMID: 21159481 DOI: 10.1016/j.pec.2010.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Revised: 11/03/2010] [Accepted: 11/21/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Previous community research has demonstrated the link between adult self-classification and health behaviors. The present study investigated the extent to which individuals with type 1 diabetes (ages 18-30 years) classified themselves as adults as compared with individuals without diabetes. Adult self-classification was examined in relation to illness coping and glycemic control. METHODS A total of 194 patients and 287 control individuals participated. Adult self-classification was assessed using a single item, coping was assessed using the Diabetes Coping Measure, and glycemic control was determined by HbA(1c) values. RESULTS Compared with control participants, more patients classified themselves as adults. Furthermore, adult self-classification was positively related to glycemic control. Structural equation modeling indicated that coping mediated the relationship between adult self-classification and glycemic control. CONCLUSION Individuals with diabetes classified themselves as adults more often than did their peers without diabetes, possibly due to their need to master their lives when confronted with diabetes. Adult self-classification appeared to function as a resource for glycemic control through its relationship with specific coping strategies. PRACTICE IMPLICATIONS The present study underscores the need to assess adult self-classification in individuals with diabetes. Our findings call for a developmentally tailored transition from pediatric to adult care.
Collapse
Affiliation(s)
- Koen Luyckx
- Catholic University Leuven, Leuven, Belgium.
| | | | | |
Collapse
|
13
|
Innovative Schulungskonzepte in der medizinischen Rehabilitation. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2011; 54:444-50. [DOI: 10.1007/s00103-011-1237-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
14
|
Reusch A, Ströbl V, Ellgring H, Faller H. Effectiveness of small-group interactive education vs. lecture-based information-only programs on motivation to change and lifestyle behaviours. A prospective controlled trial of rehabilitation inpatients. PATIENT EDUCATION AND COUNSELING 2011; 82:186-192. [PMID: 20554148 DOI: 10.1016/j.pec.2010.04.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Revised: 04/01/2010] [Accepted: 04/28/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Although patient education may promote motivation to change health behaviours, the most effective method has not yet been determined. METHODS This prospective, controlled trial compared an interactive, patient-oriented group program with lectures providing only information. We evaluated motivational stages of change and self-reported behaviours in three domains (sports, diet, relaxation) at four times up to one year (60% complete data) among 753 German rehabilitation inpatients (mean age 50 years, 52% male) with orthopaedic (59%) or cardiologic disorders (10%) or diabetes mellitus (31%). RESULTS We found improvements between baseline and follow up regarding each outcome (p<.001) in both groups. At the end of rehabilitation, participants of the interactive group, as compared to the lectures, showed more advanced motivation regarding diet (p<.10) and sports (p=.006). Interactive group patients reported healthier diets both after 3 months (p=0.013) and 12 months (p=0.047), more relaxation behaviours (p=.029) after 3 months and higher motivation for sports after 12 months (p=.08). CONCLUSIONS The superior effectiveness of the interactive group was only partly confirmed. PRACTICE IMPLICATIONS This short, 5-session interactive program may not be superior to lectures to induce major sustainable changes in motivation.
Collapse
Affiliation(s)
- Andrea Reusch
- University of Würzburg, Institute of Psychotherapy and Medical Psychology, Würzburg, Germany
| | | | | | | |
Collapse
|
15
|
Heinrich E, Candel MJJM, Schaper NC, de Vries NK. Effect evaluation of a Motivational Interviewing based counselling strategy in diabetes care. Diabetes Res Clin Pract 2010; 90:270-8. [PMID: 20950883 DOI: 10.1016/j.diabres.2010.09.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Revised: 09/05/2010] [Accepted: 09/16/2010] [Indexed: 11/28/2022]
Abstract
AIM The present study assessed the effects of a Motivational Interviewing (MI) based counselling training for nurses on clinical, behavioural and process outcomes among diabetes type 2 patients. METHODS The study is an RCT with follow-up measurements after 12 and 24 months. Thirty-three nurses and 584 patients participated. Nurses in the experimental condition received the training; control group nurses were trained after the study. The training consisted of two training sessions, two follow-up meetings, written feedback and three direct feedback sessions. Basic MI-principles and techniques and an MI-based counselling protocol were addressed. RESULTS Results indicated disadvantageous effects on fat intake and HDL and advantageous effects on chance locus of control and knowledge. No effects were found on vegetable or fruit intake, physical activity, HbA1c, weight, blood pressure, total cholesterol, LDL, triglycerides, health care climate, quality of life or on self-efficacy. CONCLUSIONS As in other MI studies, mixed results were found. It would be premature to recommend dissemination of MI in diabetes care. More studies are needed in real-world settings with health care professionals of the field instead of intensively trained MI interventionists. Knowledge should be gained about adequate training and factors contributing to the implementation of MI in daily practice.
