The influence of beliefs about health and illness on foot care in diabetic subjects with severe foot lesions: a comparison of foreign- and Swedish-born individuals

Patient-reported outcomes in diabetes-related foot conditions: Is patient experience influenced by ethnicity? A mixed-methods systematic review

AIMS

Research in diabetes-related foot conditions (DRFC) often focuses on ulcer-related care, whilst the patient experience and influence of sociodemographic factors are under-researched. This systematic review investigated patient-reported outcomes and experience in people with DRFC.

METHODS

Multiple databases were searched from inception to 16 August 2023. All original articles that assessed any patient-reported outcome or experience in DRFC and reported participant ethnicity were included. Data were synthesized using a sequential contingent approach. Study quality was assessed using study design-specific tools.

RESULTS

Twenty-three studies were included (11 qualitative, 11 quantitative and one mixed-methods). DRFC had a largely negative impact on various life dimensions, including social and daily life, work, emotional and psychological well-being, necessitating dependence on others in the form of emotional, social and/or religious support, which were experienced differently by different groups. Patient DRFC knowledge and self-care habits were typically suboptimal, and levels of hope and feeling of control over their condition varied between groups. Outcomes varied slightly between ethnicities across studies, with some ethnicity-specific themes identified such as beliefs about disease cause and footwear habits. Quantitative and qualitative findings were mostly congruent.

CONCLUSIONS

DRFC profoundly and negatively impacts patient-reported outcomes and experience, with limited evidence suggesting an influence of ethnicity.

Perceptions and experiences of diabetic foot ulceration and foot care in people with diabetes: A qualitative meta-synthesis

Diabetic foot ulceration (DFU) is a common and debilitating complication of diabetes that is preventable through active engagement in appropriate foot-related behaviours, yet many individuals with diabetes do not adhere to foot care recommendations. The aim of this paper was to synthesise the findings of qualitative papers exploring diabetic people's perceptions and experiences of DFU in order to identify how they could be better supported to prevent ulceration or manage its impact. Five databases (MEDLINE, PsycINFO, CINAHL, EMBASE, Web of Science) were searched in May 2016 to identify eligible articles. Findings were synthesised using a meta-ethnographic approach. Forty-two articles were eligible for inclusion. Synthesis resulted in the development of five overarching themes: personal understandings of diabetic foot ulceration; preventing diabetic foot ulceration: knowledge, attitudes, and behaviours; views on health care experiences; development of diabetic foot ulceration and actions taken; and wide-ranging impacts of diabetic foot ulceration. The findings highlight various barriers and facilitators of foot care experienced by people with diabetes and demonstrate the significant consequences of ulcers for their physical, social, and psychological well-being. The insights provided could inform the development of interventions to promote foot care effectively and provide appropriate support to those living with ulceration.

Beyond dichotomous thinking: a process perspective on diabetic foot disease

Background: Diabetic foot (DF) disease causes severe suffering around the world, and appropriate self-care activities are needed to prevent and treat this condition. However, all too often, self-care activities are less than optimal and clinicians find themselves unable to influence them in a positive direction. Clinicians' and researchers' mental models of the DF tend to be dichotomous: either the patient has or does not have an active ulcer or other DF disease. This mode of thinking hides the long-term perspective of DF disease, where patients' previous experiences and expectations for the future influence their current behavior. Thus, there is a need for a different perspective on DF disease to better understand patients' perspectives and thereby improve self-care, leading to more effective prevention and treatment. Objective: To present a novel framework, the process perspective on the DF, which can explain inadequate self-care behaviors not easily understood with a dichotomous perspective, and how they can be changed. Results: Three fictive clinical examples are used to illustrate how the process perspective on the DF can be used to understand how patients' previous experiences and expectations for the future influence their current behavior. In particular, this process perspective is used to understand how patients' beliefs and behaviors are sometimes self-reinforcing, resulting in stable behavior patterns, here referred to as 'DF cycles'. These cycles are quite common in clinical practice but are difficult to analyze using a dichotomous perspective on DF disease. The process perspective on the DF is used to analyze specific 'vicious' DF cycles of inadequate patient behavior and to find ways to transform them into 'virtuous' DF cycles, resulting in effective prevention and treatment. Conclusions: The process perspective on the DF seems suitable for understanding inadequate patient behaviors not easily understood with a dichotomous perspective on DF disease, opening up new avenues for clinical practice and research to help patients live a life with long remission phases, few relapses, and a high quality of life.

