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Craig HC, Alsaeed D, Heneghan H, Al-Najim W, Al Ozairi E, le Roux CW. Factors that determine patients considering medication for the disease of obesity: an IMI2 SOPHIA study. Int J Obes (Lond) 2024:10.1038/s41366-024-01524-4. [PMID: 38693212 DOI: 10.1038/s41366-024-01524-4] [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] [Received: 12/21/2023] [Revised: 04/13/2024] [Accepted: 04/17/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE Obesity-related problems can now be managed with effective nutritional therapy, pharmacotherapy, and surgeries that achieve >10% weight loss. Assessing patient preferences, treatment choices, and factors affecting patients can improve treatment compliance and efficacy. Our aim was to identify factors affecting patient preference and subsequent choice of pharmacotherapy among those seeking treatment for obesity-related disorders. METHODS A participatory action study using purposeful sampling recruited 33 patients with obesity complications. They were referred to specialist clinics in non-alcoholic fatty liver disease, diabetes mellitus, hypertension, and chronic kidney disease. Sixteen males and seventeen females aged 18-70 years, with BMI > 35 kg/m2 were recruited. Before the interview, participants watched a 60-minute video explaining nutritional therapy, pharmacotherapy, and surgery in equipoise. Data were collected in semi-structured interviews; Reflective thematic analysis was used. This sub study focuses only on patients who expressed specific attitudes (positive or negative) towards pharmacotherapy. RESULTS Ten (30%) patients expressed a view on pharmacotherapy. Eight (24%) patients chose pharmacotherapy alone, whereas two (6%) patients chose pharmacotherapy combined with nutritional therapy. In this sub study focusing on pharmacotherapy, five themes were identified related to choosing whether or not to take medication: (1) attitudes towards pharmacotherapy, (2) attitudes toward size of obesity and its complications, (3) weighing the benefits and risks of treatment, (4) knowledge and reassurance of health professionals, and (5) costs associated with drug therapy. CONCLUSION The primary concerns regarding pharmacotherapy for intentional weight loss were efficacy, side effects, lifelong dosing, pharmacokinetics, and cost. Providing access to information about all the pharmacotherapies and the benefits is likely to result in greater penetrance of treatment.
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Affiliation(s)
- H C Craig
- Diabetes Complications Research Centre, UCD Conway Institute of Biomedical and Biomolecular Research, School of Medicine, University College Dublin, Dublin, Ireland.
| | - D Alsaeed
- Dasman Diabetes Institute, PO Box 1180, Dasman, Kuwait
| | - H Heneghan
- Surgery, School of Medicine, University College Dublin, Dublin, Ireland
| | - W Al-Najim
- Diabetes Complications Research Centre, UCD Conway Institute of Biomedical and Biomolecular Research, School of Medicine, University College Dublin, Dublin, Ireland
| | - E Al Ozairi
- Dasman Diabetes Institute, PO Box 1180, Dasman, Kuwait
| | - C W le Roux
- Diabetes Complications Research Centre, UCD Conway Institute of Biomedical and Biomolecular Research, School of Medicine, University College Dublin, Dublin, Ireland
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Moore TH, Dawson S, Wheeler J, Hamilton-Shield J, Barrett TG, Redwood S, Litchfield I, Greenfield SM, Searle A. Views of children with diabetes from underserved communities, and their families on diabetes, glycaemic control and healthcare provision: A qualitative evidence synthesis. Diabet Med 2023; 40:e15197. [PMID: 37573564 DOI: 10.1111/dme.15197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/15/2023]
Abstract
AIMS Children and young people with diabetes (CYPD) from socio-economically deprived and/or ethnic minority groups tend to have poorer glucose control and greater risk of diabetes-related complications. In this systematic review of qualitative evidence (qualitative evidence synthesis, QES), we aimed to explore the experiences and views of clinical encounters in diabetes care from the perspectives of CYPD and their family/carers from underserved communities and healthcare professionals in diabetes care. METHODS We searched 6 databases to March 2022 with extensive search terms, and used a thematic synthesis following methods of Thomas and Harden. RESULTS We identified 7 studies and described 11 descriptive themes based on primary and secondary constructs. From these, three "analytical themes" were developed. (1) "Alienation of CYPD" relates to their social identity and interaction with peers, family and health service practitioners in the context of diabetes self- and family/carer management and is impacted by communication in the clinical encounter. (2) "Empowerment of CYPD and family/carers" explores families' understanding of risks and consequences of diabetes and taking responsibility for self- and family/carer management in the context of their socio-cultural background. (3) "Integration of diabetes (into self and family)" focuses on the ability to integrate diabetes self-management into the daily lives of CYPD and family/carers beyond the clinical consultation. CONCLUSIONS The analytical themes are interdependent and provide a conceptual framework from which to explore and strengthen the therapeutic alliance in clinical encounters and to foster greater concordance with treatment plans. Communicating the biomedical aspects of managing diabetes in the clinical encounter is important, but should be balanced with addressing socio-emotional factors important to CYPD and family/carers.
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Affiliation(s)
- Theresa H Moore
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah Dawson
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Jessica Wheeler
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Timothy G Barrett
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Sabi Redwood
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ian Litchfield
- IOEM, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sheila M Greenfield
- IOEM, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Aidan Searle
- NIHR Bristol Biomedical Research Centre Nutrition theme, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
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Telaak SH, Howe LC, Persky S. Physician weight influences responses to a public health message about the genetics of obesity. PATIENT EDUCATION AND COUNSELING 2023; 115:107853. [PMID: 37542821 DOI: 10.1016/j.pec.2023.107853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 06/01/2023] [Accepted: 06/12/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE Many patients prefer lean physicians to physicians with obesity and place higher credence in their weight management advice. Because genetic information about weight can be viewed as self-serving for individuals with overweight or obesity, physicians with obesity may be discounted when sharing such information. As provision of genetic information regarding weight becomes increasingly common in public health messaging, could a physician's own weight influence how these messages are received by the public? METHODS In an online survey, 967 participants were randomly assigned a physician profile (lean v. has obesity) with a media interview transcript discussing genetic factors of a common health condition (obesity v. osteoporosis). RESULTS Participants perceived the physician with obesity who discussed genetic factors in obesity as less trustworthy and less credible. Participants were also less likely to anticipate following her advice on weight-related issues. Participants with higher BMI had less negative perceptions of this physician. CONCLUSION Physicians with obesity, when providing public health messaging regarding genetic information about obesity, may be met with distrust and negative attitudes toward the physician. PRACTICAL IMPLICATIONS Future research should investigate health communication strategies that address this form of weight stigma while accurately conveying genetic factors that contribute to weight.
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Affiliation(s)
- Sydney H Telaak
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, USA
| | - Lauren C Howe
- Department of Business Administration, University of Zurich, Switzerland
| | - Susan Persky
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, USA.
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Byrne A, Jones K, Backhouse M, Rose F, Moatt E, van der Feltz-Cornelis C. Patient and primary care practitioners' perspectives on consultations for fibromyalgia: a qualitative evidence synthesis. Prim Health Care Res Dev 2023; 24:e58. [PMID: 37750736 PMCID: PMC10540196 DOI: 10.1017/s1463423623000506] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/29/2023] [Accepted: 08/28/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Fibromyalgia presents a challenge to both the patients experiencing symptoms and the staff aiming to treat them. This qualitative review aimed to synthesise how patients and practitioners experience primary care consultations, develop a rounded picture of how they perceive each other, the challenges to primary care consultation and how they might be tackled. METHODS CINAHL, Embase, CENTRAL and Medline were searched from inception to November 2021. Qualitative studies were included if they explored the perspectives and experiences of either fibromyalgia patients or primary care practitioners. Quantitative data, studies not published in English, not set in primary care or that did not distinguish the type of patient or clinician were excluded. Included studies were analysed using thematic synthesis and their quality assessed. RESULTS In total, 30 studies met the inclusion criteria. Thematic synthesis identified three overarching themes: (1) life turned upside down - exploring the chaos experienced by patients as they seek help; (2) negative cycle - highlighting how patient and practitioner factors can create a detrimental cycle; and (3) breaking the cycle - validating patient-doctor relationships underpinned by clear communication can help break the negative cycle. CONCLUSIONS Fibromyalgia patients experience uncertainty and chaos that can clash with the attitudes of GPs and the help they can feasibly provide. Difficult consultations in which neither the GP nor patient are satisfied can easily occur. Promoting supportive, reciprocal and open patient-doctor relationships is essential. Future research is required to further explore GP attitudes and to develop an intervention that could improve consultations, patient outcomes and GP satisfaction.
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Affiliation(s)
- Ailish Byrne
- York Trials Unit, Department of Health Sciences, University of York, Heslington, York, UK
| | - Katherine Jones
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | | | - Fiona Rose
- York Trials Unit, Department of Health Sciences, University of York, Heslington, York, UK
| | - Emma Moatt
- York Trials Unit, Department of Health Sciences, University of York, Heslington, York, UK
| | - Christina van der Feltz-Cornelis
- Mental Health and Addictions Research Group, Department of Health Sciences, Hull York Medical School, University of York, Heslington, York, UK
- Institute of Health Informatics, University College London, London, UK
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Hikaka J, Abey-Nesbit R, McIntosh B, Schluter PJ, Nishtala PS, Scrase R, Jamieson HA. Utility of Big Data to Explore Medication Adherence in Māori and Non-Māori Community-Dwelling Older Adults with Heart Failure in Aotearoa New Zealand: A Cross-sectional Study. Drugs Aging 2023; 40:847-855. [PMID: 37386345 PMCID: PMC10450015 DOI: 10.1007/s40266-023-01044-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Medication adherence improves morbidity and mortality-related outcomes in heart failure, and knowledge of patterns of medication adherence supports patient and clinician decision-making. Routinely collected national data facilitate the exploration of medication adherence and associated factors in older adults with heart failure, including the association between ethnicity and adherence. There are known inequities in access to medicines between Māori (Indigenous People of Aotearoa New Zealand) and non-Māori, yet ethnic variation in medicines adherence in community-dwelling older adults with heart failure has not been explored. OBJECTIVE Here we identify medication adherence rates for community-dwelling older adults diagnosed with heart failure and differences in adherence rates between Māori and non-Māori. METHODS Cross-sectional analysis of interRAI (comprehensive standardised assessment) data in a continuously recruited national cohort from 2012 to 2019. RESULTS Overall, 13,743 assessments (Māori N = 1526) for older community-dwelling adults with heart failure diagnoses were included. The mean age of participants was 74.5 years [standard deviation (SD) 9.1 years] for Māori and 82.3 years (SD 7.8 years) non-Māori. In the Māori cohort, 21.8% did not adhere fully to their medication regimen, whereas in the non-Māori cohort, this figure was 12.8%. After adjusting for confounders, the Māori cohort were more likely to be medication non-adherent than non-Māori [prevalence ratio 1.53, 95% confidence interval (CI) 1.36-1.73]. CONCLUSIONS There was a significant disparity between Māori and non-Māori concerning medication adherence. Given the international use of the interRAI-HC assessment tool, these results have significant transferability to other countries and allow the identification of underserved ethnic groups for which culturally appropriate interventions can be targeted.