Collapse
Affiliation(s)
- Evelien Heinrich
- Department of Health Promotion, Maastricht University, Caphri, The Netherlands.
| | | | | | | |
Collapse
|
16
|
Tang TS, Funnell MM, Brown MB, Kurlander JE. Self-management support in "real-world" settings: an empowerment-based intervention. PATIENT EDUCATION AND COUNSELING 2010; 79:178-184. [PMID: 19889508 PMCID: PMC2856771 DOI: 10.1016/j.pec.2009.09.029] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Revised: 09/16/2009] [Accepted: 09/18/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVE This study examined the impact of a 6-month, empowerment-based diabetes self-management support (DSMS) intervention on clinical outcomes, self-care behaviors, and quality of life (QOL) compared to a 6-month control period. METHODS This control-intervention cohort study recruited 77 African-American adults with type 2 diabetes. Baseline, 6-month, and 12-month assessments measured A1C, weight, body mass index (BMI), blood pressure, lipids, self-care behaviors, and QOL. During the control period, participants received weekly educational newsletters. During the intervention period, participants attended weekly DSMS groups as frequently as they needed. Sessions were guided by participants' self-management questions and concerns, and also emphasized experiential learning, coping, problem-solving, and goal-setting. RESULTS The control period found significant improvements for diastolic BP (p<0.05), serum cholesterol (p<0.001), following a healthy diet (p<0.01), and monitoring blood glucose (p<0.01). The intervention period found significant additional improvements for A1C (p<0.001), weight (p<0.05), BMI (p<0.05), and LDL (p<0.001). Compared to the control period, participation in the intervention led to a significant reduction in A1C (p<0.01). CONCLUSION Findings suggest that an empowerment-based, DSMS intervention is promising for improving and/or maintaining diabetes-related health, particularly A1C. PRACTICAL IMPLICATIONS Incorporating empowerment principles in DSMS interventions may be useful for supporting patients' self-management efforts in "real-world" settings.
Collapse
Affiliation(s)
- Tricia S Tang
- Department of Medical Education, University of Michigan Medical School and Michigan Diabetes Research and Training Center, University of Michigan, MI, USA.
| | | | | | | |
Collapse
|
17
|
Luyckx K, Vanhalst J, Seiffge-Krenke I, Weets I. A typology of coping with Type 1 diabetes in emerging adulthood: associations with demographic, psychological, and clinical parameters. J Behav Med 2010; 33:228-38. [DOI: 10.1007/s10865-010-9249-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2009] [Accepted: 01/15/2010] [Indexed: 11/28/2022]
|
18
|
Chiu YW, Chang JM, Lin LI, Chang PY, Lo WC, Wu LC, Chen TC, Hwang SJ. Adherence to a diabetic care plan provides better glycemic control in ambulatory patients with type 2 diabetes. Kaohsiung J Med Sci 2010; 25:184-92. [PMID: 19502135 DOI: 10.1016/s1607-551x(09)70059-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Tight control of blood sugar improves the outcomes for diabetic patients, but it can only be achieved by adhering to a well-organized care plan. To evaluate the effect of a diabetes care plan with reinforcement of glycemic control in diabetic patients, 98 ambulatory patients with type 2 diabetes who visited our diabetes clinic every 3-4 months and who completed four education courses given by certified diabetes educators within 3 months after the first visit, were defined as the Intervention group. A total of 82 patients fulfilling the inclusion criteria for the Intervention group but who missed at least half of the diabetes education sessions were selected as controls. Both groups had comparable mean hemoglobin A1c (HbA1c) levels at baseline, which decreased significantly at 3 months and were maintained at approximately constant levels at intervals for up to 1 year. The HbA1c decrement in the Intervention group was significantly greater than that in the Control group over the 1-year follow-up period (HbA1c change: -2.5 +/- 1.8% vs. -1.1 +/- 1.7%, p < 0.01). The maximal HbA1c decrement occurred during the first 3 months, and accounted for 95.6% and 94.6% of the total HbA1c decrements in the Intervention and Control groups, respectively. In the multiple regression model, after adjustment for age, body mass index, and duration of diabetes, the Intervention group may still have a 12.6% improvement in HbA1c from their original value to the end of 1 year treatment compared with the Control group (p < 0.05). Diabetes care, with reinforcement from certified diabetes educators, significantly improved and maintained the effects on glycemic control in ambulatory patients with type 2 diabetes.
