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Ferrazza I, Pesantes MA. Men With Type II Diabetes in Peru: The Role of Masculine Gender Norms in the Perception of Family Support. Am J Mens Health 2024; 18:15579883241239552. [PMID: 38567927 PMCID: PMC10993681 DOI: 10.1177/15579883241239552] [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: 10/09/2023] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 04/05/2024] Open
Abstract
Type II diabetes is increasingly becoming a problem in Latin American countries such as Peru. People living with diabetes must incorporate several behavioral changes in their everyday lives, which are done outside the purview of medical professionals. Support from friends and family members is essential to the successful management of any chronic condition. Our study discusses the role of family involvement in supporting the management of diabetes among Peruvian men and examines how masculine norms play a role in the way such support is received and perceived, and their influence in motivation to adhere to treatment recommendations. In-depth interviews with 20 men from a low socioeconomic status, aged 27 to 68 with a diagnosis of Type II diabetes were conducted. Our analysis suggests the importance of the close, complex, and integrated experience that connects family members and patients with a chronic condition. Participant accounts demonstrate they receive multiple forms of support from a diverse range of social relationships. The overwhelming majority of the people giving the support were female and were especially significant in supporting management practices. The participants' accounts were able to demonstrate how living with a chronic condition, such as diabetes, affects the whole family-physically, mentally, and emotionally-and they experience the disease as one unit. Our study demonstrates the need for a family health experience approach that considers masculine gender norms around health and provides relevant insights to inform family-based treatments and therapies to allow for more and better targeted health care for men.
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Affiliation(s)
- Isabella Ferrazza
- Department of Anthropology and Archaeology, Dickinson College, Carlisle, PA, USA
| | - M. Amalia Pesantes
- Department of Anthropology and Archaeology, Dickinson College, Carlisle, PA, USA
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Gulyani P, Rawat P, Elmi Y, Gupta S, Wan CS. Barriers and facilitators of lifestyle management among adult South Asian migrants living with chronic diseases: A mixed-methods systematic review. Diabetes Metab Syndr 2024; 18:102944. [PMID: 38281447 DOI: 10.1016/j.dsx.2024.102944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND AND AIM South Asian migrants have a higher prevalence of chronic diseases than Caucasians. Despite much literature that has explored challenges in chronic disease management amongst the South Asian population in the past decades, their chronic disease management is still suboptimal. Understanding their determinants of disease management behaviour using the Theoretical Domains Framework will inform the development of a culturally sensitive intervention relevant to consumer-end-users. This study aimed to synthesise qualitative and quantitative studies on chronic disease management among adult South Asian immigrants. METHODS A mixed-methods systematic review was conducted using electronic databases. The Mixed Methods Appraisal Tool assessed the quality of the included studies. Quantitative data were transformed into qualitative data and analysed thematically. Subthemes were mapped in the Theoretical Domains Framework presenting barriers and facilitators under each theme. RESULTS 18293 studies were identified, of which 37 studies were included. The barriers and facilitators identified were categorised into four overarching themes: patient-provider interaction and relationship (e.g., complex language use by health professionals), the impact of migration (e.g., weather conditions had an impact on engagement with physical activity), heritage-based practices (e.g., an obligation to consume energy-dense food in social gatherings), and chronic disease management strategies (e.g., lack understanding of appropriate disease management strategies). CONCLUSION This review provides a comprehensive understanding of the complexity of chronic disease management among South Asian migrants and insights into developing multifaceted interventions to address barriers to chronic disease management, guiding the healthcare professionals in helping overcome South Asians perceived barriers to managing chronic disease in the host countries.
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Affiliation(s)
- Purva Gulyani
- Department of Sport, Exercise and Nutrition Sciences, La Trobe University, Bundoora, Australia; Diet Yumm, Craigieburn, Victoria, Australia.
| | | | - Yusra Elmi
- Diet Yumm, Craigieburn, Victoria, Australia
| | - Sabrina Gupta
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Ching Shan Wan
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Australia; National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Australia
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Baumeister A, Aldin A, Chakraverty D, Hübner C, Adams A, Monsef I, Skoetz N, Kalbe E, Woopen C. Interventions for improving health literacy in migrants. Cochrane Database Syst Rev 2023; 11:CD013303. [PMID: 37963101 PMCID: PMC10645402 DOI: 10.1002/14651858.cd013303.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
BACKGROUND Health literacy (HL) is a determinant of health and important for autonomous decision-making. Migrants are at high risk for limited HL. Improving HL is important for equitable promotion of migrants' health. OBJECTIVES To assess the effectiveness of interventions for improving HL in migrants. To assess whether female or male migrants respond differently to the identified interventions. SEARCH METHODS We ran electronic searches to 2 February 2022 in CENTRAL, MEDLINE, Embase, PsycInfo and CINAHL. We also searched trial registries. We used a study filter for randomised controlled trials (RCTs) (RCT classifier). SELECTION CRITERIA We included RCTs and cluster-RCTs addressing HL either as a concept or its components (access, understand, appraise, apply health information). DATA COLLECTION AND ANALYSIS We used the methodological procedures recommended by Cochrane and followed the PRISMA-E guidelines. Outcome categories were: a) HL, b) quality of life (QoL), c) knowledge, d) health outcomes, e) health behaviour, f) self-efficacy, g) health service use and h) adverse events. We conducted meta-analysis where possible, and reported the remaining results as a narrative synthesis. MAIN RESULTS We included 28 RCTs and six cluster-RCTs (8249 participants), all conducted in high-income countries. Participants were migrants with a wide range of conditions. All interventions were adapted to culture, language and literacy. We did not find evidence that HL interventions cause harm, but only two studies assessed adverse events (e.g. anxiety). Many studies reported results for short-term assessments (less than six weeks after total programme completion), reported here. For several comparisons, there were also findings at later time points, which are presented in the review text. Compared with no HL intervention (standard care/no intervention) or an unrelated HL intervention (similar intervention but different information topic) Self-management programmes (SMP) probably improve self-efficacy slightly (standardised mean difference (SMD) 0.28, 95% confidence interval (CI) 0.06 to 0.50; 2 studies, 333 participants; moderate certainty). SMP may improve HIV-related HL (understanding (mean difference (MD) 4.25, 95% CI 1.32 to 7.18); recognition of HIV terms (MD 3.32, 95% CI 1.28 to 5.36)) (1 study, 69 participants). SMP may slightly improve health behaviours (3 studies, 514 participants), but may have little or no effect on knowledge (2 studies, 321 participants) or subjective health status (MD 0.38, 95% CI -0.13 to 0.89; 1 study, 69 participants) (low certainty). We are uncertain of the effects of SMP on QoL, health service use or adverse events due to a lack of evidence. HL skills building courses (HLSBC) may improve knowledge (MD 10.87, 95% CI 5.69 to 16.06; 2 studies, 111 participants) and any generic HL (SMD 0.48, 95% CI 0.20 to 0.75; 2 studies, 229 participants), but may have little or no effect on depression literacy (MD 0.17, 95% CI -1.28 to 1.62) or any health behaviour (2 studies, 229 participants) (low certainty). We are uncertain if HLSBC improve QoL, health outcomes, health service use, self-efficacy or adverse events, due to very low-certainty or a lack of evidence. Audio-/visual education without personal feedback (AVE) probably improves depression literacy (MD 8.62, 95% CI 7.51 to 9.73; 1 study, 202 participants) and health service use (MD -0.59, 95% CI -1.11 to -0.07; 1 study, 157 participants), but probably has little or no effect on health behaviour (risk ratio (RR) 1.07, 95% CI 0.91 to 1.25; 1 study, 135 participants) (moderate certainty). AVE may improve self-efficacy (MD 3.51, 95% CI 2.53 to 4.49; 1 study, 133 participants) and may slightly improve knowledge (MD 8.44, 95% CI -2.56 to 19.44; 2 studies, 293 participants) and intention to seek depression treatment (MD 1.8, 95% CI 0.43 to 3.17), with little or no effect on depression (SMD -0.15, 95% CI -0.40 to 0.10) (low certainty). No evidence was found for QoL and adverse events. Adapted medical instruction may improve understanding of health information (3 studies, 478 participants), with little or no effect on medication adherence (MD 0.5, 95% CI -0.1 to 1.1; 1 study, 200 participants) (low certainty). No evidence was found for QoL, health outcomes, knowledge, health service use, self-efficacy or adverse events. Compared with written information on the same topic SMP probably improves health numeracy slightly (MD 0.7, 95% CI 0.15 to 1.25) and probably improves print literacy (MD 9, 95% CI 2.9 to 15.1; 1 study, 209 participants) and self-efficacy (SMD 0.47, 95% CI 0.3 to 0.64; 4 studies, 552 participants) (moderate certainty). SMP may improve any disease-specific HL (SMD 0.67, 95% CI 0.27 to 1.07; 4 studies, 955 participants), knowledge (MD 11.45, 95% CI 4.75 to 18.15; 6 studies, 1101 participants) and some health behaviours (4 studies, 797 participants), with little or no effect on health information appraisal (MD 1.15, 95% CI -0.23 to 2.53; 1 study, 329 participants) (low certainty). We are uncertain whether SMP improves QoL, health outcomes, health service use or adverse events, due to a lack of evidence or low/very low-certainty evidence. AVE probably has little or no effect on diabetes HL (MD 2, 95% CI -0.15 to 4.15; 1 study, 240 participants), but probably improves information appraisal (MD -9.88, 95% CI -12.87 to -6.89) and application (RR 1.51, 95% CI 1.29 to 1.77) (1 study, 608 participants; moderate certainty). AVE may slightly improve knowledge (MD 8.35, 95% CI -0.32 to 17.02; low certainty). No short-term evidence was found for QoL, depression, health behaviour, self-efficacy, health service use or adverse events. AVE compared with another AVE We are uncertain whether narrative videos are superior to factual knowledge videos as the evidence is of very low certainty. Gender differences Female migrants' diabetes HL may improve slightly more than that of males, when receiving AVE (MD 5.00, 95% CI 0.62 to 9.38; 1 study, 118 participants), but we do not know whether female or male migrants benefit differently from other interventions due to very low-certainty or a lack of evidence. AUTHORS' CONCLUSIONS Adequately powered studies measuring long-term effects (more than six months) of HL interventions in female and male migrants are needed, using well-validated tools and representing various healthcare systems.
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Affiliation(s)
- Annika Baumeister
- Center for Life Ethics/Hertz Chair TRA 4, University of Bonn, Bonn, Germany
| | - Angela Aldin
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Digo Chakraverty
- Medical Psychology, Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Constanze Hübner
- Center for Life Ethics/Hertz Chair TRA 4, University of Bonn, Bonn, Germany
| | - Anne Adams
- Institute of Medical Statistics and Computational Biology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Ina Monsef
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nicole Skoetz
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Elke Kalbe
- Medical Psychology, Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Christiane Woopen
- Center for Life Ethics/Hertz Chair TRA 4, University of Bonn, Bonn, Germany
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Mansyur CL, Rustveld LO, Nash SG, Jibaja-Weiss ML. Gender Differences in Self-Efficacy for Diabetes Self-Management Among Hispanics: The Mediating Role of Perceived Support and Depressive Symptoms. Sci Diabetes Self Manag Care 2023; 49:91-100. [PMID: 36942695 DOI: 10.1177/26350106231158827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
PURPOSE The purpose of this study is to examine the extent to which perceived support and depressive symptoms might interfere with Hispanic patients' ability to manage their diabetes and whether these effects vary by gender. METHODS Data were collected from a cohort of 232 Hispanic men and women with type 2 diabetes mellitus (T2DM). Conditional process analysis was used to test a moderated mediation model of the time-lagged processes associating gender, diabetes support, and depressive symptoms with reported self-efficacy after 3 months. RESULTS Increased depressive symptoms were associated with lower self-efficacy, but the conditional effects varied among men and women. The index of moderated mediation was significant, indicating that among women, the indirect effect of depressive symptoms on self-efficacy was contingent on lower levels of perceived support. Among men, increased depressive symptoms were directly associated with declines in self-efficacy and were not conditional on perceived support. CONCLUSIONS Results of the study have important implications for gender health equity. Mental health screening and an assessment of support needs may be important for determining appropriate complementary therapies when treating Hispanic women with chronic conditions such as diabetes. Attention to possible differences in gender-specific mental health needs could lead to improved self-management, better glycemic control, and more equitable health outcomes.