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Affiliation(s)
- Joanna Hikaka
- Facility of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - Brendon McIntosh
- Department of Medicine, University of Otago, Christchurch, New Zealand
- Kia Kaha Chemists, Christchurch, New Zealand
| | - Philip J Schluter
- Te Kaupeka Oranga/Faculty of Health, Te Whare Wānanga o Waitaha/University of Christchurch, Christchurch, 8041, New Zealand
- Primary Care Clinical Unit, School of Clinical Medicine, The University of Queensland, Brisbane, Australia
| | - Prasad S Nishtala
- Department of Life Sciences, Centre for Therapeutic Innovation, University of Bath, Bath, United Kingdom
| | - Richard Scrase
- Department of Medicine, University of Otago, Burwood Campus, PO box, 4345, Christchurch, New Zealand
| | - Hamish A Jamieson
- Department of Medicine, University of Otago, Burwood Campus, PO box, 4345, Christchurch, New Zealand.
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Hultman L, Hultman M. "Believe me, only I know how I feel." An autoethnographic account of experiences of epistemic injustice in mental health care. Front Psychiatry 2023; 14:1058422. [PMID: 36911123 PMCID: PMC9997454 DOI: 10.3389/fpsyt.2023.1058422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/31/2023] [Indexed: 02/25/2023] Open
Abstract
In Sweden, support and service for people with disabilities is provided under the Swedish disability legislation, which has a clear focus on the individual's right to a life like that of any other citizen and on promoting equality and participation in society. Nevertheless, having a physical impairment makes it clear that equal mental health care is not provided in practice. This becomes particularly salient when there is a need for mental health in-patient care. In this article, the aim is to explore our own experiences of epistemic injustice in relation to mental health care provision in a situation where one of us has a mobility impairment that require the presence of personal assistants in everyday life. Critical personal narrative is applied to highlight the different, but intertwined experiences of a young female mental health user with a physical disability and her mother. Diary entrances, shared discussions and extracts from health care records are used to illustrate how epistemic injustice may occur in health care practices. In the analysis, we use Fricker's concepts that relate to different aspects of epistemic injustice, to show how power is exerted. Healthcare professionals' inability to value and integrate patients experience-based knowledge into practice where the lack of a holistic perspective visualizes what happens when people do not fit into predefined categories. Instead of strengthening patients' rights, health care professionals discredit patients' and family members knowledge, and thereby giving themselves epistemic privilege. People with the combined experience of both disabilities and mental health issues are vulnerable to epistemic injustice and epistemic harm since they are commonly denied both epistemic credibility and authority. Our results highlight the importance of counteracting resilient structures of social privilege and power and identifying and, in as far as possible, removing the mechanisms that exclude the epistemic resources of people with disabilities and their family members from being part of shared epistemic resources.
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Affiliation(s)
- Lill Hultman
- Department of Social Sciences, Marie Cederschiöld University, Stockholm, Sweden
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Trimarco V, Izzo R, Mone P, Lembo M, Manzi MV, Pacella D, Falco A, Gallo P, Esposito G, Morisco C, Santulli G, Trimarco B. Therapeutic concordance improves blood pressure control in patients with resistant hypertension. Pharmacol Res 2023; 187:106557. [PMID: 36402254 PMCID: PMC9943685 DOI: 10.1016/j.phrs.2022.106557] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/10/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION An empathetic approach may be particularly useful in patients with therapy-resistant hypertension (TRH), defined as the failure to achieve target blood pressure (BP) despite a maximal doses of 3 antihypertensive drugs including a diuretic. However, the effects of therapeutic concordance have not been determined in hypertensive patients. METHODS We designed a study to explore the impact of therapeutic concordance in patients with TRH, who were included in an intervention arm based on a protocol in which trained personnel periodically verified the pharmacological regimen of these patients. RESULTS From a cohort of 5331 hypertensive patients followed-up for 77.64 ± 34.44 months, 886 subjects were found to have TRH; of these, 322 had apparent TRH (aTRH: uncontrolled office BP but optimal home BP) and 285 refused to participate in a second follow-up study, yielding a population of 279 patients with true TRH (tTRH). These tTRH patients were followed according to the therapeutic concordance protocol for 91.91 ± 54.7 months, revealing that 210 patients (75.27%) remained with uncontrolled BP (uncontrolled tTRH, Group I) while 69 patients (24.73%) reached an optimal BP control (average BP <140/90 mmHg in at least 50% of follow-up visits, Group II). Strikingly, at the end of the second follow-up, the percentage of patients displaying a decline in kidney function was significantly smaller in Group II than in Group I (8.5% vs 23.4%, p < 0.012). CONCLUSIONS Taken together, our findings indicate for the first time that therapeutic concordance significantly improves the outcome of antihypertensive treatment in a population of patients with TRH.
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Affiliation(s)
- Valentina Trimarco
- Department of Neuroscience, Reproductive Sciences and Dentistry, “Federico II” University, Naples, Italy
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy
| | - Pasquale Mone
- Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York City, NY, USA
| | - Maria Lembo
- Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy
| | - Maria Virginia Manzi
- Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy
| | - Daniela Pacella
- Department of Public Health, “Federico II” University, Naples, Italy
| | - Angela Falco
- Department of Neuroscience, Reproductive Sciences and Dentistry, “Federico II” University, Naples, Italy
| | - Paola Gallo
- Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy
| | - Carmine Morisco
- Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy,International Translational Research and Medical Education (ITME) Consortium, Naples, Italy
| | - Gaetano Santulli
- Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy; Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Albert Einstein College of Medicine, New York City, NY, USA; International Translational Research and Medical Education (ITME) Consortium, Naples, Italy; Department of Molecular Pharmacology, Fleischer Institute for Diabetes and Metabolism (FIDAM), Albert Einstein College of Medicine, New York City, NY, USA.
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, “Federico II” University, Naples, Italy,International Translational Research and Medical Education (ITME) Consortium, Naples, Italy
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Healthcare Providers’ Perspective about the Use of Telemedicine in Egypt: A National Survey. Int J Telemed Appl 2022; 2022:3811068. [PMID: 35313723 PMCID: PMC8934233 DOI: 10.1155/2022/3811068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 01/02/2022] [Accepted: 02/16/2022] [Indexed: 11/17/2022] Open
Abstract
Incorporation of telemedicine in general clinical practice is becoming a compelling need nowadays in the context of COVID-19 pandemic and its consequent burdens on the healthcare systems. Though telemedicine appears to be appealing and carries a lot of advantages, yet it is still faced by many challenges and barriers especially in developing countries. Our aim was to explore the impression of healthcare providers about telemedicine and its applicability in clinical practice in Egypt. A cross-sectional study was conducted among healthcare providers from different Egyptian governorates through a web-based survey. The survey gathered information about demographic, socioeconomic features of the enrolled healthcare participants; their knowledge, previous experience, impression about telemedicine, advantages of telemedicine over traditional medical services, barriers that may face telemedicine, and additional services that can be provided by telemedicine were also explored. Our study enrolled 642 healthcare providers from all over Egypt, 43.77% were females, of which 55.5% were physicians, 27.3% were nurses, 6.1% were technicians, 7.6% were administrative clerks, and 3.6% were medical directors. Sixty-four percent of participants reported that they have never used telemedicine. Smartphones were the most commonly used mean in the group who used telemedicine (65%), and smartphone applications were the favorable telemedicine service for about 50% of participants. Participants assumed that the use of telemedicine might not have a negative effect on the doctor-patient relationship but raised some concerns regarding the privacy and security of patients' data. Despite the fact that telemedicine appears to be appealing and widely accepted by healthcare providers, yet still, its implementation is confronted by some obstacles. Precise organizational guidelines need to be developed to clearly figure out the exact role of each healthcare provider to minimize their doubtfulness about telemedicine and to facilitate its adoption.
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Lewis S, Willis K, Franklin M, Smith L. Challenging times: disconnects between patient and professional temporalities in chronic condition management. CRITICAL PUBLIC HEALTH 2022. [DOI: 10.1080/09581596.2022.2046705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Sophie Lewis
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Karen Willis
- Institute for Health & Sport, Victoria University, Melbourne, Victoria, Australia
| | - Marika Franklin
- Centre for Workforce Futures, Macquarie Business School, Macquarie University, Sydney, New South Wales, Australia
| | - Lorraine Smith
- Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Kim S, Malova E. From Compliance to Adherence in Diabetes Self-care: Examining the Role of Patient's Potential for Mindful Non-Adherence and Physician-Patient Communication. Am J Health Promot 2022; 36:1094-1103. [PMID: 35081760 DOI: 10.1177/08901171211068401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To examine the roles of patient mindful non-adherence and physician-patient communication as important factors that facilitate an understanding of the relationship between compliance and adherence in diabetes management. DESIGN A cross-sectional survey Setting: Online data collection Subjects: 365 respondents at least 18 years of age and currently in treatment for diabetes Measures: We measured patients' compliance, adherence, mindfulness, and perceptions about physician-patient communication, as well as their demographic characteristics. ANALYSIS A moderated mediation analysis was conducted to examine the conditioned indirect effect of compliance on adherence. RESULTS The direct effect of compliance on adherence was positive and significant (β = .378, SE = .073, p < .05, BootCI [.234, .521]), but the compliance-adherence association was also partially mediated by patient's potential for mindful non-adherence. A higher level of compliance increased potential for mindful non-adherence (β = .716, SE = .082, p < .05, BootCI [.555, .876]), and, in turn, the increased potential for mindful non-adherence reduced adherence (β = -.107, SE = .045, p < .05, BootCI [-.196, -.018]). This detrimental mediating effect of potential for mindful non-adherence was contingent on the perceived quality of physician-patient communication (index = .076, SE = .038, 95% BootCI [.003, .153]), indicating that the positive perception significantly reduced the negative mediating effect of potential for mindful non-adherence on adherence.