Working with interpreters: practical advice for use of an interpreter in healthcare

The aim of this descriptive commentary is to improve communication in healthcare when an interpreter is used by providing practical advice to healthcare staff when they consider using interpreters. This descriptive commentary considered the issues of preparation and implementation of interpretation sessions to reveal the complexities and dilemmas of an effective healthcare encounter with interpreters. Using the design of a discursive paper, this article seeks to explore and position of what is published in the literature on the topic studied and on the basis of previous studies to provide practical advice on the use of interpreters. The descriptive commentary showed that the interpreter should be used not only as a communication aid but also as a practical and informative guide in the healthcare system. In preparing the interpretation session, it is important to consider the type (trained professional interpreter, family member or bilingual healthcare staff as interpreters) and mode (face to face and telephone) of interpreting. Furthermore, it is important to consider the interpreter's ethnic origin, religious background, gender, language or dialect, social group, clothes, appearance and attitude. During the healthcare encounter, the interpreter should follow the recommendations given in guidelines for interpreters. Healthcare staff should choose an appropriate room and be aware of their own behaviour, appearance and attitude during the healthcare encounter. Good planning is needed, with carefully considered choices concerning the right kind of interpreter, mode of interpretation and individual preferences for the interpretation in order to deliver high-quality and cost-effective healthcare. Depending on the nature of the healthcare encounter, healthcare staff need to plan interpreting carefully and in accordance with the individuals' desires and choose the type of interpreter and mode of interpreting that best suits the need in the actual healthcare situation in order to deliver high-quality healthcare.

The influence of beliefs about health and illness on foot care in ugandan persons with diabetic foot ulcers

Diabetes mellitus is becoming pandemic, particularly affecting Sub-Saharan Africa, and the prevalence of complications is increasing. Diabetic foot disorders are a major source of morbidity and disability. Delay in the health care process due to patients' beliefs may have deleterious consequences for limb and life in persons with diabetic foot ulcers. No previous studies of beliefs about health and illness in persons with diabetic foot ulcers living in Africa have been found. The aim of the study was to explore beliefs about health and illness among Ugandans with diabetic foot ulcers that might affect self-care and care seeking behaviour. In an explorative study with consecutive sample semi-structured interviews were held with 14 Ugandan men and women, aged 40-79, with diabetic foot ulcer. Knowledge was limited about causes, management and prevention of diabetic foot ulcers. Foot ulcers were often detected as painful sores, perceived to heal or improve, and led to stress and social isolation due to smell and reduced mobility. Most lacked awareness of the importance of complete daily foot care and seldom practised self-care. Health was described as absence of disease and pain. Many feared future health and related it to contact with nurses in the professional sector from whom they sought information, blood tests and wound dressings and desired better organised diabetes clinics offering health education and more opening hours. Many have an underutilised potential for self-care and need education urgently, delivered in well-organised diabetes clinics working to raise awareness of the threat and prevent foot ulcers.

Gestational diabetes: prospective interview-study of the developing beliefs about health, illness and health care in migrant women

AIMS AND OBJECTIVES

To explore the development over time of beliefs about health, illness and health care in migrant women with gestational diabetes mellitus born in the Middle East and living in Sweden and to study the influence on self-care and care seeking.

BACKGROUND

With today's extensive global migration, contact with the new society/health care confronts the migrant's culture of origin with the culture of the host country. The question is whether immigrants' patterns of beliefs about health, illness and health-related behaviour change over time, as no previous studies have been found on this topic.

DESIGN

A qualitative prospective exploratory study.