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Affiliation(s)
- Carol L Mansyur
- Department of Public Health, California State University, Sacramento, California
| | - Luis O Rustveld
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Susan G Nash
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas
| | - Maria L Jibaja-Weiss
- School of Health Professions, Baylor College of Medicine, Houston, Texas
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
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Daniel-Ulloa J, Reyes JA, Morales-Campos DY, Villareal E, López Cevallos DF, Hernandez H, Baquero B. Rural Latino Men’s Experiences and Attitudes Toward Health: A Pilot Photovoice Study. Am J Mens Health 2023. [PMCID: PMC9998422 DOI: 10.1177/15579883231158525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
Much of the research regarding Latino men’s health tends to focus on specific health outcomes (e.g., HIV or diabetes). Few studies have examined how Latino men perceive factors that influence their health and/or health-related behaviors. This study explored rural Latino men’s experiences and attitudes toward health, using photovoice, in the context of a community-based participatory research partnership. We recruited nine Latino men living in a small town in Southeastern Iowa. Four to nine men attended four sessions and led a community forum. All the men were foreign-born, identified as Latino, aged between 34 and 67 years, and had lived in the United States for at least 7 years. Five themes were identified: (a) cultural conflict, (b) too much and discordant information, (c) lifestyles conflict, (d) sacrifice, and (e) family connectedness. An important implication of this study derives from familial and community connections and sacrifice. Feeling disconnected from family may impact physical and mental health and health-promoting behaviors. Future research should explore ways to inform community- and family-level interventions to connect rural Latino men more strongly to their family and local community and help them to take better control of their health.
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Affiliation(s)
- Jason Daniel-Ulloa
- College of Public Health, University of Iowa, Iowa City, IA, USA
- Department of Nursing and Health Studies, University of Washington, Bothell, Bothell, WA, USA
| | | | | | | | - Daniel F. López Cevallos
- School of Language, Culture, and Society, College of Liberal Arts, Oregon State University, Corvallis, OR, USA
- School of Public Health and Health Sciences, University of Massachusetts, Amherst, Amherst, MA, USA
| | | | - Barbara Baquero
- College of Public Health, University of Iowa, Iowa City, IA, USA
- School of Public Health, University of Washington, Seattle, WA, USA
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Liu Y, Jiang J, You W, Gong D, Ma X, Wu M, Li F. Exploring facilitators and barriers to self-management engagement of Chinese people with type 2 diabetes mellitus and poor blood glucose control: a descriptive qualitative study. BMC Endocr Disord 2022; 22:294. [PMID: 36435767 PMCID: PMC9701421 DOI: 10.1186/s12902-022-01214-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 11/11/2022] [Indexed: 11/28/2022] Open
Abstract
AIMS To explore facilitators and barriers to self-management engagement of Chinese people with poorly controlled type 2 diabetes. METHODS Purposive sampling method was used for recruitment. Semi-structured interview and thematic analysis was used for data collection and analysis. RESULTS Twenty-six semi-structured interviews were conducted. Poor blood glucose control introduced awareness of susceptibility to complications, while mental disorders could be concomitant. General knowledge about healthy lifestyle and unhealthy habits impeded lifestyle management. Temporary remission of hyperglycemia and no perceived symptoms interfered engagement of medication therapy and regular blood glucose monitoring. Family and work environments could impact self-management engagement. Accessibility to reliable diabetes-related information influenced self-management engagement. CONCLUSIONS Awareness of susceptibility to complications motivated self-management engagement, while the awareness could cause mental disorders that need to be addressed. Customized lifestyle plans and behavior change technologies were crucial for lifestyle management. The progression of diabetes, importance of continuity of medication therapy, and the value of blood glucose monitoring should be clarified in diabetes education. Building diabetes-friendly social environments and providing reliable diabetes-related information were essential.
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Affiliation(s)
- Yuan Liu
- National Metabolic Management Center, Institute for Chronic Disease Management, Jining No. 1 People's Hospital, Jining, China.
| | - Jiajia Jiang
- National Metabolic Management Center, Institute for Chronic Disease Management, Jining No. 1 People's Hospital, Jining, China
| | - Wenjun You
- Department of Endocrinology, Jining No. 1 People's Hospital, Jining, China
| | - Dandan Gong
- Department of Endocrinology, Jining No. 1 People's Hospital, Jining, China
| | - Xiaoqing Ma
- Department of Endocrinology, Jining No. 1 People's Hospital, Jining, China
| | - Min Wu
- Department of Endocrinology, Jining No. 1 People's Hospital, Jining, China
| | - Feng Li
- Department of Endocrinology, Jining No. 1 People's Hospital, Jining, China
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Vidal TM, Williams CA, Ramoutar UD, Haffizulla F. Type 2 Diabetes Mellitus in Latinx Populations in the United States: A Culturally Relevant Literature Review. Cureus 2022; 14:e23173. [PMID: 35444916 PMCID: PMC9009996 DOI: 10.7759/cureus.23173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 03/15/2022] [Indexed: 11/22/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) affects a large number of the American population. When compared to their representation in the general American population, a disproportionate number of Latinx individuals are affected. Within the Latinx American population, T2DM prevalence rates vary among individuals based on their country of origin. Deaths from T2DM among Latinx American population are also more compared to other ethnicities. This disparity underlines the importance of understanding the cultural considerations of T2DM disease presentation and management in Latinx communities, including risk factors, socioeconomic variables, and other social determinants of health such as access to care. There are various modifiable and non-modifiable risk factors for the development of T2DM, regardless of race. Staple foods in the diet of Latinx American communities, such as tortillas, rice, and beans, can cause spikes in blood sugar levels and can lead to obesity, which predisposes patients to develop T2DM. Latinx American populations suffer from lower access to healthcare than the general population due to many reasons, including language proficiency, immigration status, socioeconomic status, and level of acculturation. This study utilized the format of a commentary, while incorporating elements of a scoping review for data collection, to further explore these disparities and their impact on these populations. Understanding the cultural beliefs of Latinx individuals and how these beliefs contribute to the perceived development of T2DM is essential to properly treat these unique populations. Despite high rates of T2DM affecting Latinx individuals, non-adherence to prescribed diabetes medications is high among these populations. Interventions in the form of culturally tailored preventative education, in addition to active T2DM management, are necessary to combat the toll of this disease on Latinx Americans. Generic interventional techniques and methods should be replaced entirely by those that acknowledge, highlight, and utilize the sociocultural characteristics of Latinx Americans.
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Leena KC, Alvares I, Sequeira SKL, Pereira PS, Deepika NC, Sequeira HA. Compliance of Diabetic Clients: Effect of Nurse-Led Home Care Interventions and Monitoring. JOURNAL OF HEALTH AND ALLIED SCIENCES NU 2021. [DOI: 10.1055/s-0041-1736278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Abstract
Objectives Type 2 diabetes impacts greatly on quality of life. Health-care providers must focus on efforts to detect, treat, and manage clients through supportive educative approach. This study aims to measure effectiveness of nurse-led home care interventions.
Materials and Methods This study among 103 diabetic subjects measured baseline blood pressure (BP), weight, and blood glucose levels. Information on compliance was obtained using a rating scale consisting of domains: dietary habits, exercise, rest, sleep, symptom management, prevention of complications, medication, and follow-up. Individualized comprehensive nursing interventions (education, testing, counselling) were provided, that were reinforced two times a week for 4 weeks, with minimum 7 home visits carried out by the researchers who are registered nurses and teaching faculty along with six interns of BSc nursing program. Post-tests were obtained at second and fourth weeks after start of intervention.
Results Significant improvement in blood sugar (p < 0.05), systolic BP (p < 0.001), and diastolic BP (p < 0.001) was observed. There was no change in body mass index (BMI) (p > 0.05). Post-hoc analysis found significant difference between pre-, post1- and post2-measures. Significant association was found between dietary habits and BMI (p < 0.05) and diastolic BP (p < 0.05). Compliance improved from 29 (28.2%) to 47(45.6%), partially compliant from 55 (53.4%) to 45 (43.7%) and noncompliant 19 (18.4%) to 11 (10.7%), with a clear improvement in each of the domains of compliance.
Conclusion Individualized comprehensive interventions delivered at the natural environment of families by registered nurses effectively improve compliance to diabetes management.
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Affiliation(s)
- K C Leena
- Yenepoya Nursing College, Yenepoya (deemed to be) University, Mangalore, Karnataka, India
| | - Irene Alvares
- Father Muller College of Nursing, Mangalore, Karnataka, India
| | | | | | - N C Deepika
- Father Muller College of Nursing, Mangalore, Karnataka, India
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Khan MM, Roberson S, Reid K, Jordan M, Odoi A. Geographic disparities and temporal changes of diabetes prevalence and diabetes self-management education program participation in Florida. PLoS One 2021; 16:e0254579. [PMID: 34270601 PMCID: PMC8284795 DOI: 10.1371/journal.pone.0254579] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 06/30/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although Diabetes Self-Management Education (DSME) programs are recommended to help reduce the burden of diabetes and diabetes-related complications, Florida is one of the states with the lowest DSME participation rates. Moreover, there is evidence of geographic disparities of not only DSME participation rates but the burden of diabetes as well. Understanding these disparities is critical for guiding control programs geared at improving participation rates and diabetes outcomes. Therefore, the objectives of this study were to: (a) investigate geographic disparities of diabetes prevalence and DSME participation rates; and (b) identify predictors of the observed disparities in DSME participation rates. METHODS Behavioral Risk Factor Surveillance System (BRFSS) data for 2007 and 2010 were obtained from the Florida Department of Health. Age-adjusted diabetes prevalence and DSME participation rates were computed at the county level and their geographic distributions visualized using choropleth maps. Significant changes in diabetes prevalence and DSME participation rates between 2007 and 2010 were assessed and counties showing significant changes were mapped. Clusters of high diabetes prevalence before and after adjusting for common risk factors and DSME participation rates were identified, using Tango's flexible spatial scan statistics, and their geographic distribution displayed in maps. Determinants of the geographic distribution of DSME participation rates and predictors of the identified high rate clusters were identified using ordinary least squares and logistic regression models, respectively. RESULTS County level age-adjusted diabetes prevalence varied from 4.7% to 17.8% while DSME participation rates varied from 26.6% to 81.2%. There were significant (p≤0.05) increases in both overall age-adjusted diabetes prevalence and DSME participation rates from 2007 to 2010 with diabetes prevalence increasing from 7.7% in 2007 to 8.6% in 2010 while DSME participation rates increased from 51.4% in 2007 to 55.1% in 2010. Generally, DSME participation rates decreased in rural areas while they increased in urban areas. High prevalence clusters of diabetes (both adjusted and unadjusted) were identified in northern and central Florida, while clusters of high DSME participation rates were identified in central Florida. Rural counties and those with high proportion of Hispanics tended to have low DSME participation rates. CONCLUSIONS The findings confirm that geographic disparities in both diabetes prevalence and DSME participation rates exist. Specific attention is required to address these disparities especially in areas that have high diabetes prevalence but low DSME participation rates. Study findings are useful for guiding resource allocation geared at reducing disparities and improving diabetes outcomes.