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Affiliation(s)
- Soyoon Kim
- Communication Studies5452University of Miami - Coral Gables Campus
| | - Ekaterina Malova
- Communication Studies5452University of Miami - Coral Gables Campus
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11
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Schut RA. Racial disparities in provider-patient communication of incidental medical findings. Soc Sci Med 2021; 277:113901. [PMID: 33866084 DOI: 10.1016/j.socscimed.2021.113901] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/18/2021] [Accepted: 03/31/2021] [Indexed: 12/17/2022]
Abstract
Health disparities research often focuses on the social patterning of health outcomes. Increasingly, there has been an emphasis on understanding the mechanisms perpetuating disparities, even after issues of patient access to health services are addressed. The following study utilizes a novel dataset of electronic medical records (EMR), radiology records, and U.S. Census data to investigate the racial/ethnic patterning of provider-patient communication among patients diagnosed with incidental medical findings requiring follow-up. My results indicate that racial/ethnic disparities in follow-up adherence stem from initial disparities in provider-patient communication. These communication disparities persist even after accounting for multiple socioeconomic, health, and provider characteristics, indicating a bias in medicine, whereby providers are less likely to communicate information about incidental medical findings to patients of color relative to White patients. This paper has important clinical implications, as it sheds new light on why we might see low adherence to medical advice among patients of color. Findings also have social, political, and policy relevance, as they suggest an important mechanism through which health inequalities persist. To finally eliminate racial/ethnic health inequalities in the United States, racial bias and discrimination within medical and public health infrastructures must be eliminated.
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Affiliation(s)
- Rebecca A Schut
- Population Studies Center, University of Pennsylvania, 239 McNeil Building, 3718 Locust Walk, Philadelphia, PA, 19104, USA.
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Patel T, Umeh K, Poole H, Vaja I, Newson L. Cultural Identity Conflict Informs Engagement with Self-Management Behaviours for South Asian Patients Living with Type-2 Diabetes: A Critical Interpretative Synthesis of Qualitative Research Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2641. [PMID: 33807965 PMCID: PMC7967381 DOI: 10.3390/ijerph18052641] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 02/07/2023]
Abstract
The prevalence of type-2 diabetes (T2D) is increasing, particularly among South Asian (SA) communities. Previous research has highlighted the heterogeneous nature of SA ethnicity and the need to consider culture in SA patients' self-management of T2D. We conducted a critical interpretative synthesis (CIS) which aimed to a) develop a new and comprehensive insight into the psychology which underpins SA patients' T2D self-management behaviours and b) present a conceptual model to inform future T2D interventions. A systematic search of the literature retrieved 19 articles, including 536 participants. These were reviewed using established CIS procedures. Analysis identified seven constructs, from which an overarching synthesizing argument 'Cultural Conflict' was derived. Our findings suggest that patients reconstruct knowledge to manage their psychological, behavioural, and cultural conflicts, impacting decisional conflicts associated with T2D self-management and health professional advice (un)consciously. Those unable to resolve this conflict were more likely to default towards cultural identity, continue to align with cultural preferences rather than health professional guidance, and reduce engagement with self-management. Our synthesis and supporting model promote novel ideas for self-management of T2D care for SA patients. Specifically, health professionals should be trained and supported to explore and mitigate negative health beliefs to enable patients to manage social-cultural influences that impact their self-management behaviours.
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Affiliation(s)
- Tasneem Patel
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool L69 3BX, UK;
- Faculty of Health, School of Psychology, Liverpool John Moores University, Liverpool L3 3AF, UK; (K.U.); (H.P.); (I.V.)
| | - Kanayo Umeh
- Faculty of Health, School of Psychology, Liverpool John Moores University, Liverpool L3 3AF, UK; (K.U.); (H.P.); (I.V.)
| | - Helen Poole
- Faculty of Health, School of Psychology, Liverpool John Moores University, Liverpool L3 3AF, UK; (K.U.); (H.P.); (I.V.)
| | - Ishfaq Vaja
- Faculty of Health, School of Psychology, Liverpool John Moores University, Liverpool L3 3AF, UK; (K.U.); (H.P.); (I.V.)
- NHS Bradford Teaching Hospital, Bradford BD9 6RJ, UK
| | - Lisa Newson
- Faculty of Health, School of Psychology, Liverpool John Moores University, Liverpool L3 3AF, UK; (K.U.); (H.P.); (I.V.)
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Banasiak K, Hux J, Lavergne C, Luk J, Sohal P, Paty B. Facilitating barriers: Contextual factors and self-management of type 2 diabetes in urban settings. Health Place 2020; 61:102267. [PMID: 32329732 DOI: 10.1016/j.healthplace.2019.102267] [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] [Received: 02/27/2019] [Revised: 11/28/2019] [Accepted: 12/03/2019] [Indexed: 10/25/2022]
Abstract
Urban environments create unique challenges for the management of type 2 diabetes (T2D). City living is associated with unhealthy occupational, nutritional, and physical activity patterns. However, it has also been linked to behaviours that promote health, such as walking and cycling for transportation. Our research is situated at the intersection of these contradictory findings. We ask: What aspects of urban living impact the ability of those living with diabetes to reach optimal health? What contextual and structural factors influence how barriers are experienced in the everyday lives of those living with T2D? We conducted semi-structured interviews with 29 individuals living in Toronto and Vancouver. Interviews were recorded, transcribed, and systematically coded for themes and sub-themes. In addition to affirming readily acknowledged barriers to diabetes management, such as accessing healthy, culturally appropriate food and the cost of management, our findings suggest that the unpredictable nature of urban living creates barriers to routinizing self-management practices. As large, cosmopolitan centres with an abundance of activities on offer, cities pulls people away from home, making adherence to self-management recommendations more difficult. Moreover, our findings challenge commonly held assumptions about the mutually exclusive and static nature of barriers and facilitators. Public transit, a readily acknowledged facilitator of healthy living, can be experienced as a barrier to diabetes management. Participants report intentional non-adherence to their medication regimens for fear of hypoglycemia in subway or traffic delays. While the stimulating nature of cities promotes walkability, it produces barriers as well: participants partake in more restaurant eating than they would if they lived in a rural area and were home to cook their own meals. Understanding how barriers are experienced by people living with diabetes will help mitigate some of the unintended consequences associated with various contextual factors. We recommend that healthcare professionals acknowledge and support people with T2D in routinizing self-management and developing contingency plans for the unpredictability and complexity that urban living entails. We suggest further research be carried out to develop contextually-tailored municipal policies and interventions that will support self-management and improve outcomes for individuals living with T2D in urban settings.
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Caldwell KL, Vicidomini D, Wells R, Wolever RQ. Engaging Patients in their Health Care: Lessons From a Qualitative Study on the Processes Health Coaches Use to Support an Active Learning Paradigm. Glob Adv Health Med 2020; 9:2164956120904662. [PMID: 32110473 PMCID: PMC7016303 DOI: 10.1177/2164956120904662] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/23/2019] [Accepted: 01/15/2020] [Indexed: 11/25/2022] Open
Abstract
Background While recent health-care trends rely on activated patients, few studies report direct observations of how to engage and activate patients to be full participants in their own health care. The interpersonal processes and communication strategies used in integrative health coaching (IHC) may offer important insight into how clinicians can help patients step into a more active learning model rather than more typical passive roles. Objective This study uses verbatim transcripts of medical patients’ first few IHC sessions to identify the actual processes used to help patients embrace this more active learning role. Methods A thematic analysis was conducted of 72 verbatim transcripts from IHC sessions of 26 patients with severe dysfunction from tinnitus. The patients participated in 6 months of IHC as part of a larger integrative intervention in a randomized, controlled pilot designed to assess feasibility for a larger randomized, controlled trial on the clinical effectiveness of an integrative intervention. Results Four themes emerged: (1) Describing the Health Coaching Process to patients; (2) Using Key Procedures for Action Planning—optimal health future self-visualization, Wheel of Health, and exploration of the gap between current and desired states to help patients set goals for themselves; (3) Supporting Action and Building Momentum—the creation and support of action steps with frequent reinforcement of self-efficacy; and (4) Active Listening and Inviting the Patient to Articulate Learning—coaches’ active listening process included reflection, clarifying questions, turning patient questions back to the patients, highlighting values, identifying potential barriers and resources, and inviting patients to articulate what they were learning. Conclusion The processes identified in IHC incorporate key principles of adult learning theory and engage patients’ innate resources of goal orientation, self-direction, and intrinsic motivation. These interpersonal processes help patients embrace a more active learning role, with implications for patient engagement in other clinical contexts.
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Affiliation(s)
- Karen L Caldwell
- Department of Human Development and Psychological Counseling, Appalachian State University, Boone, North Carolina
| | - Delia Vicidomini
- Department of Human Development and Psychological Counseling, Appalachian State University, Boone, North Carolina
| | - Reese Wells
- Department of Human Development and Psychological Counseling, Appalachian State University, Boone, North Carolina
| | - Ruth Q Wolever
- Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Medicine at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee.,School of Nursing, Vanderbilt University, Nashville, Tennessee
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15
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Green J, Jester R. Challenges to concordance: theories that explain variations in patient responses. Br J Community Nurs 2019; 24:466-473. [PMID: 31604052 DOI: 10.12968/bjcn.2019.24.10.466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
To meet the challenges of an increasingly ageing and multimorbid population, patients must be fully engaged to work in partnership with their health professional (HP) in the management of their condition(s). The NHS Long Term Plan (2019) outlines goals to manage the increasing demands on the health service-hospital admission avoidance, shorter length of hospital stays through enhanced recovery pathways, increased management of patients within primary care and ensuring a person-centred approach to care provision. Meeting these goals is predicated on HPs being equipped to activate patients using the skills of motivational interviewing, person-centred care and a willingness to share decision making. This article presents a range of psychological theories that could explain the everyday challenges faced in care delivery. Awareness of these theories may help HPs target their approach to care delivery more effectively, to understand patient responses and, therefore, optimise the provision of person-centred care.