Collapse
Affiliation(s)
- Yi-Wen Chiu
- Department of Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Beryl Pilkington F, Daiski I, Bryant T, Dinca-panaitescu M, Dinca-panaitescu S, Raphael D. The Experience of Living with Diabetes for Low-income Canadians. Can J Diabetes 2010. [DOI: 10.1016/s1499-2671(10)42008-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
20
|
Huang MF, Courtney M, Edwards H, McDowell J. Psychometric Evaluation of the Chinese Version of the Diabetes Coping Measure Scale. J Nurs Scholarsh 2009; 41:385-90. [DOI: 10.1111/j.1547-5069.2009.01306.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
21
|
Roek MGA, Welschen LMC, Kostense PJ, Dekker JM, Snoek FJ, Nijpels G. Web-based guided insulin self-titration in patients with type 2 diabetes: the Di@log study. Design of a cluster randomised controlled trial [TC1316]. BMC FAMILY PRACTICE 2009; 10:40. [PMID: 19508712 PMCID: PMC2703619 DOI: 10.1186/1471-2296-10-40] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Accepted: 06/09/2009] [Indexed: 11/10/2022]
Abstract
BACKGROUND Many patients with type 2 diabetes (T2DM) are not able to reach the glycaemic target level of HbA1c < 7.0%, and therefore are at increased risk of developing severe complications. Transition to insulin therapy is one of the obstacles in diabetes management, because of barriers of both patient and health care providers. Patient empowerment, a patient-centred approach, is vital for improving diabetes management. We developed a web-based self-management programme for insulin titration in T2DM patients. The aim of our study is to investigate if this internet programme helps to improve glycaemic control more effectively than usual care. METHODS/DESIGN T2DM patients (n = 248), aged 35-75 years, with an HbA1c > or = 7.0%, eligible for treatment with insulin and able to use the internet will be selected from general practices in two different regions in the Netherlands. Cluster randomisation will be performed at the level of general practices. Patients in the intervention group will use a self-developed internet programme to assist them in self-titrating insulin. The control group will receive usual care.Primary outcome is the difference in change in HbA1c between intervention and control group. Secondary outcome measures are quality of life, treatment satisfaction, diabetes self-efficacy and frequency of hypoglycaemic episodes. Results will be analysed according to the intention-to-treat principle. DISCUSSION An internet intervention supporting self-titration of insulin therapy in T2DM patients is an innovative patient-centred intervention. The programme provides guided self-monitoring and evaluation of health and self-care behaviours through tailored feedback on input of glucose values. This is expected to result in a better performance of self-titration of insulin and consequently in the improvement of glycaemic control. The patient will be enabled to 'discover and use his or her own ability to gain mastery over his/her diabetes' and therefore patient empowerment will increase. Based on the self-regulation theory of Leventhal, we hypothesize that additional benefits will be achieved in terms of increases in treatment satisfaction, quality of life and self-efficacy. TRIAL REGISTRATION Dutch Trial Register TC1316.