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Affiliation(s)
- Md Marufuzzaman Khan
- Department of Public Health, College of Education, Health, and Human Sciences, The University of Tennessee, Knoxville, Tennessee, United States of America
| | - Shamarial Roberson
- Florida Department of Health, Tallahassee, Florida, United States of America
| | - Keshia Reid
- Florida Department of Health, Tallahassee, Florida, United States of America
| | - Melissa Jordan
- Florida Department of Health, Tallahassee, Florida, United States of America
| | - Agricola Odoi
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, Tennessee, United States of America
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10
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Harandi TF, Mahmoodi Z, Ghavidel N, Sharifipour Z. Factors affecting self-management in Iranian tuberculosis patients: A path analysis model. ACTA ACUST UNITED AC 2021; 57:73-78. [PMID: 34212074 PMCID: PMC8221375 DOI: 10.29390/cjrt-2021-009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Self-management behaviors can reduce the progression of an illness. Although various factors affect self-management, no study has been conducted on the self-management of tuberculosis (TB) through path analysis. Objectives This study evaluated the factors affecting self-management in TB patients using path analysis. Methods A cross-sectional study was done on 133 non-prisoner TB patients that referred to all health centers in Karaj, Iran, in 2017. A structured questionnaire was applied. Data were analyzed with SPSS-17 and Lisrel 8.8, utilizing statistical path analysis to evaluate the relationships between self-management and its related factors. Results Overall, 52.3% of the participants in the study were female and 47.7% were male. Respondents of were 46.9% smear-positive, 9.4% smear-negative, and 43.8% extra-pulmonary TB. Fit indices confirmed the model fitness and logical relationships between the variables according to the conceptual model (χ2 = 49.80, df = 25). The final path model showed that age (β = 0.84), attitude (β = 0.10), marital status (β = 0.04), and house condition (β = 0.03) impact self-management through the direct path. Knowledge (β = 0.83) and education (β = 0.16) affect self-management through both direct and indirect paths. Education indirectly affects self-management through both knowledge and attitude. Knowledge indirectly impacts self-management through attitude. In other words, knowledge and attitude mediate the relationship between some factors and self-management. Conclusions This study provided an empirical model that illustrates the relationships between self-management and related factors in TB patients. The knowledge can be the target of interventions in support of self-management.
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Affiliation(s)
- Tayebeh Fasihi Harandi
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran.,Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Zohreh Mahmoodi
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran.,Dietary Supplements and Probiotic Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Nooshin Ghavidel
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Zhila Sharifipour
- Department of Health Education and Promotion, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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11
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Green AR, Boyd CM, Gleason KS, Wright L, Kraus CR, Bedoy R, Sanchez B, Norton J, Sheehan OC, Wolff JL, Reeve E, Maciejewski ML, Weffald LA, Bayliss EA. Designing a Primary Care-Based Deprescribing Intervention for Patients with Dementia and Multiple Chronic Conditions: a Qualitative Study. J Gen Intern Med 2020; 35:3556-3563. [PMID: 32728959 PMCID: PMC7728901 DOI: 10.1007/s11606-020-06063-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 07/15/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patients with dementia and multiple chronic conditions (MCC) frequently experience polypharmacy, increasing their risk of adverse drug events. OBJECTIVES To elucidate patient, family, and physician perspectives on medication discontinuation and recommended language for deprescribing discussions in order to inform an intervention to increase awareness of deprescribing among individuals with dementia and MCC, family caregivers and primary care physicians. We also explored participant views on culturally competent approaches to deprescribing. DESIGN Qualitative approach based on semi-structured interviews with patients, caregivers, and physicians. PARTICIPANTS Patients aged ≥ 65 years with claims-based diagnosis of dementia, ≥ 1 additional chronic condition, and ≥ 5 chronic medications were recruited from an integrated delivery system in Colorado and an academic medical center in Maryland. We included caregivers when present or if patients were unable to participate due to severe cognitive impairment. Physicians were recruited within the same systems and through snowball sampling, targeting areas with large African American and Hispanic populations. APPROACH We used constant comparison to identify and compare themes between patients, caregivers, and physicians. KEY RESULTS We conducted interviews with 17 patients, 16 caregivers, and 16 physicians. All groups said it was important to earn trust before deprescribing, frame deprescribing as routine and positive, align deprescribing with goals of dementia care, and respect caregivers' expertise. As in other areas of medicine, racial, ethnic, and language concordance was important to patients and caregivers from minority cultural backgrounds. Participants favored direct-to-patient educational materials, support from pharmacists and other team members, and close follow-up during deprescribing. Patients and caregivers favored language that explained deprescribing in terms of altered physiology with aging. Physicians desired communication tips addressing specific clinical situations. CONCLUSIONS Culturally sensitive communication within a trusted patient-physician relationship supplemented by pharmacists, and language tailored to specific clinical situations may support deprescribing in primary care for patients with dementia and MCC.
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Affiliation(s)
- Ariel R Green
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Mason F. Lord Center Tower, 7th floor, 5200 Eastern Avenue, Baltimore, MD, 21224, USA.
| | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Mason F. Lord Center Tower, 7th floor, 5200 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Kathy S Gleason
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Leslie Wright
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Courtney R Kraus
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Ruth Bedoy
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Bianca Sanchez
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Jonathan Norton
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Mason F. Lord Center Tower, 7th floor, 5200 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Orla C Sheehan
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Mason F. Lord Center Tower, 7th floor, 5200 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Jennifer L Wolff
- Department of Health Policy and Management, Roger C. Lipitz Center for Integrated Health Care, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emily Reeve
- Quality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Matthew L Maciejewski
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA
| | - Linda A Weffald
- Department of Clinical Pharmacy, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Elizabeth A Bayliss
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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12
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Sibounheuang P, Olson PS, Kittiboonyakun P. Patients' and healthcare providers’ perspectives on diabetes management: A systematic review of qualitative studies. Res Social Adm Pharm 2020; 16:854-874. [DOI: 10.1016/j.sapharm.2019.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 08/22/2019] [Accepted: 09/01/2019] [Indexed: 12/23/2022]
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13
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Lindberg NM, Vega-López S, Arias-Gastelum M, Stevens VJ. Alternative Medicine Methods Used for Weight Loss and Diabetes Control by Overweight and Obese Hispanic Immigrant Women. HISPANIC HEALTH CARE INTERNATIONAL 2020; 18:49-54. [PMID: 31234651 DOI: 10.1177/1540415319858075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Middle-aged Hispanic women have the highest prevalence of overweight and lifetime risk for diabetes of all gender/racial groups. This study examines use of alternative medicine for weight loss and diabetes management among overweight and obese Mexican American women with or at risk for diabetes. METHOD As part of a diabetes risk-reduction intervention targeting overweight and obese Hispanic women at a federally qualified health center in Hillsboro, Oregon, we administered a survey of different treatment modalities, including alternative medicine, traditional Mexican medicine, and home remedies to 85 Hispanic women. We also asked participants how often they disclosed their use of alternative methods to their providers. RESULTS Nearly all participants with diabetes (97%) reported using at least one alternative strategy for diabetes control, with home remedies, commercial weight-loss products, and herbal teas being the most endorsed. Most participants with diabetes and half of those without diabetes reported never telling their provider. CONCLUSION This group of women reported a high prevalence of use of alternative methods for weight control and diabetes management. Yet most participants with diabetes never reported this use to a health care provider. To ensure patient safety, providers treating Hispanic women need to probe for complementary and alternative medicine practices.
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Affiliation(s)
- Nangel M Lindberg
- Kaiser Permanente Northwest Center for Health Research, Portland, OR, USA
| | | | | | - Victor J Stevens
- Kaiser Permanente Northwest Center for Health Research, Portland, OR, USA
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14
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Hildebrand JA, Billimek J, Lee JA, Sorkin DH, Olshansky EF, Clancy SL, Evangelista LS. Effect of diabetes self-management education on glycemic control in Latino adults with type 2 diabetes: A systematic review and meta-analysis. PATIENT EDUCATION AND COUNSELING 2020; 103:266-275. [PMID: 31542186 PMCID: PMC8087170 DOI: 10.1016/j.pec.2019.09.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 08/01/2019] [Accepted: 09/07/2019] [Indexed: 05/13/2023]
Abstract
PURPOSE This systematic review and meta-analysis evaluated the effectiveness of diabetes self-management education (DSME) in reducing glycosylated hemoglobin (A1C) levels in adult Latinos with type 2 diabetes (T2DM). METHODS Five databases were searched for DSME randomized controlled trials or quasi-experimental trials published between January 1997 and March 2019. A random effects model was utilized to calculate combined effect sizes. Subgroup analyses were performed to explore possible sources of heterogeneity between studies. RESULTS Twenty-three unique studies met criteria for this systematic review and of these, 18 were included in the meta-analysis. Pooled estimate effect of DSME on A1C from the random effect model was -0.240 (95% confidence interval = -0.345, -0.135, p < 0.001). There was moderate heterogeneity (Cochrane Q=30.977, P=0.020, I^2 = 45.121) between the studies. Subgroup analyses demonstrated greater A1C reductions in studies with intervention duration ≤6 months, initial A1C baseline values >8.0 [69 mmol/mol], and team-based approach. CONCLUSIONS Meta-analysis results showed that culturally tailored DSME interventions significantly reduce AIC in Latinos with T2DM despite the heterogeneity across the studies. IMPLICATIONS The heterogeneity in the study methodologies reinforce the need for additional studies to better understand DSME interventions to reduce disparities in Latino adults with T2DM.
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Affiliation(s)
- Janett A Hildebrand
- University of Southern California, Suzanne Dworak-Peck School of Social Work, Department of Nursing.
| | - John Billimek
- Program in Medical Education for the Latino Community, Health Policy Research Institute, Departments of Medicine and Family Medicine, University of California, Irvine, USA
| | - Jung-Ah Lee
- Sue and Bill Gross School of Nursing, University of California, Irvine, USA
| | - Dara H Sorkin
- Department of Medicine, University of California, Irvine, USA
| | - Ellen F Olshansky
- Sue and Bill Gross School of Nursing, University of California, Irvine, USA
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15
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Mora Pinzon M, Myers S, Jacobs EA, Ohly S, Bonet-Vázquez M, Villa M, Castro A, Mahoney J. "Pisando Fuerte": an evidence-based falls prevention program for Hispanic/Latinos older adults: results of an implementation trial. BMC Geriatr 2019; 19:258. [PMID: 31533636 PMCID: PMC6751582 DOI: 10.1186/s12877-019-1273-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/10/2019] [Indexed: 01/05/2023] Open
Abstract
Background We previously developed Pisando Fuerte (PF), a linguistically and culturally appropriate version of “Stepping On”, an evidence-based fall prevention program building on self-efficacy and adult learning principles. The purpose of this study is to describe the implementation of PF at two community organizations in Wisconsin. Methods PF consisted of 2 h sessions delivered in Spanish over the course of 8 weeks by two trained leaders, at two community sites in Wisconsin. Participants identified strategies for falls prevention and practiced progressive balance and strength exercises. The RE-AIM framework guided the mixed-methods evaluation. Falls Behavioral Risk Scale (FaB) (Outcomes), and uptake of protective behaviors (Individual Maintenance) were evaluated 6 months after completion. Fidelity of delivery (Implementation) was evaluated by an independent assessor for three sessions at each site using a-priori criteria based on key elements of Stepping On. Results Twenty-four Hispanic/Latino individuals, whose primary language is Spanish, were enrolled in two workshops. The mean age was 70.5 years; 71% were female, and five reported a fall in the year prior. Outcomes: There was a non-statically significant decrease in the number of falls per person [RR: 0.33 (95%CI: 0.096–1.13)] at 6 months. There was a statistically significant improvement of the mean Falls Behavioral Risk Scale (FaB) (baseline = 2.69 vs. 6-months post-intervention = 3.16, p < 0.001). Adoption: Barriers to adoption included leader training in English, time to identify Spanish-speaking guest experts, and time to prepare for each session. Implementation: Satisfactory fidelity of delivery was achieved in 69% of the elements; fidelity lapses were more common in the use of adult learning strategies and programmatic aspects. Eighty eight percent of participants completed the program, and 95% of them adequately demonstrated the exercises. Maintenance: At 6 months, 57.9% of participants continued doing exercises, 94% adopted safer walking strategies, and 67% executed at least one home safety recommendation. These results are similar to those seen in the original Stepping On program. Conclusions Our study shows good fidelity of delivery with implementation of “Pisando Fuerte”. Pre-post data demonstrate a significant reduction in falls behavioral risk among Hispanic/Latino participants, similar to results with “Stepping On”. Trial registration ClinicalTrials.gov, NCT03895021. Registered March 29, 2019.