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Affiliation(s)
- Julie Green
- Dean of Education, Keele University; Queen's Nurse, Chair Royal College of Nursing (RCN) District and Community Nursing Forum, RCN Professional Nursing Committee, member of the Association of District Nurse Educators
| | - Rebecca Jester
- Professor of Nursing, Faculty of Education, Health and Wellbeing, Institute of Health, University of Wolverhampton
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Ueno H, Ishikawa H, Suzuki R, Izumida Y, Ohashi Y, Yamauchi T, Kadowaki T, Kiuchi T. The association between health literacy levels and patient-reported outcomes in Japanese type 2 diabetic patients. SAGE Open Med 2019; 7:2050312119865647. [PMID: 31384463 PMCID: PMC6651654 DOI: 10.1177/2050312119865647] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 07/01/2019] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES The aim of this study is to empirically examine a full pathway model of health literacy, and health and well-being outcomes among patients with type 2 diabetes. METHODS A three-wave longitudinal survey was administered to 148 patients with diabetes. Covariance structure analysis was conducted to create a path diagram, with health literacy and burden of medical expenses included as independent variables and with psychosocial factors, behaviors, and health and well-being outcomes included as dependent variables. RESULTS The model fit indices showed a comparative fit index of 0.985 at baseline, 0.959 after 3 months, and 0.948 after 6 months, with a root mean square error of approximation of 0.040 at baseline, 0.079 after 3 months, and 0.085 after 6 months. There were 14 significant paths across the three time points between health literacy and understanding of diabetes care, self-efficacy, communication with doctors, and medication adherence. CONCLUSION The model fitness index showed an adequate result. Health literacy was significantly positively associated with understanding of diabetes care, self-efficacy, communication with doctors, and medication adherence. Health literacy had a direct positive influence on medication adherence and possibly an indirect positive influence on exercise/diet via self-efficacy. The results were generally consistent across the three time points, suggesting good reliability of the models. Improving health literacy may lead to better self-management of diabetes and favorable health outcomes.
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Affiliation(s)
- Haruka Ueno
- Department of Health Communication, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hirono Ishikawa
- Department of Health Communication, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Graduate School of Public Health, Teikyo University, Tokyo, Japan
| | - Ryo Suzuki
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Division of Diabetes, Metabolism, Endocrinology, Rheumatology and Collagen Diseases Tokyo Medical University, Tokyo, Japan
| | - Yoshihiko Izumida
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yumiko Ohashi
- Nursing Department, The University of Tokyo Hospital, Tokyo, Japan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takashi Kadowaki
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Prevention of Diabetes and Life-style Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Metabolism and Nutrition, Mizonokuchi Hospital, Teikyo University, Kawasaki, Kanagawa, Japan
| | - Takahiro Kiuchi
- Department of Health Communication, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Mifsud M, Molines M, Cases AS, N'Goala G. It's MY health care program: Enhancing patient adherence through psychological ownership. Soc Sci Med 2019; 232:307-315. [DOI: 10.1016/j.socscimed.2019.05.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 05/04/2019] [Accepted: 05/14/2019] [Indexed: 10/26/2022]
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Settineri S, Frisone F, Merlo EM, Geraci D, Martino G. Compliance, adherence, concordance, empowerment, and self-management: five words to manifest a relational maladjustment in diabetes. J Multidiscip Healthc 2019; 12:299-314. [PMID: 31118655 PMCID: PMC6499139 DOI: 10.2147/jmdh.s193752] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 01/23/2019] [Indexed: 12/15/2022] Open
Abstract
Background: The pathological reality of diabetes and the incidents in following the prescribed therapies have been considered and are still a serious and relevant problem in the health sector. Objective: This review aims at highlighting the importance of clinical psychological phenomena that underlie the notion of therapies. Methods: The review was conducted through search engines such as PubMed, Medline, Web of Science and Google Scholar. The articles related to compliance, adherence, concordance, empowerment and the self-management of diabetes were included, in order to highlight the possible similarities and differences that these terms bring with them in them management of diabetes. Results: Starting from 252 initial publications, 101 articles were selected that highlighted the practical implications that each term has compared to the others. Conclusion: The review can represent a bridge between the medical approach and clinical psychology, in which integration can suggest paths aiming at improving patients' existential conditions and adaptation.
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Affiliation(s)
- Salvatore Settineri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Fabio Frisone
- Department of Cognitive Sciences, Psychology, Educational and Cultural Studies (COSPECS), University of Messina, Messina, Italy
| | - Emanuele Maria Merlo
- Department of Cognitive Sciences, Psychology, Educational and Cultural Studies (COSPECS), University of Messina, Messina, Italy
| | - Daniele Geraci
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Gabriella Martino
- Department of Clinical and Experimental Medicine, University of Messina, Italy
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Pakdaman M, Geravandi S, keyghobadi N, Sahab Moradi M. Nurses’ and Patients’ Perspective toward Patient-Centered Care in Selected Hospitals of Yazd. CASPIAN JOURNAL OF HEALTH RESEARCH 2019. [DOI: 10.29252/cjhr.4.2.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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20
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Håkansson Eklund J, Holmström IK, Kumlin T, Kaminsky E, Skoglund K, Höglander J, Sundler AJ, Condén E, Summer Meranius M. "Same same or different?" A review of reviews of person-centered and patient-centered care. PATIENT EDUCATION AND COUNSELING 2019; 102:3-11. [PMID: 30201221 DOI: 10.1016/j.pec.2018.08.029] [Citation(s) in RCA: 357] [Impact Index Per Article: 71.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 08/24/2018] [Accepted: 08/25/2018] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To provide a synthesis of already synthesized literature on person-centered care and patient-centered care in order to identify similarities and differences between the two concepts. METHODS A synthesis of reviews was conducted to locate synthesized literature published between January 2000 and March 2017. A total of 21 articles deemed relevant to this overview were synthesized using a thematic analysis. RESULTS The analysis resulted in nine themes present in person-centered as well as in patient-centered care: (1) empathy, (2), respect (3), engagement, (4), relationship, (5) communication, (6) shared decision-making, (7) holistic focus, (8), individualized focus, and (9) coordinated care. The analysis also revealed that the goal of person-centered care is a meaningful life while the goal of patient-centered care is a functional life. CONCLUSIONS While there are a number of similarities between the two concepts, the goals for person-centered and patient-centered care differ. The similarities are at the surface and there are important differences when the concepts are regarded in light of their different goals. PRACTICE IMPLICATIONS Clarification of the concepts may assist practitioners to develop the relevant aspects of care. Person-centered care broadens and extends the perspective of patient-centered care by considering the whole life of the patient.
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Affiliation(s)
- Jakob Håkansson Eklund
- School of Health, Care and Social Welfare, Mälardalen University, Postbox 883, SE-72123, Sweden.
| | - Inger K Holmström
- School of Health, Care and Social Welfare, Mälardalen University, Postbox 883, SE-72123, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Sweden
| | - Tomas Kumlin
- School of Health, Care and Social Welfare, Mälardalen University, Postbox 883, SE-72123, Sweden
| | - Elenor Kaminsky
- Department of Public Health and Caring Sciences, Uppsala University, Sweden
| | - Karin Skoglund
- School of Health, Care and Social Welfare, Mälardalen University, Postbox 883, SE-72123, Sweden
| | - Jessica Höglander
- School of Health, Care and Social Welfare, Mälardalen University, Postbox 883, SE-72123, Sweden
| | - Annelie J Sundler
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-50190, Borås, Sweden
| | - Emelie Condén
- Centre for Clinical Research, Västmanland Hospital, Uppsala University, Sweden
| | - Martina Summer Meranius
- School of Health, Care and Social Welfare, Mälardalen University, Postbox 883, SE-72123, Sweden
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21
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Gorst SL, Young B, Williamson PR, Wilding JPH, Harman NL. Incorporating patients' perspectives into the initial stages of core outcome set development: a rapid review of qualitative studies of type 2 diabetes. BMJ Open Diabetes Res Care 2019; 7:e000615. [PMID: 30899531 PMCID: PMC6398822 DOI: 10.1136/bmjdrc-2018-000615] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 01/29/2019] [Indexed: 01/08/2023] Open
Abstract
Conducting systematic reviews of qualitative studies to incorporate patient perspectives within the early stages of core outcome set (COS) development can be resource intensive. We aimed to identify an expedited approach to be used as part of the wider COS development process. Specifically, we undertook a rapid review of qualitative studies of patients' views and experiences of type 2 diabetes. We searched MEDLINE from inception to June 2017 to identify studies reporting qualitative empirical findings of perspectives of people with type 2 diabetes. Qualitative methodological filters were used to minimize irrelevant references. Drawing on content analysis, data synthesis involved identifying text in eligible studies relevant to outcomes of type 2 diabetes and interpreting and categorizing this according to the 38 core domains of the Core Outcome Measures in Effectiveness Trials taxonomy. Of 146 studies screened, 26 were included. Four hundred and fifty-eight outcomes were derived from the included studies. In comparison to the outcomes extracted from clinical trials, more life impact outcomes were derived from the qualitative studies, but fewer physiological/clinical outcomes. Outcomes relating to 'mortality/survival' and 'role functioning' were more prevalent in studies conducted in low/middle-income countries. This rapid review and synthesis of qualitative studies identified outcomes that had not previously been identified by a systematic review of clinical trials. It also identified differences in the types of outcomes given prominence to in the clinical trials and qualitative literatures. Incorporating qualitative evidence on patient perspectives from the outset of the COS development process can help to ensure outcomes that matter to patients are not overlooked. Our method provides a pragmatic and resource-efficient way to do this. For those developing international COS, our method has potential for incorporating the perspectives of patients from diverse countries in the early stages of COS development.