Collapse
Affiliation(s)
- Mariëlle G A Roek
- The EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
| | | | | | | | | | | |
Collapse
|
22
|
|
23
|
Chen YC, Li IC. Effectiveness of interventions using empowerment concept for patients with chronic disease: a systematic review. ACTA ACUST UNITED AC 2009; 7:1179-1233. [DOI: 10.11124/01938924-200907270-00001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
24
|
Chen YC, Li IC. Effectiveness of interventions using empowerment concept for patients with chronic disease: a systematic review. ACTA ACUST UNITED AC 2009. [DOI: 10.11124/jbisrir-2009-208] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
25
|
Identity development, coping, and adjustment in emerging adults with a chronic illness: the sample case of type 1 diabetes. J Adolesc Health 2008; 43:451-8. [PMID: 18848673 DOI: 10.1016/j.jadohealth.2008.04.005] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Revised: 04/10/2008] [Accepted: 04/19/2008] [Indexed: 11/23/2022]
Abstract
PURPOSE The present study focused on identity development in emerging adults (aged 18-30 years) with type 1 diabetes. The three study aims were to examine the following: (1) whether identity development was affected by having diabetes, as compared with development in a nondiabetic sample; (2) how identity development was related to depressive symptoms, coping with diabetes, and diabetes-related problems in the diabetic sample; and (3) whether the pathways from identity development to problems with diabetes and depressive symptoms were mediated through coping strategies in the diabetic sample. METHODS A total of 194 emerging adults with type 1 diabetes and 344 nondiabetic emerging adults participated. RESULTS First, using analyses of variance, some mean identity differences between the diabetic and comparison samples were found, with emerging adults with diabetes scoring lower on proactive identity exploration. Using cluster analysis, we found that the same identity types or statuses emerged in both the diabetic and nondiabetic samples. Second, in emerging adults with diabetes, these identity statuses were differentially related to diabetes-related problems, depressive symptoms, and illness coping, with the identity statuses representing a strong sense of identity being accompanied by less diabetes-related problems and depressive symptoms and more adequate coping strategies. Third, using structural equation modeling, the pathways from a strong sense of identity to diabetes-related problems and depressive symptoms were mediated through adaptive and maladaptive coping. CONCLUSIONS Clinicians should be sensitive to the normative task of identity development in emerging adults with diabetes because identity development can function as a resource in coping with and adjusting to diabetes.
Collapse
|
26
|
Aujoulat I, Marcolongo R, Bonadiman L, Deccache A. Reconsidering patient empowerment in chronic illness: A critique of models of self-efficacy and bodily control. Soc Sci Med 2008; 66:1228-39. [PMID: 18155338 DOI: 10.1016/j.socscimed.2007.11.034] [Citation(s) in RCA: 217] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2006] [Indexed: 01/08/2023]
Affiliation(s)
- Isabelle Aujoulat
- Université Catholique de Louvain, Health and Patient Education Unit RESO, School of Public Health, Avenue Mounier, Bruxelles, Belgium.
| | | | | | | |
Collapse
|
27
|
Zhang X, Norris SL, Chowdhury FM, Gregg EW, Zhang P. The Effects of Interventions on Health-Related Quality of Life Among Persons With Diabetes. Med Care 2007; 45:820-34. [PMID: 17712252 DOI: 10.1097/mlr.0b013e3180618b55] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Health-related quality of life (HRQL) is increasingly used to measure the outcomes of interventions among people with chronic diseases. OBJECTIVES To assess the effect of interventions for adults with diabetes on HRQL, as measured by the Short Form (SF)-36 questionnaire. RESEARCH DESIGN The systematic review was conducted using the methods of the Cochrane Collaboration. Studies reporting SF-36 scores before and after an intervention focused on adults with diabetes were obtained from searches of multiple bibliographic databases. The mean changes and standardized mean differences between pre- and post-intervention were reported as outcome measures. Pooled estimates were obtained using random effects models. RESULTS : We identified 33 studies examining a wide range of interventions, including diabetes education and behavioral modifications (15 studies), pharmacotherapy (11 studies), and surgery (7 studies). Interventions generally demonstrated improvement in HRQL. When all available profile scores were examined together, the ranges of mean changes in scores were as follows: surgery for treating diabetes comorbidities, 15.0 to 42.0 point improvement; surgery for treating diabetes complications, -13.0 to 37.9; pharmacotherapy using insulin to optimize glycemic control, -4.6 to 27.6; pharmacotherapy for treating comorbidities, 3.8 to 33.2; pharmacotherapy for treating complications, -2.6 to 14.6. Pooled effects from 5 randomized controlled trials of educational interventions demonstrated significantly improved physical function [3.4 (95% CI, 0.1-6.6)] and mental health [4.2 (95% CI, 1.8-6.6)], and a decrease in bodily pain [3.6 (95% CI, 0.6-6.7)]. CONCLUSIONS A variety of interventions can improve HRQL among adults with diabetes, but the magnitude of effects varied with the interventions. The mechanism of these changes needs to be further examined in the future research.