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Affiliation(s)
- Maria Mora Pinzon
- Department of Medicine, Division of Geriatrics and Gerontology, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA. .,Community Academic Aging Research Network (CAARN), University of Wisconsin - Madison, 610 Walnut St. Office 330E, Madison, WI, 53704, USA.
| | - Shannon Myers
- Community Academic Aging Research Network (CAARN), University of Wisconsin - Madison, 610 Walnut St. Office 330E, Madison, WI, 53704, USA.,Wisconsin Institute for Healthy Aging, Madison, WI, USA
| | - Elizabeth A Jacobs
- Division of Primary Care and Value Based Health, Departments of Internal Medicine and Population Health, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Sherri Ohly
- JCS Consulting Solutions, Milwaukee, WI, USA
| | | | | | - Al Castro
- United Community Center, Milwaukee, WI, USA
| | - Jane Mahoney
- Department of Medicine, Division of Geriatrics and Gerontology, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA.,Community Academic Aging Research Network (CAARN), University of Wisconsin - Madison, 610 Walnut St. Office 330E, Madison, WI, 53704, USA
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16
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Garcia ML, Castañeda SF, Allison MA, Elder JP, Talavera GA. Correlates of low-adherence to oral hypoglycemic medications among Hispanic/Latinos of Mexican heritage with Type 2 Diabetes in the United States. Diabetes Res Clin Pract 2019; 155:107692. [PMID: 30954512 PMCID: PMC9494711 DOI: 10.1016/j.diabres.2019.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 02/18/2019] [Accepted: 04/01/2019] [Indexed: 12/19/2022]
Abstract
AIMS We examined psychosocial- and social/economic factors related to low medication adherence, and sex differences, among 279 adults of Mexican heritage with Type 2 Diabetes. METHODS Self-report and health record data were used for cross-sectional analyses. Bivariate analyses tested the association of demographic, psychosocial (depression, anxiety, stress) and social/economic factors (insurance type, health literacy, social support) and medication adherence measured by proportion of days covered. Hierarchical regression analyses examined associations between demographic, psychosocial- and social/economic- related factors and low medication adherence stratified by sex. RESULTS More males than females demonstrated low adherence to hypoglycemic medications (75.0.% vs. 70.3%) (p < 0.05). We found significant differences between levels social support and medication adherence (p < 0.05). In hierarchical models, being US born and higher levels of social support were associated with low adherence among males (p < 0.05, and p < 0.001). CONCLUSIONS Approximately 72% of Mexican heritage adults demonstrated low adherence (PDC ≤ 0.50) to their hypoglycemic regimen, and gender differences exist. Interventions should address gender differences in preferences for social support to improve medication-taking behaviors among Mexican heritage males.
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Affiliation(s)
- Melawhy L Garcia
- Division of Health Promotion and Behavioral Science, School of Public Health, San Diego State University and Institute for Behavioral and Community Health, 9245 Sky Park Court, Suite 221 San Diego, CA 92123-4311, USA; Department of Family Medicine and Public Health, School of Medicine and Women's Cardiovascular Research Center, University of California San Diego, 8950 Villa La Jolla Drive, Suite A2016, La Jolla, CA 92307, USA.
| | - Sheila F Castañeda
- Division of Health Promotion and Behavioral Science, School of Public Health, San Diego State University and Institute for Behavioral and Community Health, 9245 Sky Park Court, Suite 221 San Diego, CA 92123-4311, USA
| | - Matthew A Allison
- Department of Family Medicine and Public Health, School of Medicine and Women's Cardiovascular Research Center, University of California San Diego, 8950 Villa La Jolla Drive, Suite A2016, La Jolla, CA 92307, USA
| | - John P Elder
- Division of Health Promotion and Behavioral Science, School of Public Health, San Diego State University and Institute for Behavioral and Community Health, 9245 Sky Park Court, Suite 221 San Diego, CA 92123-4311, USA
| | - Gregory A Talavera
- Division of Health Promotion and Behavioral Science, School of Public Health, San Diego State University and Institute for Behavioral and Community Health, 9245 Sky Park Court, Suite 221 San Diego, CA 92123-4311, USA
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17
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Luciani M, Rebora P, Rossi E, Tonoli L, Androni S, Ballerini E, Fabrizi D, Riegel B, Ausili D, Di Mauro S. How Do Basic Human Values Affect Self-Care of Type 2 Diabetes Patients? A Multicentre Observational Study. Clin Nurs Res 2019; 29:304-312. [PMID: 30658535 DOI: 10.1177/1054773818825003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In type 2 diabetes mellitus (T2DM) patients, human values have been identified as having a possible impact on self-care. Despite this, basic human values have never been described in the T2DM population and the association between basic human values and self-care has not been assessed. The aims of this study were to describe basic human values and self-care, and investigate the associations between basic human values and self-care in adults with T2DM. The study was cross-sectional multicentre with T2DM patients (n = 390). Sociodemographic and clinical data were collected from charts, and two questionnaires were administered. The Portrait Values Questionnaire (PVQ) measured basic human values and allowed us to group patients into four groups based on the value profile: (A) Openness to Change and Self-Transcendence, (B) Conservation and Self-Transcendence, (C) Conservation and Self-Enhancement, and (D) Openness to Change and Self-Enhancement. The Self-care of Diabetes Inventory measured self-care maintenance, self-care monitoring, self-care management, and self-care confidence, according to the Middle-Range Theory of Self-Care of Chronic Illness. Multiple regression models were used to assess associations between the basic human values and self-care. Group D (Openness to Change and Self-Enhancement) performed significantly lower self-care maintenance (p = .024) and self-care monitoring (p = .031) when compared with Group A, and lower self-care monitoring (p = .008) and self-care management (p = .018) when compared with Group B. Group D showed significantly lower self-care monitoring (p = .027) when compared with Group C. People with T2DM who value more self-enhancement and openness to change might be more prone to perform worse self-care compared with those who value conservation and self-transcendence. Clinicians should consider this when designing interventions aimed at improving self-care behaviors in patients with T2DM.
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Affiliation(s)
- Michela Luciani
- University of Milano-Bicocca, Monza, Italy.,University of Rome Tor Vergata, Roma, Italy
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18
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Knowledge and self-care management of the uncontrolled diabetes patients. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2019. [DOI: 10.1016/j.ijans.2018.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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19
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Muchiri JW, Gericke GJ, Rheeder P. Stakeholders’ perceptions of dietary and related self-management challenges and education programme preferences for type 2 diabetes adults. JOURNAL OF ENDOCRINOLOGY METABOLISM AND DIABETES OF SOUTH AFRICA 2018. [DOI: 10.1080/16089677.2018.1541211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- JW Muchiri
- Department of Human Nutrition, University of Pretoria, Pretoria, South Africa
| | - GJ Gericke
- Department of Human Nutrition, University of Pretoria, Pretoria, South Africa
| | - P Rheeder
- Department of Internal Medicine, University of Pretoria, Pretoria, South Africa
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20
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Khairnar R, Kamal KM, Giannetti V, Dwibedi N, McConaha J. Primary care physician perspectives on barriers and facilitators to self-management of type 2 diabetes. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2018. [DOI: 10.1111/jphs.12280] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Abstract
Objectives
To assess physician perspectives on perceived barriers and facilitators to type 2 diabetes self-management (DSM) in a primary care setting.
Methods
The study utilized survey methodology to measure perspectives of primary care physicians on DSM and the challenges they face in managing patients with poor glycaemic stability. Demographic and practice site-related information of the physicians were also collected.
Key findings
Of the 21 physicians who responded (53.8% response rate), 71.2% were aged 50 years or older, 54.2% had ≥25 years of clinical experience, and 50% practiced in an urban setting. The physicians examined 5–60 patients with type 2 diabetes per week (mean = 20), and over 75% of them spent <20 min on face-to-face visits. Approximately, 95% of physicians considered self-care activities such as regular moderate exercise, following a recommended diet, regular blood glucose testing, proper insulin administration and adherence to oral medication as extremely important. Practice-related aspects such as patient–physician communication, patient health literacy and patient follow-up were unanimously considered extremely important, and performance on these measures was rated positively. Interestingly, 66% of physicians felt responsible to some extent for their patient's failure to reach type 2 DSM goals. Physician perceived barriers that contributed to clinical inertia included cost of medications, lack of patient motivation and knowledge, non-compliance with diet and medications, polypharmacy and lack of time and social support.
Conclusions
The study results underscore the importance of DSM in the overall management of type 2 diabetes. Addressing the challenges faced by physicians may result in better self-management and improved clinical outcomes in type 2 diabetes population.
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Affiliation(s)
- Rahul Khairnar
- Department of Pharmaceutical Health Services Research, University of Maryland, Baltimore, Baltimore, MD, USA
| | - Khalid M. Kamal
- Division of Pharmaceutical, Administrative and Social Sciences, School of Pharmacy, Duquesne University, Pittsburgh, PA, USA
| | - Vincent Giannetti
- Division of Pharmaceutical, Administrative and Social Sciences, School of Pharmacy, Duquesne University, Pittsburgh, PA, USA
| | - Nilanjana Dwibedi
- Department of Pharmaceutical Systems and Policy, West Virginia University, Morgantown, WV, USA
| | - Jamie McConaha
- Division of Pharmacy Practice, School of Pharmacy, Duquesne University, Pittsburgh, PA, USA
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Process evaluation of integrated diabetes management at primary healthcare facilities in Pakistan: a mixed-methods study. BJGP Open 2018; 2:bjgpopen18X101612. [PMID: 30723798 PMCID: PMC6348331 DOI: 10.3399/bjgpopen18x101612] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 07/02/2018] [Indexed: 11/08/2022] Open
Abstract
Background Integrated care for diabetes and associated conditions at primary level health facilities can make care available to a much larger population, especially in rural areas. Aim This process evaluation was to understand how the authors' integrated care was implemented and experienced by the care providers and patients, and to inform modifications prior to province-wide scale-up. Design & setting The mixed-method study was conducted as part of a cluster randomised trial on integrated diabetes care at 14 public health facilities. Method The care practices were assessed by analysing the routine clinical records of 495 registered patients with diabetes. Then semi-structured interviews with service providers and patients were used to understand their respective care experiences. A framework approach was applied to analyse and interpret the qualitative data. Results The intervention and the study were implemented as intended under routine conditions in rural health centres. Key service processes effectively delivered included: skill-based training; screening and diagnostic tests; treatment card records; and the additional case management as per desk guide, including monitoring progress in glucose and weight at follow-up consultations, and mobile phone calls to help adherence. However, social and cultural factors affected clients' ability to change lifestyles, especially for women. The intervention effect was limited by the short study follow-up of only 9 months. Conclusion Integrated diabetes care was feasible, both for providers and patients, and potentially scalable at primary care facilities under routine conditions in Pakistan. Additional operational interventions are required for sustained drug supplies, supervision, in-service training, and to address the social challenges to healthy activity and eating, especially for women.