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Affiliation(s)
- Sarah L Gorst
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Bridget Young
- MRC North West Hub for Trials Methodology Research, Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Paula R Williamson
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - John P H Wilding
- Obesity and Endocrinology Clinical Research Group, University of Liverpool and Aintree University Hospital, Liverpool, UK
| | - Nicola L Harman
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Liverpool, UK
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22
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Schlegel V, Leray E. From Medical Prescription to Patient Compliance: A Qualitative Insight into the Neurologist-Patient Relationship in Multiple Sclerosis. Int J MS Care 2018; 20:279-286. [PMID: 30568565 DOI: 10.7224/1537-2073.2017-043] [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: 12/29/2022]
Abstract
Background Approximately 12 disease-modifying treatments are available worldwide for patients with relapsing multiple sclerosis (MS). These recent therapeutic advances have led to major changes in patient and neurologist attitudes toward drug prescription. Herein, we aimed to characterize patient choice regarding treatment for MS and identify how neurologists assess and monitor patient compliance during follow-up. Methods In 29 patients with MS, we observed visits to their neurologist to understand how questions related to compliance were addressed in the doctor-patient relationship. Face-to-face interviews were conducted with 15 of the 29 patients to discuss how they dealt with their drug prescription from a patient-centered perspective. Results Of the 15 patients with MS, nine were offered a choice of treatment. However, we found that neurologists were not always willing to consider the patients' input. Even if physicians attempt to align treatment choice with patient preferences to ensure compliance, preferences are often assumed rather than solicited from patients. Furthermore, patients may be unwilling to make their own treatment decisions. Various ways for neurologists to assess compliance during visits were also identified. Noncompliance can be considered as a way for patients to communicate their preferences and demonstrate involvement in their drug therapy, and it can lead to a renegotiation of the current treatment course. Conclusions These findings suggest that the neurologist-patient relationship has a great influence on patient compliance throughout the MS disease course.
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Abstract
INTRODUCTION Prevention of type 2 diabetes (T2D) is important to reduce suffering and health care costs. A precursor to T2D is impaired glucose regulation (IGR), a condition of elevated plasma glucose that is associated with insulin resistance and increased risk of cardiovascular disease. Prevention of T2D is determined by preservation of pancreatic β cell function which can be achieved by the use of anti-hyperglycemic medications or intensive lifestyle interventions (ILIs) to modify dietary and physical activity habits that induce modest weight loss (≥5%). Both interventions have beneficial effects on normal glucose regulation (NGR), but ILI is preferred due to its safety, efficacy, and cost. AREAS COVERED Traditional approaches to the prevention of T2D have used a variety of screening methods to identify those who are at high risk for developing T2D (prediabetes). People designated with prediabetes are then treated with ILI. An alternative approach for preventing T2D is to offer ILI to all overweight/obese adults who volunteer for weight loss treatment. EXPERT COMMENTARY This new alternative has several potential advantages: more rapid recruitment of participants with lower burden of care and early, aggressive treatment of potential β cell dysfunction. Cost-effectiveness studies of this alternative approach are needed.
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Affiliation(s)
- Donald A Williamson
- a Health Psychology Laboratory , Pennington Biomedical Research Center , Landrum , SC , USA
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Psarou A, Cooper H, Wilding JPH. Patients' Perspectives of Oral and Injectable Type 2 Diabetes Medicines, Their Body Weight and Medicine-Taking Behavior in the UK: A Systematic Review and Meta-Ethnography. Diabetes Ther 2018; 9:1791-1810. [PMID: 30120753 PMCID: PMC6167276 DOI: 10.1007/s13300-018-0490-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Indexed: 01/03/2023] Open
Abstract
UNLABELLED The aim of this review is to identify peoples' perspectives of their glucose-lowering and anti-obesity drugs in relation to diabetes and weight control and to explore how these views affect medication adherence. Theoretical perspectives associated with medicine-taking behavior are also explored. The systematic review was based on a meta-ethnography of qualitative studies identified through a search of 12 medical and social science databases and subsequent citation searches. The quality of all studies was assessed. Sixteen studies were included with data from 360 UK individuals. No relevant studies were identified which focused on anti-obesity and non-insulin injectable drugs. The review revealed that the patients' perspectives and emotional state were influenced by starting and/or changing to a new glucose-lowering medicine. These were also influenced by prior medication experience, disease perceptions and interactions with clinicians. Despite reports of positive experiences with and positive perceptions of medicines, and of participation in strategies to regain life control, medication non-adherence was common. Accepting glucose-lowering medicines impacted on the individual's perception of lifestyle changes, and it was notable that weight loss was not perceived as a strategy to support diabetes management. Synthesis revealed that more than one theory is required to explain medicine-taking behavior. New insights into the underlying factors of poor adherence and the specific practical issues identified in this review can help in the development of patient-centered interventions. FUNDING Diabetes UK.
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Affiliation(s)
- Aikaterini Psarou
- Obesity and Endocrinology Research, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK.
| | - Helen Cooper
- Faculty of Health and Social Care, Department of Public Health and Wellbeing, University of Chester, Chester, UK
| | - John P H Wilding
- Obesity and Endocrinology Research, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
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Luetsch K. From enforcement to advocacy - Developing a Foucauldian perspective of pharmacists' reflections on interactions with complex patients. Res Social Adm Pharm 2018; 15:528-535. [PMID: 29980482 DOI: 10.1016/j.sapharm.2018.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/31/2018] [Accepted: 06/28/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pharmacists are extending their engagement in health care beyond the supply and monitoring of medicines. Extended roles for pharmacists propose participation in health promotion, disease monitoring and other health surveillance activities, involving them more closely in the lives of patients. OBJECTIVES To explore pharmacists' written reflections on patient-centred practice after interactions with people who experience complexity and difficulties to participate in their health care, using a Foucauldian approach. METHODS For this qualitative study, pharmacists enrolled in a postgraduate program first watched a video introducing them to the concept of complexity and conflicting patient priorities in health care. They then interacted with patients and reflected on these encounters, their understanding and practice of patient-centeredness. The reflective texts were thematically analysed, using the constant comparison method. Foucault's method of problematisation was used to construct and interpret themes. RESULTS Sixty-six pharmacists provided reflective accounts of their patient interaction. Main themes showed how pharmacists emphasised adherence to prescribed medicines, disease monitoring and other desirable health behaviours over tailoring advice to patients' priorities. The Foucauldian analysis elucidated how they prioritised supporting individual patient responsibility over addressing complexity in medication regimens and prescribed health care, risking normalisation of an enforcing role. Pharmacists acknowledged a discrepancy in their patient-centred practice when taking responsibility for patients' medication taking behaviour while encouraging the adoption of certain disciplines to achieve compliance. When pharmacists respected patients' agency and tailored advice and professional support to the needs, wishes and capacities of patients, they developed opportunities for advocacy via increased patient-centeredness. CONCLUSION Pharmacists' discursive practices as described in their reflections raise questions of how they employ their sociological and professional roles in negotiating the relatively best outcomes for patients. Pharmacists increasing their awareness of how they conduct themselves may enhance their patient-centeredness when extending participation in disease monitoring and surveillance.
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Affiliation(s)
- Karen Luetsch
- School of Pharmacy, The University of Queensland, 20 Cornwall St, Woolloongabba, Qld, 4102, Australia.
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26
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Goldring MR, Persky S. Preferences for physician weight status among women with overweight. Obes Sci Pract 2018; 4:250-258. [PMID: 29951215 PMCID: PMC6009989 DOI: 10.1002/osp4.162] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/19/2018] [Accepted: 01/27/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Women with overweight experience stigma in clinical interactions. Emerging evidence suggests that one near-term approach to offset the negative consequences of weight stigma could be to capitalize on benefits of patient-physician weight concordance. However, it is likely that patient attitudes towards physicians with overweight are complicated and multifaceted and may include stigmatization of providers with overweight. METHODS Two-hundred ninety-eight women with overweight completed an online questionnaire and indicated preference for a physician who is 'overweight', 'not overweight', or indicated no preference. Participants provided reasons for their choice and answered questions about their weight-related beliefs and experiences. RESULTS The majority of women indicated no weight preference (63%), and a portion (36%) of the sample explicitly preferred physicians who are not overweight. Reasons provided for these preferences were primarily based on stereotyped notions of physician aptitude based on weight. Compared with having no preference, those who preferred physicians who are not overweight had fewer previous negative weight-related physician interactions and had increased beliefs about the controllability of weight. CONCLUSIONS These findings elucidate patient attitudes towards physicians with overweight in a sample at increased risk for weight stigmatization. Findings underscore the need for stigma-reducing interventions so that clinical experiences for both women and physicians with overweight can be improved.
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Affiliation(s)
| | - S. Persky
- Social and Behavioral Research BranchNational Human Genome Research InstituteBethesdaMDUSA
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Tan C, Hassali M, Neoh C, Saleem F, Horne R. Cultural Adaptation and Linguistic Validation of the Beliefs about Medicines Questionnaire in Malaysia. Value Health Reg Issues 2018; 15:161-168. [DOI: 10.1016/j.vhri.2017.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 11/29/2017] [Accepted: 12/03/2017] [Indexed: 02/08/2023]
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Cameron D, Harris F, Evans JMM. Self-monitoring of blood glucose in insulin-treated diabetes: a multicase study. BMJ Open Diabetes Res Care 2018; 6:e000538. [PMID: 30258646 PMCID: PMC6150144 DOI: 10.1136/bmjdrc-2018-000538] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 07/24/2018] [Accepted: 08/13/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To explore how and why self-monitoring of blood glucose (SMBG) is carried out in a real-world context. RESEARCH DESIGN AND METHODS We conducted a multicase study among ten people with type 1 and insulin-treated type 2 diabetes mellitus in Scotland, alongside seven nominated support people and four healthcare professionals. All participants were interviewed in depth and six participants provided SMBG diaries. Stones' version of structuration theory informed the analysis. RESULTS People with diabetes were able to provide immediate motives for SMBG at particular times, often having different motives on different occasions. We identified six such motives, including routine, in response to symptoms, associated with a diabetes review, to facilitate lifestyle, when a 'good' result was expected, and higher level motives for longer term glycemic control. These motives were influenced by underlying attitudes toward diabetes that included level of engagement and responsibility for diabetes, a desire not to be controlled by diabetes, resistance to diabetes, diabetes education and relationship with the health service, fear of hypoglycemia, and prevention of diabetes complications. Five responses to test results were identified, depending on the immediate motive and underlying attitudes. CONCLUSIONS People with insulin-treated diabetes do not necessarily self-monitor with an explicit goal of improving long-term glycemic control, but may have other motives that are important to them. An individualized understanding is therefore needed to advise people with diabetes how SMBG can be optimized for them.