Collapse
Affiliation(s)
- Xuanping Zhang
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
| | | | | | | | | |
Collapse
|
28
|
Virtanen H, Leino-Kilpi H, Salanterä S. Empowering discourse in patient education. PATIENT EDUCATION AND COUNSELING 2007; 66:140-6. [PMID: 17349769 DOI: 10.1016/j.pec.2006.12.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2006] [Revised: 12/18/2006] [Accepted: 12/22/2006] [Indexed: 05/14/2023]
Abstract
OBJECTIVE A systematic literature review, using a metasummary technique for qualitative studies (n=15) was conducted to describe the nature of empowering discourses between patient and nurse. METHODS Computerised searches from 1995 to October 2005 were conducted on the Ovid Medline database using the keywords empower(*), power(*), resource(*), participat(*), facilitat(*), negotiat(*), communicat(*), interact(*), dialog(*), discours(*), discuss(*), encount(*), conversat(*) and 'nurse-patient relations'. All statements concerning empowering discourse were integrated into 29 abstracted findings. Frequency and intensity effect sizes were then calculated. RESULTS Empowering discourses vary from study to study. Analysed as a whole, an empowering discourse has specific characteristics and structure. Both patients and nurses have essential roles within this type of discourse and their relationship is characterized by an appreciation of each other's expertise within these roles. CONCLUSION The results of this review show empowerment during discourse between patient and nurse has a complex and multifaceted but analysable nature. More research is needed to find systematic methods of empowering discourse. PRACTICE IMPLICATIONS The results of this study increase nurses' understanding of empowering methods in patient education identifying ways of facilitating patient empowerment.
Collapse
Affiliation(s)
- Heli Virtanen
- University of Turku, Department of Nursing Science, FIN-20014, Finland.
| | | | | |
Collapse
|
29
|
Aujoulat I, d'Hoore W, Deccache A. Patient empowerment in theory and practice: polysemy or cacophony? PATIENT EDUCATION AND COUNSELING 2007; 66:13-20. [PMID: 17084059 DOI: 10.1016/j.pec.2006.09.008] [Citation(s) in RCA: 351] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2006] [Revised: 09/22/2006] [Accepted: 09/22/2006] [Indexed: 05/12/2023]
Abstract
OBJECTIVE This paper examines how the term "empowerment" has been used in relation to the care and education of patients with chronic conditions over the past decade. METHODS Fifty-five articles were analysed, using a qualitative method of thematic analysis. RESULTS Empowerment is more often defined according to some of its anticipated outcomes rather than to its very nature. However, because they do not respect the principle of self-determination, most anticipated outcomes and most evaluation criteria are not specific to empowerment. Concerning the process of empowerment, our analysis shows that (i) the educational objectives of an empowerment-based approach are not disease-specific, but concern the reinforcement or development of general psychosocial skills instead; (ii) empowering methods of education are necessarily patient-centred and based on experiential learning; and (iii) the provider-patient relationship needs to be continuous and self-involving on both sides. CONCLUSION Our analysis did not allow for the unfolding of a well-articulated theory on patient empowerment but revealed a number of guiding principles and values. PRACTICE IMPLICATIONS The goals and outcomes of patient empowerment should neither be predefined by the health-care professionals, nor restricted to some disease and treatment-related outcomes, but should be discussed and negotiated with every patient, according to his/her own particular situation and life priorities.
Collapse
Affiliation(s)
- Isabelle Aujoulat
- Health and Patient Education Unit RESO, Université Catholique de Louvain, Bruxelles, Belgium.
| | | | | |
Collapse
|