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22
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Exploring the ‘Patient Experience’ of Individuals with Limited English Proficiency: A Scoping Review. J Immigr Minor Health 2018; 21:853-878. [DOI: 10.1007/s10903-018-0816-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Irfan Khan A, Gill A, Cott C, Hans PK, Steele Gray C. mHealth Tools for the Self-Management of Patients With Multimorbidity in Primary Care Settings: Pilot Study to Explore User Experience. JMIR Mhealth Uhealth 2018; 6:e171. [PMID: 30154073 PMCID: PMC6134226 DOI: 10.2196/mhealth.8593] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 05/20/2018] [Accepted: 06/21/2018] [Indexed: 12/19/2022] Open
Abstract
Background Given the complex and evolving needs of individuals with multimorbidity, the adoption of mHealth tools to support self-management efforts is increasingly being explored, particularly in primary care settings. The electronic patient-reported outcomes (ePRO) tool was codeveloped with patients and providers in an interdisciplinary primary care team in Toronto, Canada, to help facilitate self-management in community-dwelling adults with multiple chronic conditions. Objective The objective of study is to explore the experience and expectations of patients with multimorbidity and their providers around the use of the ePRO tool in supporting self-management efforts. Methods We conducted a 4-week pilot study of the ePRO tool. Patients’ and providers’ experiences and expectations were explored through focus groups that were conducted at the end of the study. In addition, thematic analyses were used to assess the shared and contrasting perspectives of patients and providers on the role of the ePRO tool in facilitating self-management. Coded data were then mapped onto the Individual and Family Self-Management Theory using the framework method. Results In this pilot study, 12 patients and 6 providers participated. Both patients and providers emphasized the need for a more explicit recognition of self-management context, including greater customizability of content to better adapt to the complexity and fluidity of self-management in this particular patient population. Patients and providers highlighted gaps in the extent to which the tool enables self-management processes, including how limited progress toward self-management goals and the absence of direct provider engagement through the ePRO tool inhibited patients from meeting their self-management goals. Providers highlighted proximal outcomes based on their experience of the tool and specifically, they indicated that the tool offered valuable insights into the broader patient context, which helps to inform the self-management approach and activities they recommend to patients, whereas patients recognized the tool’s potential in helping to improve access to different providers in a team-based primary care setting. Conclusions This study identifies a more explicit recognition of the contextual factors that influence patients’ ability to self-manage and greater adaptability to accommodate patient complexity and provider workflow as next steps in refining the ePRO tool to better support self-management efforts in primary care ahead of its application in a full-scale randomized pragmatic trial.
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Affiliation(s)
- Anum Irfan Khan
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Ashlinder Gill
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Cheryl Cott
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Parminder Kaur Hans
- Bridgepoint Campus, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
| | - Carolyn Steele Gray
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Bridgepoint Campus, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
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Peyrot M, Egede LE, Funnell MM, Hsu WC, Ruggiero L, Siminerio LM, Stuckey HL. US ethnic group differences in self-management in the 2nd diabetes attitudes, wishes and needs (DAWN2) study. J Diabetes Complications 2018; 32:586-592. [PMID: 29709335 DOI: 10.1016/j.jdiacomp.2018.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/01/2018] [Accepted: 03/05/2018] [Indexed: 12/20/2022]
Abstract
AIMS Understanding the relationship between ethnicity and self-management is important due to disparities in healthcare access, utilization, and outcomes among adults with type 2 diabetes from different ethnic groups in the US. METHODS Self-reports of self-management and interest in improving self-management from US people with diabetes (PWD) in the 2nd Diabetes Attitudes, Wishes and Needs (DAWN2) study, a multinational, multi-stakeholder survey, were analyzed, including 447 non-Hispanic White, 241 African American, 194 Hispanic American, and 173 Chinese American PWD (>18 years). RESULTS Overall, self-management behavior was highest for medication taking and lowest for physical activity. Non-Hispanic Whites had lowest physical activity and highest adherence to insulin therapy. Chinese Americans had lowest foot care and highest healthy eating. Overall, interest was highest for improving healthy eating and physical activity. Chinese Americans and Hispanic Americans were more interested than non-Hispanic Whites in improving most self-management behaviors. Chinese Americans were more interested than African Americans in improving most self-management behaviors. Healthcare providers telling PWD that their A1c needs improvement was associated with lower self-rated glucose control, which was associated with higher PWD interest in improving self-management behaviors. CONCLUSIONS Diabetes care providers should use patient-centered approaches and consider ethnicity in tailoring self-management support.
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Affiliation(s)
- Mark Peyrot
- Loyola University Maryland, Baltimore, MD, USA.
| | - Leonard E Egede
- Division of General Internal Medicine Froedtert & The Medical College of Wisconsin, WI, USA
| | | | - William C Hsu
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | - Laurie Ruggiero
- College of Health Sciences, School of Nursing, University of Delaware, Newark, DE, USA
| | | | - Heather L Stuckey
- The Pennsylvania State University College of Medicine, Hershey, PA, USA
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Perceptions of insulin use in type 2 diabetes in primary care: a thematic synthesis. BMC FAMILY PRACTICE 2018; 19:70. [PMID: 29788908 PMCID: PMC5964885 DOI: 10.1186/s12875-018-0753-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 05/01/2018] [Indexed: 01/29/2023]
Abstract
Background Increasing numbers of patients with type 2 diabetes mellitus are progressing to insulin therapy, and despite its potency many such individuals still have suboptimal glycaemic control. Insulin initiation and intensification is now often conducted by Practice Nurses and General Practitioners in many parts of the UK. Therefore, gaining insight into perspectives of patients and primary care clinicians is important in determining self-management and engagement with insulin. A thematic synthesis of studies was conducted exploring the views and experiences of people with type 2 diabetes and of healthcare professionals on insulin use and management in the context of primary care. Methods Protocol based systematic searches of electronic databases (CINAHL, Cochrane Library, EMBASE, MEDLINE, PsycINFO, and Web of Science) were performed on 1 October 2014 and updated on 31 March 2015, to identify studies that identified the views and experiences of adults with type 2 diabetes or primary care clinicians on the use of insulin in the management of type 2 diabetes. Studies meeting the review inclusion criteria were critically appraised using the CASP qualitative research checklist or Barley’s checklist for survey designs. A thematic synthesis was then conducted of the collected studies. Results Thirty-four studies were selected. Of these, 12 used qualitative interviews (nine with patients and three with healthcare professionals) and 22 were survey based (14 with patients, three with healthcare professionals, and five with both). Twelve key themes were identified and formed three domains, patient perceptions, healthcare professional perceptions, and health professional-patient relationships. The patient-centred themes were: insulin-related beliefs, social influences, psychological factors, hypoglycaemia, and therapy barriers. The clinician-related themes were: insulin skills of general practitioners, healthcare integration, healthcare professional-perceived barriers, hypoglycaemia, and explanations for adherence. Healthcare professional-patient relationship themes were drawn from the perspectives of patients and from clinicians. Conclusions This review reveals multiple barriers to optimal insulin use in primary care at both the patient and healthcare professional levels. These barriers indicate the need for multimodal interventions to: improve the knowledge and competencies of primary care professionals in insulin use; provide more effective patient education and self-management support; and introduce integrated insulin support systems. Electronic supplementary material The online version of this article (10.1186/s12875-018-0753-2) contains supplementary material, which is available to authorized users.
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Testerman J, Chase D. Influences on Diabetes Self-Management Education Participation in a Low-Income, Spanish-Speaking, Latino Population. Diabetes Spectr 2018; 31:47-57. [PMID: 29456426 PMCID: PMC5813308 DOI: 10.2337/ds16-0046] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate influences on participation in diabetes self-management education (DSME) classes in a low-income, Spanish-speaking, Latino population. METHODS Fifteen patients from an Oregon clinic participated in semi-structured interviews designed to understand influences on their participation in DSME classes, and the authors conducted a thematic analysis. RESULTS Four themes characterized the data: 1) limited resources, 2) culture, 3) relationship with diabetes, and 4) relationship with clinic. Barriers to class attendance included lack of time, childcare, and transportation; male participants' shame of illness and lack of interest in health; and difficulty contacting participants by telephone. Motivators of class attendance included interest in being healthy for the sake of family; interest in nutrition; knowledge of the effects of diabetes on self, friends, and family; and positive experiences with group support and self-efficacy in class. PRACTICE IMPLICATIONS AND CONCLUSION Participation in DSME classes in this low-income, Spanish-speaking, Latino population was influenced by many factors. Understanding these factors is an important step toward creating classes that are successful in increasing attendance rates for this and similar populations. Creative, targeted approaches to designing DSME classes for low-income, Spanish-speaking, Latino patients and similar populations are needed. These may include classes that remove the barriers of shame and lack of interest for male participants; focus on family involvement, celebration of culturally appropriate foods, group support, and self-efficacy; are accessible to resource-limited participants; and use alternative methods to recruit hard-to-reach participants.
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Abstract
Persons from Somalia constitute the largest group of immigrants and refugees from Africa among whom diabetes-related health disparities are well documented. As one of the first steps toward developing a behavioral intervention to address diabetes among Somali immigrants and refugees, we administered a face to face interview-based survey to Somali and Latino adults with diabetes in a single community to assess diabetes knowledge, attitudes and behaviors. Respondents (N = 78) reported several barriers to optimal diabetes management for physical activity and glucose self-monitoring, as well as a high burden of disease and negative perceptions of diabetes. High participant engagement in disease management, self-efficacy, and social support were important assets. Similarities suggest that the shared experiences of immigration and related systemic socioeconomic and linguistic factors play a significant role in the understanding and self-management of diabetes in these populations. Together with previously collected qualitative work, the survey findings will inform development of a behavioral intervention to improve outcomes and reduce diabetes-related health disparities among immigrant and refugee groups to the U.S.
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"They called me a terrorist": Social and Internalized Stigma in Latino Youth with Type 1 Diabetes. HEALTH PSYCHOLOGY REPORT 2018; 6:307-320. [PMID: 31032396 DOI: 10.5114/hpr.2018.80004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Diabetes-related stigma (DRS) globally affects patients' lives. Over a third of adolescents with type 1 diabetes (T1D) in Puerto Rico reported concerns of others knowing about their diabetes and about being different. Participants and Procedures We examined DRS among 65 T1D Latino youth (aged 12-17). During a depression-treatment study screening, they answered open-ended questions about diabetes-related concerns/difficulties and issues bothering them while interacting with peers, family, and healthcare professionals because of T1D. Using content analysis, we classified responses into Social Stigma (SS), Internalized Stigma (IS), and No Stigma. Four SS and IS sub-categories were developed. Results After coding, inter-rater reliability (Cohen's kappa) ranged from .73 to .1.00 (p≤.001). Forty-four youth (67.69%) reported at least one DRS verbalization, and 25 reported more than one. Both SS and IS were identified in 32 (49.23%) adolescents. Among SS experiences were: "they call me a junkie [because of insulin shots]"; "they call me a terrorist [because of insulin pump]". IS verbalizations included: "I've never wanted to accept that I have T1D, so I don't practice good self-care"; "at times I do not feel the same as others". We found more stigma-related verbalizations among those from urban zones or larger families. DRS was related to increased depressive symptoms and risk of a depressive disorder. Peers were the main source of SS. Conclusion DRS was common, pervasive, and linked to depression. This study innovatively examines DRS in an exclusively T1D Latino and adolescent sample. Understanding its extent and nature is essential for developing interventions to address DRS.
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Jones V, Crowe M. How people from ethnic minorities describe their experiences of managing type-2 diabetes mellitus: A qualitative meta-synthesis. Int J Nurs Stud 2017; 76:78-91. [DOI: 10.1016/j.ijnurstu.2017.08.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 08/22/2017] [Accepted: 08/27/2017] [Indexed: 11/29/2022]
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Reyes J, Tripp-Reimer T, Parker E, Muller B, Laroche H. Factors Influencing Diabetes Self-Management Among Medically Underserved Patients With Type II Diabetes. Glob Qual Nurs Res 2017; 4:2333393617713097. [PMID: 28660239 PMCID: PMC5476324 DOI: 10.1177/2333393617713097] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 04/24/2017] [Accepted: 05/01/2017] [Indexed: 11/26/2022] Open
Abstract
In this study, researchers compare and contrast issues regarding diabetes self-management between persons in good versus poor glycemic control. The sample comprises low-income racially diverse adults with diabetes from four mid-western community health centers; 44 patients participated in eight focus groups divided by control status (HbA1c of > 9 [uncontrolled] or < 7 [controlled]). Themes common to both groups included the impact of dietary restrictions on social interactions, food cravings, the impact of mental health on self-management, and the importance of formal and informal (friends and family) support. Those in the uncontrolled groups described fear about being able to control their diabetes, confusion about self-management, and difficulty managing their diabetes while caring for family members. Although those in the controlled groups acknowledged difficulties, they discussed resisting cravings, making improvements with small changes, positive feelings about their ability to control their diabetes, and enjoying new foods and exercise. Interventions should include mental health support, incorporate formal and informal patient support structures, and address literacy issues. Health care providers and intervention personnel should be very concrete about how to do self-management tasks and guide patients on how to alter their diabetes regimens for social and other important life events.