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Affiliation(s)
- Dawn Cameron
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Fiona Harris
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Josie M M Evans
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
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Szafran O, Kennett SL, Bell NR, Green L. Patients’ perceptions of team-based care in family practice: access, benefits and team roles. J Prim Health Care 2018; 10:248-257. [DOI: 10.1071/hc18018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
ABSTRACT INTRODUCTION The increasing complexity of health care and escalating prevalence of multiple chronic conditions have driven interprofessional team-based care in family practice. Most published studies examine team-based care from the perspective of health professionals. The purpose of this study was to examine patients’ perceptions of team-based care in family practice. METHODS This was a waiting room survey conducted in five family medicine academic teaching clinics in Edmonton, Alberta, Canada. Patients aged ≥18 years were invited to participate in a survey addressing patient access to team-based care, perceived benefits, preferred health professional and team member roles. RESULTS Of the 44.3% (565/1274) of respondents, 41.8% (231/552) reported receiving care from a team of health professionals, primarily for chronic disease management or pharmacy consultations. While there was a consistent pattern of patient perception that many aspects of care did not worsen with team-based care, improvements in knowledge of their medical condition (67.4%); the care received (65.0%); access to care (51.1%); ability to self-care (48.9%) and maintain their independence (43.7%); and overall health (51.1%) were reported. Some patients felt that team-based care reduced emergency visits (34.6%) and hospitalisations (29.9%), and 44.1% of patients felt that they had an active role on the team and made decisions about their care together with health professionals. CONCLUSION Patients perceive that team-based care in family practice has improved their knowledge and access to care, overall health and avoided some emergency department visits and hospital admissions. The findings support the continued development of team-based care in family practice.
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Lingard L, Sue-Chue-Lam C, Tait GR, Bates J, Shadd J, Schulz V. Pulling together and pulling apart: influences of convergence and divergence on distributed healthcare teams. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2017; 22:1085-1099. [PMID: 28116565 PMCID: PMC5668127 DOI: 10.1007/s10459-016-9741-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 12/20/2016] [Indexed: 05/19/2023]
Abstract
Effective healthcare requires both competent individuals and competent teams. With this recognition, health professions education is grappling with how to factor team competence into training and assessment strategies. These efforts are impeded, however, by the absence of a sophisticated understanding of the the relationship between competent individuals and competent teams . Using data from a constructivist grounded theory study of team-based healthcare for patients with advanced heart failure, this paper explores the relationship between individual team members' perceived goals, understandings, values and routines and the collective competence of the team. Individual interviews with index patients and their healthcare team members formed Team Sampling Units (TSUs). Thirty-seven TSUs consisting of 183 interviews were iteratively analysed for patterns of convergence and divergence in an inductive process informed by complex adaptive systems theory. Convergence and divergence were identifiable on all teams, regularly co-occurred on the same team, and involved recurring themes. Convergence and divergence had nonlinear relationships to the team's collective functioning. Convergence could foster either shared action or collective paralysis; divergence could foster problematic incoherence or productive disruption. These findings advance our understanding of the complex relationship between the individual and the collective on a healthcare team, and they challenge conventional narratives of healthcare teamwork which derive largely from acute care settings and emphasize the importance of common goals and shared mental models. Complex adaptive systems theory helps us to understand the implications of these insights for healthcare teams' delivery of care for the complex, chronically ill.
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Affiliation(s)
- L Lingard
- Centre for Education Research and Innovation, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, Room 112, Health Sciences Addition, London, ON, N6A 5C1, Canada.
| | - C Sue-Chue-Lam
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - G R Tait
- Department of Psychiatry and Division of Medical Education, Dalhousie University, Halifax, NS, Canada
| | - J Bates
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - J Shadd
- Division of Palliative Care, Department of Family Medicine, DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - V Schulz
- Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre, London, ON, Canada
- Western University, London, ON, Canada
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Dickinson JK, Guzman SJ, Maryniuk MD, O'Brian CA, Kadohiro JK, Jackson RA, D'Hondt N, Montgomery B, Close KL, Funnell MM. The Use of Language in Diabetes Care and Education. Diabetes Care 2017; 40:1790-1799. [PMID: 29042412 DOI: 10.2337/dci17-0041] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Language is powerful and can have a strong impact on perceptions as well as behavior. A task force, consisting of representatives from the American Association of Diabetes Educators (AADE) and the American Diabetes Association (ADA), convened to discuss language in diabetes care and education. This document represents the expert opinion of the task force. The literature supports the need for a language movement in diabetes care and education. There are effective ways of communicating about diabetes. This article provides recommendations for language used by health care professionals and others when discussing diabetes through spoken or written words-whether directed to people with diabetes, colleagues, or the general public, as well as research questions related to language and diabetes.
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Affiliation(s)
- Jane K Dickinson
- Department of Health & Behavior Studies, Teachers College, Columbia University, New York, NY
| | - Susan J Guzman
- Clinical/Educational Services, Behavioral Diabetes Institute, San Diego, CA
| | | | - Catherine A O'Brian
- Department of Science and Practice, American Association of Diabetes Educators, Chicago, IL
| | - Jane K Kadohiro
- Diabetes Education and Support Consulting Services, Reno, NV
| | | | | | | | - Kelly L Close
- Close Concerns and The diaTribe Foundation, San Francisco, CA
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McSorley AMM, Peipert JD, Gonzalez C, Norris KC, Goalby CJ, Peace LJ, Waterman AD. Dialysis Providers’ Perceptions of Barriers to Transplant for Black and Low-Income Patients: A Mixed Methods Analysis Guided by the Socio-Ecological Model for Transplant. WORLD MEDICAL & HEALTH POLICY 2017. [DOI: 10.1002/wmh3.251] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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33
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Szafran O, Torti JM, Kennett SL, Bell NR. Family physicians’ perspectives on interprofessional teamwork: Findings from a qualitative study. J Interprof Care 2017; 32:169-177. [DOI: 10.1080/13561820.2017.1395828] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Olga Szafran
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Sandra L Kennett
- Clinical Nurse Specialist, Edmonton Oliver Primary Care Network, Family Medicine Clinic, Misericordia Community Hospital, Edmonton, Alberta, Canada
| | - Neil R Bell
- Department of Family Medicine, University of Alberta, Family Medicine Clinic, Misericordia Community Hospital, Edmonton, Alberta, Canada
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Ferreira P, Barbosa H. Choice of mandatory prescribed drugs in Portugal: a consumers’ perspective. INTERNATIONAL JOURNAL OF PHARMACEUTICAL AND HEALTHCARE MARKETING 2017. [DOI: 10.1108/ijphm-07-2016-0039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper aims to contribute to the understanding of what influences consumers’ choice of mandatory prescribed drugs, by looking with more detail to the substitution of branded drugs by generics. Specifically, this research looks at three factors that can influence this decision, namely, participative decision-making, perceived risk and price consciousness, within the recent changes introduced in the Portuguese pharmaceutical market by new legislation.
Design/methodology/approach
A cross-sectional study was conducted, using a self-administered questionnaire, to survey a sample of consumers/patients that visited a doctor and were prescribed some kind of drug. Data were treated using factor analysis for dimensionality reduction purposes and regression analysis to test the main hypothesis.
Findings
The results show that participative decision-making has no impact on purchase decision of generics, while perceived risk and price consciousness show a predictive power regarding purchase intention of generic drugs.
Research limitations/implications
Although the results are only applicable to the Portuguese context, it draws important conclusions regarding consumers’ behaviour when choosing between branded and generic drugs.
Practical implications
Knowing what influences consumers’ choices of generic drugs contributes to tune marketing strategies and actions. For public institutions, this paper offers insights on how to adapt public policies.
Originality/value
This paper is valuable because it is the first to look at the Portuguese pharmaceutical market from a consumer behaviour perspective since new legislation was set up.
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Dickinson JK, Guzman SJ, Maryniuk MD, O'Brian CA, Kadohiro JK, Jackson RA, D'Hondt N, Montgomery B, Close KL, Funnell MM. The Use of Language in Diabetes Care and Education. DIABETES EDUCATOR 2017; 43:551-564. [PMID: 29040034 DOI: 10.1177/0145721717735535] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Language is powerful and can have a strong impact on perceptions as well as behavior. A task force, consisting of representatives from the American Association of Diabetes Educators and the American Diabetes Association, convened to discuss language in diabetes care and education. The literature supports the need for a language movement in diabetes care and education. There are effective ways of communicating about diabetes. This article provides recommendations for language used by health care professionals and others when discussing diabetes through spoken or written words, whether directed to people with diabetes, colleagues, or the general public, as well as research questions related to language and diabetes.
