Systematic review of salutogenic-oriented lifestyle randomised controlled trials for adults with type 2 diabetes mellitus

Qualitative evaluation of a Salutogenic Healthy Eating Programme for Dutch people with type 2 diabetes

The salutogenic model of health (SMH) is a health-promoting theory that focuses on resources, strengths, and coping capacities in everyday life as a way to improve health and wellbeing. The SMH was applied to develop a programme for enabling healthy eating practices among people with type 2 diabetes mellitus (T2DM): the SALUD programme. This study aims to gain insight in how participants with T2DM experienced the content and meaning of the SALUD programme. Three focus groups with participants (six to eight participants/group) that finished the SALUD programme were conducted. The focus groups were video-recorded, transcribed ad verbatim and thematically analysed. The SALUD programme was perceived by the participants as a positive, meaningful learning experience. Key factors why the participants described the programme as positive were that they felt a sense of social-belonging and (emotionally) safe (theme 1). The SALUD programme's positive encouraging approach presented by the coach invited participants to join an active learning process (theme 2). Performing trial-and-error experiments and weekly reflecting on goals is what characterized active learning. The meaningfulness of the learning process (theme 3) was derived from (i) positive self-confrontation; (ii) exploring mind-body connections and perceiving improved health and (iii) noticing positive changes in their social environment (theme 3). To conclude, the study uncovered that the SALUD programme incited a positive, meaningful learning process for healthy eating and the contextual factors important in this. Potential leads to further improve the SALUD programme are discussed in order to maximize the chance of inciting an inclusive, active learning process.

Flourishing mental health and lifestyle behaviours in adults with Type 1 and Type 2 Diabetes Mellitus: results from the Diabetes MILES - The Netherlands Study

OBJECTIVE

To examine the associations between mental health and lifestyle in adults with type 1 and type 2 diabetes mellitus (T1DM and T2DM).

METHODS

Online survey data from the cross-sectional Diabetes MILES - The Netherlands Study was analysed, including 270 adults with T1DM and 325 with T2DM. Mental health status (flourishing, moderate and languishing) in relation to diet, physical activity, alcohol consumption and smoking was analysed with ANCOVA and logistic regressions (adjusted for confounders).

RESULTS

47% of T1DM-, and 55% of T2DM participants reported flourishing mental health. Due to an insufficient number, participants with languishing mental health were excluded. In T2DM, participants with flourishing mental health had more optimal diet quality (mean ± SEM: 70 ± 1 vs 68 ± 1 diet quality score, p = 0.015), and physical activity levels (mean ± SEM: 3484 ± 269 vs 2404 ± 273 MET minutes/week, p = 0.001) than those with moderate mental health, but did not differ with respect to alcohol consumption and smoking. In T1DM, no significant associations were found.

CONCLUSION

Only in T2DM, people with flourishing mental health had more optimal lifestyle behaviours compared to people with moderate mental health. Further research is needed to determine if mental health is more important for specific lifestyle behaviours, and if the mental health effect differs across diabetes types.

Development of a salutogenic intervention for healthy eating among Dutch type 2 diabetes mellitus patients

Healthy eating can be challenging for type 2 diabetes mellitus (T2DM) patients. The theory of salutogenesis, which focuses on the resources required to organize behavioural changes in everyday life, was used to develop an intervention for healthy eating. The aim was to describe the development, structure and content of this salutogenic intervention. The development consisted of two phases that were based on the operationalization of important key principles of salutogenesis. In Phase 1 (Exploration and synthesis), a systematic review and three qualitative studies were performed to explore important characteristics to enable healthy eating in everyday life. The results were used to develop the draft intervention. In Phase 2 (Validation and adjustment), interviews and workshops were conducted with T2DM patients, healthcare providers and scientists. Based on this, the draft intervention was modified into its final form. The developmental process resulted in a 12-week, group-based intervention that aimed to enable important resources for healthy eating via self-examination, reflection, setting goals and sharing experiences. Attention was also paid to disease information, disease acceptance, food literacy, stress management, self-identity and social support. The group sessions began following an individual intake session, with a booster session held 3 months after the intervention. The researcher’s translation of the stakeholders’ priorities into an intervention was corrected for and approved by the stakeholders concerned. This comprehensive salutogenic intervention was developed based on practical and scientific evidence. Providing transparency in developmental processes and content is important because it determines the scientific integrity and credibility of an intervention.

Healthy eating can be difficult for people with the disease type 2 diabetes. This article describes how a programme aimed at helping type 2 diabetes patients to eat healthily was developed. The draft version of the programme was based on a theoretical framework that aims to understand what creates health in everyday life, and on conversations with type 2 diabetes patients and healthcare providers. The draft programme was adjusted based on the feedback of type 2 diabetes patients, healthcare providers and scientists. This resulted in a 12-week, group-based programme that enables people to think about who they are and what they want by setting health goals and sharing experiences. Attention was also paid to disease knowledge, disease acceptance, nutritional skills, dealing with stress, self-identity and social support. The group sessions began following an individual intake session, with a booster session held 3 months after the intervention. By involving everybody, we were able to develop a programme that takes into account the preferences, needs and priorities of all stakeholders. It is important to describe the development and the content of programmes encouraging healthy eating to determine their quality and effectivity.