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Affiliation(s)
- Jimmy Reyes
- Iowa Board of Nursing, Des Moines, Iowa, USA
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DiZazzo-Miller R, Pociask FD, Bertran EA, Fritz HA, Abbas M, Tarakji S, Lysack CL, Jaber LA, Arnetz J. Diabetes Is Devastating, and Insulin Is a Death Sentence: Provider Perspectives of Diabetes Self-Management in Arab-American Patients. Clin Diabetes 2017; 35:43-50. [PMID: 28144045 PMCID: PMC5241769 DOI: 10.2337/cd15-0030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
IN BRIEF The purpose of this qualitative study was to examine providers' perspectives on cultural barriers and facilitators to diabetes self-management (DSM) in Arab Americans to identify factors to enhance DSM education in the Arab-American community. The main barriers to DSM from the providers' perspective were the disease itself and patients' denial or refusal to recognize it, reflecting the stigma of the disease. Cultural aspects also included overlapping themes that both facilitated and presented barriers to DSM. These results suggest that DSM education for Arab Americans will be most effective if developed and delivered in a manner consistent with the cultural facilitators and barriers noted by providers.
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Gonzalez-Zacarias AA, Mavarez-Martinez A, Arias-Morales CE, Stoicea N, Rogers B. Impact of Demographic, Socioeconomic, and Psychological Factors on Glycemic Self-Management in Adults with Type 2 Diabetes Mellitus. Front Public Health 2016; 4:195. [PMID: 27672634 PMCID: PMC5018496 DOI: 10.3389/fpubh.2016.00195] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 08/29/2016] [Indexed: 01/27/2023] Open
Abstract
Diabetes mellitus (DM) is reported as one of the most complex chronic diseases worldwide. In the United States, Type 2 DM (T2DM) is the seventh leading cause of morbidity and mortality. Individuals with diabetes require lifelong personal care to reduce the possibility of developing long-term complications. A good knowledge of diabetes risk factors, including obesity, dyslipidemia, hypertension, family history of DM, and sedentary lifestyle, play an essential role in prevention and treatment. Also, sociodemographic, economic, psychological, and environmental factors are directly and indirectly associated with diabetes control and health outcomes. Our review intends to analyze the interaction between demographics, knowledge, environment, and other diabetes-related factors based on an extended literature search, and to provide insight for improving glycemic control and reducing the incidence of chronic complications.
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Affiliation(s)
| | - Ana Mavarez-Martinez
- Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Carlos E Arias-Morales
- Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Nicoleta Stoicea
- Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Barbara Rogers
- Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
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Fritz H, DiZazzo-Miller R, Bertran EA, Pociask FD, Tarakji S, Arnetz J, Lysack CL, Jaber LA. Diabetes self-management among Arab Americans: patient and provider perspectives. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2016; 16:22. [PMID: 27582174 PMCID: PMC5006513 DOI: 10.1186/s12914-016-0097-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 08/20/2016] [Indexed: 11/30/2022]
Abstract
Background Arab Americans have a high burden of diabetes and poor outcomes compared to the general U.S. population. Diabetes self-management (DSM) requires a partnership between patients and providers that fosters mutual understanding and shared decision-making. Cultural factors influence this process; however, little is known regarding the cultural impact on DSM or if perceptions differ between patients and providers. Methods Qualitative content analysis was used to analyze five focus groups–two groups with Arab American providers (n = 8) and three groups with adult Arab Americans with diabetes (n = 23). Focus groups examined patient and provider perspectives on the meaning of DSM and cultural barriers and facilitators among Arab American patients. Results Four distinct themes included limited resources for DSM education and support, stigma as a barrier to ongoing support, family support as an opportunity and challenge, and Arab American patient-provider relationships. Conclusions Findings indicate several domains should be considered for clinical practice including a need to develop linguistically and culturally reliant educational materials and relevant supports for use in the Arab American population. Findings highlight differing views among providers and patients on the familial role in supporting DSM efforts and why some patients feel dissatisfied with clinical encounters.
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Affiliation(s)
- Heather Fritz
- Institute of Gerontology, Wayne State University, 87 East Ferry Street, 226 Knapp Building, Detroit, MI, 48202, USA
| | - Rosanne DiZazzo-Miller
- Department of Health Care Sciences, Wayne State University, 259 Mack Ave, Detroit, MI, 48201, USA.
| | - Elizabeth A Bertran
- Department of Pharamacy Practice, Wayne State University, 259 Mack Ave, Detroit, MI, 48201, USA
| | - Fredrick D Pociask
- Department of Health Care Sciences, Wayne State University, 259 Mack Ave, Detroit, MI, 48201, USA
| | - Sandra Tarakji
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI, 48202, USA
| | - Judith Arnetz
- Department of Family Medicine, Michigan State University, 788 Service Rd., B103 Clinical Center, East Lansing, MI, 48824, USA
| | - Catherine L Lysack
- Institute of Gerontology, Wayne State University, 87 East Ferry Street, 226 Knapp Building, Detroit, MI, 48202, USA
| | - Linda A Jaber
- Department of Pharamacy Practice, Wayne State University, 259 Mack Ave, Detroit, MI, 48201, USA
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Kline KN, Montealegre JR, Rustveld LO, Glover TL, Chauca G, Reed BC, Jibaja-Weiss ML. Incorporating Cultural Sensitivity into Interactive Entertainment-Education for Diabetes Self-Management Designed for Hispanic Audiences. JOURNAL OF HEALTH COMMUNICATION 2016; 21:658-668. [PMID: 27166651 DOI: 10.1080/10810730.2016.1153758] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Diabetes self-management education can improve outcomes in adults with Type 2 diabetes mellitus (T2DM). However, Hispanics, a group that carries a large burden of disease, may not participate in diabetes education programs. Audience engagement with entertainment-education has been associated with improved health education outcomes and may engage and empower Hispanic users to active self-care. Successful use of entertainment-education relies on the use of characters and situations with whom the viewers can feel some sense of involvement and for Hispanic audiences is encouraged when storylines and characters are culturally sensitive. In this study, we used a mixed methods approach that included descriptive statistics of closed-ended and content analysis of open-ended questions to measure the cultural sensitivity of the telenovela portion of a novel technology-based application called Sugar, Heart, and Life (SHL). Specifically, we analyzed the responses of 123 male and female patients diagnosed with uncontrolled T2DM to determine viewer involvement with characters and situations in the telenovela, viewer perceived self-efficacy in following recommendations, as well as viewer satisfaction with the program. Our findings indicate that the SHL application achieved its goal of creating a user-friendly program that depicted realistic, culturally sensitive characters and storylines that resonated with Hispanic audiences and ultimately fostered perceived self-efficacy related to following recommendations given about healthy lifestyle changes for diabetes self-management. These findings suggest that the SHL application is a culturally sensitive health education intervention for use by Hispanic male and female individuals that may empower them in self-management of T2DM.
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Affiliation(s)
- Kimberly N Kline
- a Department of Communication , The University of Texas at San Antonio , San Antonio , Texas , USA
| | - Jane R Montealegre
- b Department of Pediatrics , Baylor College of Medicine , Houston , Texas , USA
| | - Luis O Rustveld
- c Department of Family and Community Medicine , Baylor College of Medicine , Houston , Texas , USA
| | - Talar L Glover
- d Diabetes Service Line and Patient Education , Harris Health System , Houston , Texas , USA
| | - Glori Chauca
- c Department of Family and Community Medicine , Baylor College of Medicine , Houston , Texas , USA
| | - Brian C Reed
- c Department of Family and Community Medicine , Baylor College of Medicine , Houston , Texas , USA
| | - Maria L Jibaja-Weiss
- c Department of Family and Community Medicine , Baylor College of Medicine , Houston , Texas , USA
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Chávez-Courtois M, Graham C, Romero-Pérez I, Sánchez-Miranda G, Sánchez-Jiménez B, Perichart-Perera O. [Experiences, perceptions and self-management of gestational diabetes in a group of overweight multiparous women]. CIENCIA & SAUDE COLETIVA 2016; 19:1643-52. [PMID: 24897466 DOI: 10.1590/1413-81232014196.02452013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 06/04/2013] [Indexed: 11/21/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is a public health problem in Mexico and diet therapy is the main form of treatment. Self-management abilities are required to control the disease. Five women with GDM were studied to assess GDM risk perception and experiences related with self-management practices. Sociodemographic data were obtained and in-depth interviews were conducted and subsequently analyzed using Atlas ti V.5 software. The results revealed that women were conscious regarding the role of diet and physical activity in improving GDM control, and about the perinatal risks associated with the disease. Adherence to diet recommendations was partial, but gradual and positive lifestyle changes were observed. Emotionally, perception about having GDM was a key factor with respect to adhering to the diet. In conclusion, the medical and dietary treatment influences the cultural food behavior of women with GDM. Health professionals should consider sociocultural determinants when designing and implementing treatment strategies.
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Morgan HM, Entwistle VA, Cribb A, Christmas S, Owens J, Skea ZC, Watt IS. We need to talk about purpose: a critical interpretive synthesis of health and social care professionals' approaches to self-management support for people with long-term conditions. Health Expect 2016; 20:243-259. [PMID: 27075246 PMCID: PMC5354019 DOI: 10.1111/hex.12453] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2016] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Health policies internationally advocate 'support for self-management', but it is not clear how the promise of the concept can be fulfilled. OBJECTIVE To synthesize research into professional practitioners' perspectives, practices and experiences to help inform a reconceptualization of support for self-management. DESIGN Critical interpretive synthesis using systematic searches of literature published 2000-2014. FINDINGS We summarized key insights from 164 relevant papers in an annotated bibliography. The literature illustrates striking variations in approaches to support for self-management and interpretations of associated concepts. We focused particularly on the somewhat neglected question of the purpose of support. We suggest that this can illuminate and explain important differences between narrower and broader approaches. Narrower approaches support people to manage their condition(s) well in terms of disease control. This purpose can underpin more hierarchical practitioner-patient communication and more limited views of patient empowerment. It is often associated with experiences of failure and frustration. Broader approaches support people to manage well with their condition(s). They can keep work on disease control in perspective as attention focuses on what matters to people and how they can be supported to shape their own lives. Broader approaches are currently less evident in practice. DISCUSSION AND CONCLUSION Broader approaches seem necessary to fulfil the promise of support for self-management, especially for patient empowerment. A commitment to enable people to live well with long-term conditions could provide a coherent basis for the forms and outcomes of support that policies aspire to. The implications of such a commitment need further attention.
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Affiliation(s)
| | | | - Alan Cribb
- Centre for Public Policy Research, King's College London, London, UK
| | - Simon Christmas
- Centre for Public Policy Research, King's College London, London, UK
| | - John Owens
- Centre for Public Policy Research, King's College London, London, UK
| | - Zoë C Skea
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Ian S Watt
- Department of Health Sciences/Hull York Medical School, Faculty of Science, University of York, Heslington, York, UK
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Mansyur CL, Rustveld LO, Nash SG, Jibaja-Weiss ML. Hispanic Acculturation and Gender Differences in Support and Self-Efficacy for Managing Diabetes. DIABETES EDUCATOR 2016; 42:315-24. [DOI: 10.1177/0145721716640905] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this study was to determine whether perceived support, social norms, and their association with self-efficacy varied by gender and language-based acculturation in Hispanic men and women with uncontrolled type 2 diabetes mellitus (T2DM). Methods A cross-sectional, secondary analysis of baseline survey data from a randomized control trial. Participants were 248 Hispanic patients from 4 community health centers who participated in a culturally targeted intervention for diabetes management. Quantitative statistical methods were used, including chi-square analyses, one-way ANOVA, and multiple regression. Results Gender and language both moderated the relationship between social factors and self-efficacy. Regardless of language, better perceived support was associated with improved self-efficacy in women but not men. Dietary norms were associated with self-efficacy in English-speaking men and women, while physical activity norms were associated with self-efficacy for Spanish-speaking women only. Conclusions This study builds on previous research by exploring the extent to which the social context of diabetes self-management may vary in its effects depending on gender and acculturation. The findings revealed potentially important differences based on both gender and language, suggesting that interventions must be designed with these differences in mind. Diabetes-specific support from family members, especially spouses, may be especially important for Hispanic women. For both men and women, it may be effective to find creative ways of involving the family in creating healthier social norms and expectations.