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Affiliation(s)
| | | | | | | | | | | | - Nancy D'Hondt
- Ascension St John Providence Hospital and Medical Center, Detroit, Michigan
| | | | | | - Martha M Funnell
- Michigan Center for Diabetes Translational Research, Ann Arbor, Michigan
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36
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McEvoy P, Williamson T, Kada R, Frazer D, Dhliwayo C, Gask L. Improving access to mental health care in an Orthodox Jewish community: a critical reflection upon the accommodation of otherness. BMC Health Serv Res 2017; 17:557. [PMID: 28806946 PMCID: PMC5557521 DOI: 10.1186/s12913-017-2509-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 08/04/2017] [Indexed: 12/12/2022] Open
Abstract
Background The English National Health Service (NHS) has significantly extended the supply of evidence based psychological interventions in primary care for people experiencing common mental health problems. Yet despite the extra resources, the accessibility of services for ‘under-served’ ethnic and religious minority groups, is considerably short of the levels of access that may be necessary to offset the health inequalities created by their different exposure to services, resulting in negative health outcomes. This paper offers a critical reflection upon an initiative that sought to improve access to an NHS funded primary care mental health service to one ‘under-served’ population, an Orthodox Jewish community in the North West of England. Methods A combination of qualitative and quantitative data were drawn upon including naturally occurring data, observational notes, e-mail correspondence, routinely collected demographic data and clinical outcomes measures, as well as written feedback and recorded discussions with 12 key informants. Results Improvements in access to mental health care for some people from the Orthodox Jewish community were achieved through the collaborative efforts of a distributed leadership team. The members of this leadership team were a self-selecting group of stakeholders which had a combination of local knowledge, cultural understanding, power to negotiate on behalf of their respective constituencies and expertise in mental health care. Through a process of dialogic engagement the team was able to work with the community to develop a bespoke service that accommodated its wish to maintain a distinct sense of cultural otherness. Conclusions This critical reflection illustrates how dialogic engagement can further the mechanisms of candidacy, concordance and recursivity that are associated with improvements in access to care in under-served sections of the population, whilst simultaneously recognising the limits of constructive dialogue. Dialogue can change the dynamic of community engagement. However, the full alignment of the goals of differing constituencies may not always be possible, due the complex interaction between the multiple positions and understandings of stakeholders that are involved and the need to respect the other’-s’ autonomy. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2509-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Phil McEvoy
- Salford, Six Degrees Social Enterprise CIC, Southwood House, Regent Road, Salford, M5 4QH, United Kingdom.
| | - Tracey Williamson
- University of Salford, School of Nursing, Midwifery, Social Work & Social Sciences, Mary Seacole Building, Frederick Road Campus, Salford, M6 6PU, United Kingdom
| | - Raphael Kada
- Salford, Six Degrees Social Enterprise CIC, Southwood House, Regent Road, Salford, M5 4QH, United Kingdom
| | - Debra Frazer
- Salford, Six Degrees Social Enterprise CIC, Southwood House, Regent Road, Salford, M5 4QH, United Kingdom
| | - Chardworth Dhliwayo
- Salford, Six Degrees Social Enterprise CIC, Southwood House, Regent Road, Salford, M5 4QH, United Kingdom
| | - Linda Gask
- Salford, Six Degrees Social Enterprise CIC, Southwood House, Regent Road, Salford, M5 4QH, United Kingdom
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Williams IL, Mee-Lee D. Coparticipative Adherence: The Reconstruction of Discharge Categories in the Treatment of Substance Use Disorders. ALCOHOLISM TREATMENT QUARTERLY 2017. [DOI: 10.1080/07347324.2017.1322432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Izaak L. Williams
- Department of Psychology, University of Hawaii, Honolulu, Hawaii, USA
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38
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Jungwirth D, Haluza D. Information and communication technology and the future of healthcare: Results of a multi-scenario Delphi survey. Health Informatics J 2017; 25:161-173. [PMID: 28438103 DOI: 10.1177/1460458217704256] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Technological advances toward consumer-specific expectations require a sustained commitment and coordination across policy- and decision-makers. The present scenario-based study aimed at identifying prevailing perceptions regarding telehealth applications among Austrian healthcare experts. During a two-round online Delphi survey, panelists rated perceived benefits, obstacles, innovativeness, desirability, and estimated implementation date of 10 telehealth scenarios. Panelists (n = 73, 74% males) perceived that the implementation of telehealth scenarios could especially improve patients' knowledge, quality of social healthcare, and living standard. In contrast, the three top-ranked obstacles were costs, technical prerequisites, and data security. Survey participants rated innovativeness of the presented future scenarios as quite high, whereas perceived desirability was moderate. Overall, ratings suggested precautious attitudes toward technological innovations. The survey findings suggest building taskforces and enhancing communication between healthcare stakeholders to proactively shape the future of telehealth in Austria.
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Sansgiry SS, Bhansali AH, Mhatre SK, Sawant RV. Influence of patient perceived relationship with pharmacist and physician and its association with beliefs in medicine. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2017. [DOI: 10.1111/jphs.12172] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Uno M, Tsujimoto T, Inoue T. Perceptions of nurses in Japan toward their patients' expectations of care: A qualitative study. Int J Nurs Sci 2017; 4:58-62. [PMID: 31406719 PMCID: PMC6626066 DOI: 10.1016/j.ijnss.2016.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 11/17/2016] [Accepted: 12/09/2016] [Indexed: 11/27/2022] Open
Abstract
Objectives This study aimed to investigate ideal nurse involvement based on the expectations of patients. Data on conflicts between nurses and patients were obtained. The patient situation involved standard nursing treatment, rather than acute phase or palliative care. Methods Questionnaires were distributed among senior nurses attending a series of trainings in 2012 and 2013. The nurses were requested to return their completed questionnaires within two weeks. We ensured the effectiveness of the interview process to obtain accurate answers. The sample comprised 240 head nurses and assistant head nurses who were asked to respond anonymously to 57 questions about non-acute (stable) psychiatric or physical nurse–patient scenarios. Qualitative data analysis was conducted using these responses. Results We received 41 completed responses (response rate = 17.1%). The expectations of patients and their families were reflected in five categories, namely, inference, empathic understanding, listening attitude, individual treatment, and reliable skills and explanations. Inference was independently categorized as a particularly strong characteristic of Japanese patients' expectations. Conclusions Nursing care in situations where conflicts or misunderstandings may arise can be improved by encouraging nurses to be attentive to the moods, feelings, and expectations of patients and their families. The findings from this study can improve the quality of Japanese nursing care with regard to sensing (inferring) and reacting to the expectations of patients.
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Affiliation(s)
- Mayumi Uno
- Yamato University Health Faculty of Nursing, Osaka, Japan
| | - Tomomi Tsujimoto
- Osaka University Graduate School of Medicine, Division of Health Sciences, Osaka, Japan
| | - Tomoko Inoue
- Osaka University Graduate School of Medicine, Division of Health Sciences, Osaka, Japan
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41
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Carter M, Fife C. Clinic visit frequency in wound care matters: data from the US wound registry. J Wound Care 2017; 26:S4-S10. [DOI: 10.12968/jowc.2017.26.sup1.s4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- M.J. Carter
- Strategic Solutions, Inc., Cody, WY, US
- U.S. Wound Registry, The Woodlands, TX, US
| | - C.E. Fife
- U.S. Wound Registry, The Woodlands, TX, US
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42
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ICT and the future of health care: aspects of doctor-patient communication. Int J Technol Assess Health Care 2016; 30:298-305. [PMID: 25308693 DOI: 10.1017/s0266462314000294] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The current digital revolution is particularly relevant for interactions of healthcare providers with patients and the community as a whole. The growing public acceptance and distribution of new communication tools such as smart mobile phones provide the prerequisite for information and communication technology (ICT) -assisted healthcare applications. The present study aimed at identifying specifications and perceptions of different interest groups regarding future demands of ICT-supported doctor-patient communication in Austria. METHODS German-speaking Austrian healthcare experts (n = 73; 74 percent males; mean age, 43.9 years; SD 9.4) representing medical professionals, patient advocates, and administrative personnel participated in a 2-round online Delphi process. Participants evaluated scenario-based benefits and obstacles for possible prospect introduction as well as degree of innovation, desirability, and estimated implementation dates of two medical care-related future set ups. RESULTS Panelists expected the future ICT-supported doctor-patient dialogue to especially improve the three factors doctors-patient relationship, patients' knowledge, and quality of social health care. However, lack of acceptance by doctors, data security, and monetary aspects were considered as the three most relevant barriers for ICT implementation. Furthermore, inter-group comparison regarding desirability of future scenarios showed that medical professionals tended to be more skeptical about health-related technological innovations (p < .001). CONCLUSIONS The findings of this survey revealed different expectations among interest groups. Thus, we suggest building taskforces and using workshops for establishing a dialogue between stakeholders to positively shape the future of ICT-supported collaboration and communication between doctors and patients.
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Randall S, Neubeck L. What's in a name? Concordance is better than adherence for promoting partnership and self-management of chronic disease. Aust J Prim Health 2016; 22:181-184. [PMID: 27150465 DOI: 10.1071/py15140] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 11/25/2015] [Indexed: 11/23/2022]
Abstract
The choice of language health professionals use to discuss self-management of chronic disease is important and influences patients' self-management. The words compliance, adherence and concordance are used to discuss patients' agreement with prescribed treatment plans, but have different tone and meanings. Models of care linked to the words compliance and adherence are underpinned by interactions between patients and healthcare providers that merely reinforce instructions about treatments. The 'patient-professional partnership' is introduced as a model by Bodenheimer et al. (2002, p. 2469) whereby true partnership working should be an opportunity to pool the expertise of both parties to arrive at mutually agreed goals in concordance. The impact these words might have on partnership working is important in defining the patient-health professional relationship, and for the patients' healthcare outcomes and the potential effect on healthcare utilisation.
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Affiliation(s)
- Sue Randall
- Sydney Nursing School, M03 88, Mallett Street, Camperdown, NSW 2050, Australia
| | - Lis Neubeck
- Charles Perkins Centre, Sydney Nursing School, Level 2, Building D17, The University of Sydney, NSW 2006, Australia
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Trenaman L, Selva A, Desroches S, Singh K, Bissonnette J, Bansback N, Stacey D. A measurement framework for adherence in patient decision aid trials applied in a systematic review subanalysis. J Clin Epidemiol 2016; 77:15-23. [DOI: 10.1016/j.jclinepi.2016.03.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 03/24/2016] [Accepted: 03/31/2016] [Indexed: 10/21/2022]
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Katz IT, Bogart LM, Fu CM, Liu Y, Cox JE, Samuels RC, Chase T, Schubert P, Schuster MA. Barriers to HPV immunization among blacks and latinos: a qualitative analysis of caregivers, adolescents, and providers. BMC Public Health 2016; 16:874. [PMID: 27558506 PMCID: PMC4997748 DOI: 10.1186/s12889-016-3529-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 08/16/2016] [Indexed: 01/05/2023] Open
Abstract
Background Despite recommendations that 11–12-year-olds receive the full three-shot Human papillomavirus (HPV) vaccine series, national HPV immunization coverage rates remain low. Disparities exist, with Blacks and Latinos being less likely than Whites to complete the series. We aimed to identify and compare barriers to HPV immunization perceived by healthcare providers, Black and Latino adolescents, and their caregivers to inform a clinic-based intervention to improve immunization rates. Methods We conducted semi-structured interviews between March and July 2014 with Black and Latino adolescents (n = 24), their caregivers (n = 24), and nurses (n = 18), and 2 focus groups with 18 physicians recruited from two pediatric primary care clinics. Qualitative protocol topics included: general perceptions and attitudes towards vaccines; HPV knowledge; and perceived individual and systems-level barriers affecting vaccine initiation and completion. Results Themes were identified and organized by individual and systems-level barriers to HPV immunization. Adolescents and their caregivers, particularly Blacks, expressed concerns about HPV being an untested, “newer” vaccine. All families felt they needed more information on HPV and found it difficult to return for multiple visits to complete the vaccine series. Providers focused on challenges related to administering multiple vaccines simultaneously, and perceptions of parental reluctance to discuss sexually transmitted infections. Conclusions Optimizing HPV immunization rates may benefit from a multi-pronged approach to holistically address provider, structural, and individual barriers to care. Further research should examine strategies for providing multiple modalities of support for providers, including a routinized system of vaccine promotion and delivery, and for addressing families’ concerns about vaccine safety and efficacy.