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Affiliation(s)
- Carol L. Mansyur
- School of Community and Environmental Health, Old Dominion University, Norfolk, Virginia (Dr Mansyur)
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas (Dr Rustveld, Dr Nash)
- School of Allied Health Sciences, Baylor College of Medicine, Houston, Texas (Dr Jibaja-Weiss)
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas (Dr Jibaja-Weiss)
| | - Luis O. Rustveld
- School of Community and Environmental Health, Old Dominion University, Norfolk, Virginia (Dr Mansyur)
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas (Dr Rustveld, Dr Nash)
- School of Allied Health Sciences, Baylor College of Medicine, Houston, Texas (Dr Jibaja-Weiss)
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas (Dr Jibaja-Weiss)
| | - Susan G. Nash
- School of Community and Environmental Health, Old Dominion University, Norfolk, Virginia (Dr Mansyur)
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas (Dr Rustveld, Dr Nash)
- School of Allied Health Sciences, Baylor College of Medicine, Houston, Texas (Dr Jibaja-Weiss)
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas (Dr Jibaja-Weiss)
| | - Maria L. Jibaja-Weiss
- School of Community and Environmental Health, Old Dominion University, Norfolk, Virginia (Dr Mansyur)
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas (Dr Rustveld, Dr Nash)
- School of Allied Health Sciences, Baylor College of Medicine, Houston, Texas (Dr Jibaja-Weiss)
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas (Dr Jibaja-Weiss)
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Marquez B, Anderson A, Wing RR, West DS, Newton RL, Meacham M, Hazuda HP, Peters A, Montez MG, Broyles ST, Walker M, Evans-Hudsnall G. The relationship of social support with treatment adherence and weight loss in Latinos with type 2 diabetes. Obesity (Silver Spring) 2016; 24:568-75. [PMID: 26833676 PMCID: PMC4769665 DOI: 10.1002/oby.21382] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 09/23/2015] [Accepted: 10/12/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Little is known about the effects of social support on weight loss in Latinos. This study determined whether sex moderated and treatment adherence mediated the association between social support and weight loss. METHODS Data from 278 Latino males and females with type 2 diabetes in the Intensive Lifestyle Intervention of the Look AHEAD trial were analyzed. Multivariable modeling tested for moderation and parallel multiple mediator modeling simultaneously tested the mediating effects of adherence to physical activity, diet, and session attendance on the relationship between baseline social support and percent weight loss at 1 year. RESULTS Social support for physical activity (having family and friends join in physical activity) was related to weight loss. Adherence to physical activity was related to both social support for physical activity and weight loss. Sex did not moderate these relationships. Adherence to physical activity completely mediated the relationship between social support for physical activity and weight loss. CONCLUSIONS Increasing companionship for physical activity may be an effective intervention strategy to promote behaviors important for weight loss among Latinos.
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Affiliation(s)
- Becky Marquez
- Department of Family Medicine & Public Health, University of California San Diego, La Jolla, CA
| | - Andrea Anderson
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Rena R. Wing
- Weight Control and Diabetes Research Center, The Miriam Hospital and Brown University, Providence, RI
| | - Delia S. West
- Department of Exercise Science, University of South Carolina, Columbia, SC
| | - Robert L. Newton
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
| | - Maria Meacham
- Southwestern American Indian Center, Phoenix, Arizona and Shiprock, New Mexico
| | - Helen P. Hazuda
- Department of Medicine, Division of Nephrology, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Anne Peters
- Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Maria G. Montez
- Department of Medicine, Division of Nephrology, The University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Stephanie T. Broyles
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
| | - Martha Walker
- Keck School of Medicine of the University of Southern California, Los Angeles, CA
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Booth AO, Lowis C, Hunter SJ, Dean M, Cardwell CR, McKinley MC. Development and Evaluation of a Computer-Based, Self-Management Tool for People Recently Diagnosed with Type 2 Diabetes. J Diabetes Res 2016; 2016:3192673. [PMID: 27446961 PMCID: PMC4944056 DOI: 10.1155/2016/3192673] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 05/31/2016] [Accepted: 06/06/2016] [Indexed: 01/01/2023] Open
Abstract
Aim. The purpose of this study was to develop and evaluate a computer-based, dietary, and physical activity self-management program for people recently diagnosed with type 2 diabetes. Methods. The computer-based program was developed in conjunction with the target group and evaluated in a 12-week randomised controlled trial (RCT). Participants were randomised to the intervention (computer-program) or control group (usual care). Primary outcomes were diabetes knowledge and goal setting (ADKnowl questionnaire, Diabetes Obstacles Questionnaire (DOQ)) measured at baseline and week 12. User feedback on the program was obtained via a questionnaire and focus groups. Results. Seventy participants completed the 12-week RCT (32 intervention, 38 control, mean age 59 (SD) years). After completion there was a significant between-group difference in the "knowledge and beliefs scale" of the DOQ. Two-thirds of the intervention group rated the program as either good or very good, 92% would recommend the program to others, and 96% agreed that the information within the program was clear and easy to understand. Conclusions. The computer-program resulted in a small but statistically significant improvement in diet-related knowledge and user satisfaction was high. With some further development, this computer-based educational tool may be a useful adjunct to diabetes self-management. This trial is registered with clinicaltrials.gov NCT number NCT00877851.
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Affiliation(s)
- Alison O. Booth
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Carole Lowis
- Food and Health Communications, North Yorkshire YO62 6BH, UK
| | - Steven J. Hunter
- Regional Centre for Endocrinology and Diabetes, Belfast Health and Social Care Trust, Royal Victoria Hospital, Belfast BT12 6BA, UK
| | - Moira Dean
- School of Biological Sciences, Queen's University Belfast, Belfast BT9 5AG, UK
| | - Chris R. Cardwell
- Centre for Public Health, School of Medicine, Dentistry & Biomedical Science, Queen's University Belfast, Belfast BT12 6BJ, UK
| | - Michelle C. McKinley
- Centre for Public Health, School of Medicine, Dentistry & Biomedical Science, Queen's University Belfast, Belfast BT12 6BJ, UK
- *Michelle C. McKinley:
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Majeed‐Ariss R, Jackson C, Knapp P, Cheater FM. A systematic review of research into black and ethnic minority patients' views on self-management of type 2 diabetes. Health Expect 2015; 18:625-42. [PMID: 23710892 PMCID: PMC5060817 DOI: 10.1111/hex.12080] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2013] [Indexed: 01/01/2023] Open
Abstract
CONTEXT Eliciting patients' views of type 2 diabetes self-management provides insights on how policy and services might better support the needs of this population. OBJECTIVE To synthesize black and ethnic minority patients' views on the barriers and facilitators influencing the self-management of type 2 diabetes. SEARCH STRATEGY A systematic search of international literature published in nine electronic databases was undertaken in 2008. Search strategies used both MeSH and free-text terms. Two relevant journals were also hand searched. INCLUSION CRITERIA Any primary empirical study published in the English language since 1986 that reported black and ethnic minority patients' views on type 2 diabetes self-management. DATA EXTRACTION AND SYNTHESIS Data were extracted and study quality was formally assessed. Data were analysed using thematic synthesis. MAIN RESULTS Fifty-seven studies were included, of qualitative (n = 54), mixed-method (n = 2) or quantitative (n = 1) design. Studies were from North America (n = 41), Europe (n = 14) and Australia (n = 2), including 1735 participants in total. Three analytical themes emerged: 'Importance of identity'; 'Being understood by others' and 'Making sense of condition', all linked conceptually under the overarching theme 'Sense of self'. The quality of the studies varied. DISCUSSION AND CONCLUSIONS The findings provide insight into what black and minority ethnic people regard as the barriers to, and facilitators of self-management, as opposed to what health professionals, policy makers and trial researchers may have assumed. Recognition of the views of people with diabetes is essential for the design and delivery of patient-centred care and policies.
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Affiliation(s)
| | - Cath Jackson
- School of HealthcareBaines WingUniversity of LeedsUK
| | - Peter Knapp
- School of HealthcareBaines WingUniversity of LeedsUK
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Riffin C, Pillemer K, Reid MC, Lӧckenhoff CE. Decision Support Preferences Among Hispanic and Non-Hispanic White Older Adults With Chronic Musculoskeletal Pain. J Gerontol B Psychol Sci Soc Sci 2015; 71:914-25. [PMID: 26307486 DOI: 10.1093/geronb/gbv071] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 07/09/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Despite broad recognition that social networks play a key role in the management of chronic musculoskeletal pain (CMP), little is known about when and why older adults with CMP choose to involve others in treatment decisions. This study investigates the types (i.e., informational, emotional, and instrumental) and sources (i.e., formal and informal) of support Hispanic and non-Hispanic White CMP patients desire and receive when making decisions about their pain care. METHOD Semi-structured interviews were conducted with Hispanic and non-Hispanic White older adults with CMP (N = 63) recruited from one medical center and one senior center in New York City. Interviews were transcribed and then analyzed using content analysis. RESULTS CMP patients sought network members who supported their emotional well-being throughout the decision-making process. When considering high-stakes treatment decisions, participants selectively involved individuals who had similar pain conditions or first-hand experience with the procedure. Participants' perceptions of the decision-making process were contingent upon the congruence between the decision they made and the support they received for it. For Spanish-speaking participants, positive perceptions were linked with satisfactory language competence by their providers. On the other hand, lack of language competence among providers hindered Spanish speakers' ability to obtain adequate informational support. DISCUSSION Results reveal the importance of empathic patient-provider exchanges across diverse patient populations and cultural sensitivity for Spanish-speaking patients. Findings suggest that social networks beyond the patient-provider dyad influence patients' decision-making satisfaction.
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Affiliation(s)
- Catherine Riffin
- Department of Human Development, Cornell University, Ithaca, New York.
| | - Karl Pillemer
- Department of Human Development, Cornell University, Ithaca, New York
| | - Manny C Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York
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Williams JP, Schroeder D. Popular Glucose Tracking Apps and Use of mHealth by Latinos With Diabetes: Review. JMIR Mhealth Uhealth 2015; 3:e84. [PMID: 26307533 PMCID: PMC4705030 DOI: 10.2196/mhealth.3986] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 04/02/2015] [Accepted: 05/24/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Diabetes mellitus in the United States is an increasingly common chronic disease, costing hundreds of billions of dollars and contributing to hundreds of thousands of deaths each year. The prevalence of diabetes is over 50% higher in Latinos than in the general population, and this group also suffers from higher rates of complications and diabetes-related mortality than NHWs. mHealth is a promising new treatment modality for diabetes, though few smartphone apps have been designed specifically for Latinos. OBJECTIVE The objectives of our study were: (1) to identify the most common features of the most popular diabetes apps and consider how such features may be improved to meet the needs of Latinos; (2) to determine the use of diabetes apps among a sample of online Hispanics in the US. METHODS Our study consisted of two parts. First, 20 of the most popular diabetes apps were reviewed in order to ascertain the most prevalent features and functionalities. Second, an online survey was fielded through a popular health website for Latinos (HolaDoctor) inquiring about respondents' use of diabetes apps. RESULTS Approximately one-third of apps reviewed were available in Spanish. The most common features were blood glucose recording/annotation and activity logs. The majority of apps permitted exportation of data via e-mail but only a third enabled uploading to an online account. Twenty percent of apps reviewed could connect directly with a glucometer, and 30% had reminder functionalities prompting patients to take medications or check blood glucose levels. Over 1600 online surveys were completed during the second half of April 2014. More than 90% of respondents were from the United States, including Puerto Rico. The majority of respondents used a device running on an Android platform while only a quarter used an iPhone. Use of diabetes apps was approximately 3% among diabetic respondents and 3.6% among diabetic respondents who also had a smartphone. Among app users, blood glucose and medication diaries were the most frequently used functionalities while hemoglobin A1c and insulin diaries were the least used. A significant majority of app users did not share their progress on social media though many of these were willing to share it with their doctor. CONCLUSIONS Latino diabetics have unique needs and this should be reflected in diabetes apps designed for this population. Existing research as well as our survey results suggest that many Latinos do not possess the prerequisite diabetes knowledge or self-awareness to fully benefit from the most prevalent functionalities offered by the most popular diabetes apps. We recommend developers incorporate more basic features such as diabetes education, reminders to check blood glucose levels or take medications, Spanish language interfaces, and glucometer connectivities, which are relatively underrepresented in the most popular diabetes apps currently available in Spanish.
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Affiliation(s)
- John Patrick Williams
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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Boger E, Ellis J, Latter S, Foster C, Kennedy A, Jones F, Fenerty V, Kellar I, Demain S. Self-Management and Self-Management Support Outcomes: A Systematic Review and Mixed Research Synthesis of Stakeholder Views. PLoS One 2015; 10:e0130990. [PMID: 26162086 PMCID: PMC4498685 DOI: 10.1371/journal.pone.0130990] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 05/27/2015] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Self-management has received growing attention as an effective approach for long-term condition management. Little is known about which outcomes of supported self-management are valued by patients, their families, health professionals and those who commission self-management services. This study systematically reviewed published empirical evidence in accordance with PRISMA guidelines to determine the outcomes of self-management valued by these key stakeholder groups, using three prominent exemplar conditions: colorectal cancer, diabetes and stroke. AIM To systematically review the literature to identify which generic outcomes of self-management have been targeted and are considered important using three exemplar conditions (colorectal cancer, diabetes and stroke), which collectively have a range of features that are likely to be representative of generic self-management issues. METHODS Systematic searching of nine electronic databases was conducted in addition to hand searches of review articles. Abstracts were identified against inclusion criteria and appraised independently by two reviewers, using a critical appraisal tool. Synthesis of findings was conducted using mixed research synthesis. RESULTS Over 20,536 abstracts were screened. 41 studies which met the review criteria were fully retrieved and appraised. The majority of evidence related to diabetes. Few studies directly focussed on stakeholders' views concerning desired self-management outcomes; the majority of evidence was derived from studies focusing upon the experience of self-management. The views of health care commissioners were absent from the literature. We identified that self-management outcomes embrace a range of indicators, from knowledge, skills, and bio-psychosocial markers of health through to positive social networks. CONCLUSIONS Patients', families', health professionals' and commissioners' views regarding which outcomes of self-management are important have not been clearly elicited. The extent to which bio-psychosocial indicators relate to successful self-management from the perspectives of all groups of stakeholders is unknown. Further investigation regarding which self-management outcomes are considered important by all stakeholders is necessary to guide the commissioning and design of future self-management services.
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Affiliation(s)
- Emma Boger
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Jaimie Ellis
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Sue Latter
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Claire Foster
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Anne Kennedy
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Fiona Jones
- Department of Social Care and Education, St George’s and Kingston University of London, London United Kingdom
| | - Vicky Fenerty
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Ian Kellar
- Institute of Psychological Sciences, University of Leeds, Leeds, United Kingdom
| | - Sara Demain
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
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Mansyur CL, Rustveld LO, Nash SG, Jibaja-Weiss ML. Social factors and barriers to self-care adherence in Hispanic men and women with diabetes. PATIENT EDUCATION AND COUNSELING 2015; 98:805-810. [PMID: 25819551 DOI: 10.1016/j.pec.2015.03.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 01/30/2015] [Accepted: 03/01/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To explore quantitatively the extent to which social support, social norms and barriers are associated with self-efficacy and self-care adherence in Hispanic patients with diabetes and the extent to which these differ for men and women. METHODS Baseline survey data were collected from 248 low-SES, Hispanic men and women who were participants in a randomized controlled trial of a culturally targeted intervention for diabetes management. Student's t, Pearson correlations and multiple regression were used to analyze the data. RESULTS Compared to men, women were less likely to receive support, faced more barriers, reported less self-efficacy and had lower levels of self-care adherence. Perceived support was consistently correlated with better self-efficacy in women but not men, even though men reported higher levels of support. CONCLUSION The lack of adequate support seems to be a fundamental barrier for Hispanic women with diabetes. PRACTICE IMPLICATIONS Health care providers should be sensitive to sociocultural influences in Hispanic groups that may facilitate men's self-care adherence, but could potentially hamper women's efforts. Interventions designed for Hispanics should augment women's support needs and address culture and social factors that may differentially impact the ability of men and women to manage their diabetes.
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Affiliation(s)
- Carol L Mansyur
- School of Community and Environmental Health, Old Dominion University, Norfolk, USA.
| | - Luis O Rustveld
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, USA
| | - Susan G Nash
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, USA
| | - Maria L Jibaja-Weiss
- School of Allied Health Sciences, Baylor College of Medicine, Houston, USA; Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, USA
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McDowell JRS, Inverarity K, Gilmour H, Lindsay G. Professionals’ perceptions of type 2 diabetes in primary care during a service redesign. ACTA ACUST UNITED AC 2015. [DOI: 10.1002/edn.196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Barriers to initiating insulin in type 2 diabetes patients: development of a new patient education tool to address myths, misconceptions and clinical realities. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2015; 7:437-50. [PMID: 24958464 PMCID: PMC4240906 DOI: 10.1007/s40271-014-0068-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Purpose The purpose of this study was to identify patient beliefs as well as clinical realities about insulin that may be barriers to type 2 diabetes patients initiating insulin treatment when recommended by their physician. This information was then used to develop a clinically relevant, cross-culturally valid patient education tool with the goal of providing unbiased, medically informative statements addressing these barriers. Methods Thirteen focus groups were conducted in five countries (Germany, Sweden, The Netherlands, UK, and USA) to collect qualitative data on attitudes about insulin therapy from type 2 diabetes patients aged 18 or older whose physician had recommended initiating insulin treatment in the past 6 months (n = 87). Additionally, a panel of four clinical experts was interviewed to ascertain obstacles they experience in initiating insulin with their patients. Results On the basis of the interview data, the ten questions that asked about the most important barriers were generated. The clinical expert panel then generated clinically accurate and unbiased responses addressing these concerns, and the educational tool “Questions about Starting Insulin: Information on the Myths, Misconceptions and Clinical Realities about Insulin” was drafted. The draft tool was pilot tested in a group of patients and finalized. Conclusions Patient misconceptions, as well as some clinical realities, about insulin treatment and diabetes can influence the decision to initiate insulin treatment and ultimately impact disease management. The educational tool developed through this study was designed to help patients who are deciding whether or not to initiate insulin therapy as recommended by their physician, and facilitate patient–health-care provider interactions.
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Lauvergeon S, Mettler D, Burnand B, Peytremann‐Bridevaux I. Convergences and divergences of diabetic patients' and healthcare professionals' opinions of care: a qualitative study. Health Expect 2015; 18:111-23. [PMID: 23121596 PMCID: PMC5060754 DOI: 10.1111/hex.12013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2012] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To investigate opinions' convergences and divergences of diabetic patients and health-care professionals on diabetes care and the development of a regional diabetes programme. BACKGROUND Development and implementation of a regional diabetes programme. RESEARCH DESIGN Qualitative study using focus groups to elicit diabetic patients' and health-care professionals' opinions, followed by content analysis. SETTING AND PARTICIPANTS Eight focus groups: four focus groups with diabetic patients (n = 39) and four focus groups with various health-care professionals (n = 34) residing or practicing in the canton of Vaud, Switzerland, respectively. RESULTS Perceived quality of diabetes care varied between individuals and types of participants. To improve quality, patients favoured a comprehensive follow-up while professionals suggested considering existing structures and trained professionals. All participants mentioned communication difficulties between professionals and were favouring teamwork. In addition, they described the role that patients should have in care and self-management. Financial difficulties were also mentioned by both groups of participants. Finally, they were in favour of the development of a regional diabetes programme adapted to actors' needs. For patients indeed, such a programme would represent an opportunity to improve information and to have access to comprehensive care. For professionals, it would help the development of local networks and the reinforcement of existing tools and structures. DISCUSSION AND CONCLUSIONS Acknowledging convergences and divergences of opinions of both diabetic patients and health-care professionals should help the further development of a programme adapted to users' needs, taking all stakeholders interests and priorities into consideration.
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Affiliation(s)
- Stéphanie Lauvergeon
- Institute of Social and Preventive Medicine (IUMSP)Lausanne University HospitalLausanneSwitzerland
| | - Désirée Mettler
- Institute of Social and Preventive Medicine (IUMSP)Lausanne University HospitalLausanneSwitzerland
| | - Bernard Burnand
- Institute of Social and Preventive Medicine (IUMSP)Lausanne University HospitalLausanneSwitzerland
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Choi YJ, Shin DS, Kang M, Bae SS, Kim J. Evaluating Chronic Care of Public Health Centers in a Metropolitan City. HEALTH POLICY AND MANAGEMENT 2014. [DOI: 10.4332/kjhpa.2014.24.4.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Amarasekara AATD, Fongkaew W, Wimalasekera SW, Turale S, Chanprasit C. Cross-sectional study of glycemic control among adults with type 2 diabetes. Nurs Health Sci 2014; 17:223-8. [PMID: 25496606 DOI: 10.1111/nhs.12179] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 08/28/2014] [Accepted: 09/20/2014] [Indexed: 11/29/2022]
Abstract
Type 2 diabetes mellitus is a chronic condition, a global concern, and a serious issue in Sri Lanka, where there is little data regarding the influence of dietary control, exercise, and adherence to medication behaviors among adults diabetes. In this cross-sectional, descriptive study, we identified current factors influencing glycemic control and glycemic control behavior among adults with diabetes. A total of 230 people attending diabetes clinics in a tertiary hospital and a primary care institute were administered the self-report Diabetes Information Form, assessing their socioeconomic and medical information and glycemic control behaviors. Data were analyzed by frequency distribution, percentages, mean scores, and standard deviation. The results indicated that most participants had not achieved the recommended fasting blood glucose level (< 126 mg/dL). Although dietary control was practised by 72%, regular exercise was not practised by 85%, and while 77% reported adhering to regular medication, they still had poor glycemic control. The findings highlight the need for health professionals to adopt new strategies for diabetes education to overcome issues related to misconceptions and barriers in providing diabetes care in Sri Lanka.
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Sadler E, Wolfe CDA, McKevitt C. Lay and health care professional understandings of self-management: A systematic review and narrative synthesis. SAGE Open Med 2014; 2:2050312114544493. [PMID: 26770733 PMCID: PMC4607208 DOI: 10.1177/2050312114544493] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 06/30/2014] [Indexed: 12/15/2022] Open
Abstract
Objectives: Self-management is widely promoted but evidence of effectiveness is limited. Policy encourages health care professionals to support people with long-term conditions to learn self-management skills, yet little is known about the extent to which both parties share a common understanding of self-management. Thus, we compared health care professional and lay understandings of self-management of long-term conditions. Methods: Systematic review and narrative synthesis of qualitative studies identified from relevant electronic databases, hand-searching of references lists, citation tracking and recommendations by experts. Results: In total, 55 studies were included and quality was assessed using a brief quality assessment tool. Three conceptual themes, each with two subthemes were generated: traditional and shifting models of the professional–patient relationship (self-management as a tool to promote compliance; different expectations of responsibility); quality of relationship between health care professional and lay person (self-management as a collaborative partnership; self-management as tailored support) and putting self-management into everyday practice (the lived experience of self-management; self-management as a social practice). Conclusion: Self-management was conceptualised by health care professionals as incorporating both a biomedical model of compliance and individual responsibility. Lay people understood self-management in wider terms, reflecting biomedical, psychological and social domains and different expectations of responsibility. In different ways, both deviated from the dominant model of self-management underpinned by the concept of self-efficacy. Different understandings help to explain how self-management is practised and may help to account for limited evidence of effectiveness of self-management interventions.
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Affiliation(s)
- Euan Sadler
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, King's College London, London, UK
| | - Charles D A Wolfe
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, King's College London, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Christopher McKevitt
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, King's College London, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
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