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Affiliation(s)
- Ingrid T Katz
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA. .,Massachusetts General Hospital, Center for Global Health, Boston, MassachusettsMA, USA. .,Harvard Medical School, Boston, Massachusetts, USA. .,Division of Women's Health, 1620 Tremont Street, 3rd Floor BWH, Boston, MA, 02120, USA.
| | - Laura M Bogart
- Harvard Medical School, Boston, Massachusetts, USA.,Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA.,RAND Corporation, Santa Monica, California, USA
| | - Chong Min Fu
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Yingna Liu
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Joanne E Cox
- Harvard Medical School, Boston, Massachusetts, USA.,Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Ronald C Samuels
- Harvard Medical School, Boston, Massachusetts, USA.,Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Tami Chase
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Pamela Schubert
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Mark A Schuster
- Harvard Medical School, Boston, Massachusetts, USA.,Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
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Mohottige D. What Unites Us in Death. J Palliat Med 2016; 19:677-8. [PMID: 27281460 DOI: 10.1089/jpm.2016.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kumar K, Greenfield S, Raza K, Gill P, Stack R. Understanding adherence-related beliefs about medicine amongst patients of South Asian origin with diabetes and cardiovascular disease patients: a qualitative synthesis. BMC Endocr Disord 2016; 16:24. [PMID: 27230479 PMCID: PMC4880880 DOI: 10.1186/s12902-016-0103-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 05/01/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Prevalence of diabetes and cardiovascular (CVD) disease amongst UK South Asians is higher than in the general population. Non-adherence to medicines may lead to poor clinical outcomes for South Asian patients with diabetes and CVD. To understand the decision making processes associated with taking medicines, a qualitative systematic meta-synthesis exploring medicine taking behaviours, and beliefs was undertaken. METHODS Four databases (Medline, Embase, Science Citation Index and CINAHL) were searched to identify qualitative studies of South Asian patients taking diabetic medicines. Data were thematic coded and synthesised. RESULTS The following themes were identified: [1] beliefs about the need for and efficacy of medicines; [2] toxicity of medicines and polypharmacy; [3] the necessity of traditional remedies versus "western medicines"; [4] stigma and social support; and [5] communication. CONCLUSIONS South Asians described cultural social stigma associated with diabetes and reported fears about drug toxicity as barriers to taking medicines. Cultural beliefs about traditional remedies and interactions with healthcare professionals also appeared to play a role in the way people made decisions about medicines. Advice should be tailored provided to South Asian patients highlighting the long term consequences of diabetes and CVD.
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Affiliation(s)
- Kanta Kumar
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Faculty of Medical and Human Sciences, University of Manchester, Manchester, M13 9PL, UK
| | - Sheila Greenfield
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Karim Raza
- Centre for Translational Inflammation Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK
- Rheumatology Department, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, B18 7QH, UK
| | - Paramjit Gill
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Rebecca Stack
- Centre for Translational Inflammation Research, The School of Immunity and Infection, University of Birmingham, Birmingham, B15 2TT, UK
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Burtscher D, Van den Bergh R, Toktosunov U, Angmo N, Samieva N, Rocillo Arechaga EP. "My Favourite Day Is Sunday": Community Perceptions of (Drug-Resistant) Tuberculosis and Ambulatory Tuberculosis Care in Kara Suu District, Osh Province, Kyrgyzstan. PLoS One 2016; 11:e0152283. [PMID: 27019454 PMCID: PMC4809488 DOI: 10.1371/journal.pone.0152283] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 03/12/2016] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Kyrgyzstan is one of the 27 high multidrug-resistant tuberculosis (MDR-TB) burden countries listed by the WHO. In 2012, Médecins Sans Frontières (MSF) started a drug-resistant tuberculosis (DR-TB) project in Kara Suu District. A qualitative study was undertaken to understand the perception of TB and DR-TB in order to improve the effectiveness and acceptance of the MSF intervention and to support advocacy strategies for an ambulatory model of care. METHODS This paper reports findings from 63 interviews with patients, caregivers, health care providers and members of communities. Data was analysed using a qualitative content analysis. Validation was ensured by triangulation and a 'thick' description of the research context, and by presenting deviant cases. RESULTS Findings show that the general population interprets TB as the 'lungs having a cold' or as a 'family disease' rather than as an infectious illness. From their perspective, individuals facing poor living conditions are more likely to get TB than wealthier people. Vulnerable groups such as drug and alcohol users, homeless persons, ethnic minorities and young women face barriers in accessing health care. As also reported in other publications, TB is highly stigmatised and possible side effects of the long treatment course are seen as unbearable; therefore, people only turn to public health care quite late. Most patients prefer ambulatory treatment because of the much needed emotional support from their social environment, which positively impacts treatment concordance. Health care providers favour inpatient treatment only for a better monitoring of side effects. Health staff increasingly acknowledges the central role they play in supporting DR-TB patients, and the importance of assuming a more empathic attitude. CONCLUSIONS Health promotion activities should aim at improving knowledge on TB and DR-TB, reducing stigma, and fostering the inclusion of vulnerable populations. Health seeking delays and adherence problems will be countered by further implementation of shortened treatment regimens. An ambulatory model of care is proposed when convenient for the patient; hospitalisation is favoured only when seen as more appropriate for the respective individual.
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Affiliation(s)
- Doris Burtscher
- Médecins Sans Frontières, Vienna Evaluation Unit, Vienna, Austria
| | | | | | - Nilza Angmo
- Médecins Sans Frontières, Bishkek, Kyrgyzstan
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Bennett L, Bergin M, Wells JSG. The potential of critical social theory as an educational framework for people with epilepsy. Epilepsy Behav 2016; 54:80-7. [PMID: 26687291 DOI: 10.1016/j.yebeh.2015.10.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 10/29/2015] [Accepted: 10/30/2015] [Indexed: 11/25/2022]
Abstract
Effective education can support people with epilepsy to develop the attributes and skills required to function as equal partners with clinical service providers, make informed decisions, and competently self-manage their healthcare. However, despite knowledge deficits, unmet information needs, and a poor sense of empowerment, the study of education for people with epilepsy is often neglected and is a poorly understood component of holistic practice within epilepsy healthcare. Historically, the only debate with regard to education and people with epilepsy has been guided either within a positivist or within a constructivist philosophy. We argue that new pedagogies are warranted, recognizing the views of people with epilepsy regarding their illness. Therefore, this paper explores the potential of an educational framework for people with epilepsy based upon critical social theory (CST). By utilizing a CST approach for education, people with epilepsy are engaged with as active 'participants'. This is a key difference that distinguishes CST from other metatheoretical frameworks. It has the potential to support people with epilepsy to acquire the skills and confidence to manage the biopsychosocial challenges associated with their condition.
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Affiliation(s)
- Louise Bennett
- Department of Nursing, School of Health Sciences, Cork Road, Waterford Institute of Technology, Waterford, Ireland.
| | - Michael Bergin
- Department of Nursing, School of Health Sciences, Cork Road, Waterford Institute of Technology, Waterford, Ireland.
| | - John S G Wells
- School of Health Sciences, Waterford Institute of Technology, Cork Road, Waterford, Ireland.
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Brundisini F, Vanstone M, Hulan D, DeJean D, Giacomini M. Type 2 diabetes patients' and providers' differing perspectives on medication nonadherence: a qualitative meta-synthesis. BMC Health Serv Res 2015; 15:516. [PMID: 26596271 PMCID: PMC4657347 DOI: 10.1186/s12913-015-1174-8] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 11/17/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Poor adherence to medication regimens increases adverse outcomes for patients with Type 2 diabetes. Improving medication adherence is a growing priority for clinicians and health care systems. We examine the differences between patient and provider understandings of barriers to medication adherence for Type 2 diabetes patients. METHODS We searched systematically for empirical qualitative studies on the topic of barriers to medication adherence among Type 2 diabetes patients published between 2002-2013; 86 empirical qualitative studies qualified for inclusion. Following qualitative meta-synthesis methods, we coded and analyzed thematically the findings from studies, integrating and comparing findings across studies to yield a synthetic interpretation and new insights from this body of research. RESULTS We identify 7 categories of barriers: (1) emotional experiences as positive and negative motivators to adherence, (2) intentional non-compliance, (3) patient-provider relationship and communication, (4) information and knowledge, (5) medication administration, (6) social and cultural beliefs, and (7) financial issues. Patients and providers express different understandings of what patients require to improve adherence. Health beliefs, life context and lay understandings all inform patients' accounts. They describe barriers in terms of difficulties adapting medication regimens to their lifestyles and daily routines. In contrast, providers' understandings of patients poor medication adherence behaviors focus on patients' presumed needs for more information about the physiological and biomedical aspect of diabetes. CONCLUSIONS This study highlights key discrepancies between patients' and providers' understandings of barriers to medication adherence. These misunderstandings span the many cultural and care contexts represented by 86 qualitative studies. Counseling and interventions aimed at improving medication adherence among Type 2 diabetes might become more effective through better integration of the patient's perspective and values concerning adherence difficulties and solutions.
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Affiliation(s)
- Francesca Brundisini
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4 K1, Canada.
| | - Meredith Vanstone
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4 K1, Canada.
| | - Danielle Hulan
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4 K1, Canada.
| | - Deirdre DeJean
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4 K1, Canada.
| | - Mita Giacomini
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4 K1, Canada.
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