METHODS

Semi-structured interviews, with 14 women (28-44 years), on three occasions: during pregnancy in gestational weeks 34-38 and three and 14 months after delivery.

RESULTS

  There was a U-shaped development of beliefs, from focusing on worries about the baby's health during pregnancy and trying to comply with advice from health professionals, particularly a healthy diet, through regression to dietary habits (more sugar, less fibre) and lifestyle held before being diagnosed with gestational diabetes mellitus three months after delivery, back to a healthy diet/lifestyle and worries 14 months after delivery but then focusing on their own risk, as mothers, of developing type 2 diabetes and being unable to care for the child. Over time, the number of persons perceiving gestational diabetes mellitus as a transient condition decreased. Respondents lacked information about gestational diabetes mellitus, diet and follow-ups.

CONCLUSION

Beliefs changed over time and influenced health-related behaviour. Beliefs about the seriousness of gestational diabetes mellitus among healthcare staff/care organisation influence the development of patients' beliefs and need to be considered in planning care.

RELEVANCE TO CLINICAL PRACTICE

Pregnancy should be used as an opportunity to provide complete information about gestational diabetes mellitus and future health risks. This should continue after delivery and wishes for regular follow-ups should be met.

Beliefs about health and illness: a comparison between Ugandan men and women living with diabetes mellitus

BACKGROUND

The diabetes mellitus (DM) pandemic greatly affects developing countries. Self-care is an important part of management, guided by beliefs about health and illness. Dissimilarities in health-related behaviour in men and women have been described but not comparisons of their beliefs about health and illness.

AIM

To explore beliefs about health and illness that might affect self-care practice and healthcare-seeking behaviour in men and women with DM in Uganda.

METHODS

This was an exploratory study with a consecutive sample from an outpatient diabetes clinic at a university hospital. Semi-structured interviews were conducted with 15 women and 10 men aged 21-70 years. Data analysis was conducted by qualitative content analysis.

FINDINGS

Men's and women's beliefs about health and illness indicated limited knowledge about the body and DM. Dissimilar were men's focus on socio-economic factors, particularly affordability of drugs, sexual function and lifestyle, while women valued well-being, support in daily life and household activities and had a higher risk-awareness of DM. Irrespective of gender, limited self-care measures were used, and health professionals were consulted about health problems.

CONCLUSION

Similarities and dissimilarities were found between men and women in beliefs about health and illness that affect self-care practice and healthcare seeking. Underlying living conditions, with different gender roles, appear to determine the beliefs about health and illness, which are based on individual knowledge. Measures to increase knowledge about DM are urgently needed in Uganda. In diabetes care, it is important to search for individual beliefs and consider gender and living conditions.

Validity and reliability study of the Turkish version of Health Belief Model Scale in diabetic patients

BACKGROUND

Diabetes mellitus (DM) is an important health problem that leads to severe complications, is the cause of early death, and is showing an increase in frequency. The development of positive health behaviors is extremely important in the treatment of diabetic patients. There are various models that examine the health behaviors of individuals. One of these is the Health Belief Model. This model is very beneficial in explaining factors that affect patients' compliance with their disease.

PURPOSE

This research was planned to measure the validity and reliability of the Health Belief Model Scale in diabetic patients in the Turkish population.

DESIGN

Questionnaire Survey.

SETTINGS

The research population was all of the diabetic patients (4,125) registered with the Turkish Diabetes Society, Denizli Province, Turkey.

PARTICIPANTS

A convenience sample was composed of 352 patients with Type 2 DM.

METHODS

The research data were collected with three tools, a "sociodemographic data form" related to the diabetic patients, the "Health Belief Model Scale in Diabetic Patients," and the "Diabetes Management Self-Efficacy Scale."For validity studies: language validity, content validity, concurrent validity and construct validity were examined. For reliability studies: the tool's internal consistency reliability, Cronbach alpha reliability coefficient, test-retest reliability were examined.

RESULTS

The tool's internal consistency reliability subscales' Cronbach alpha coefficient values ranged from 0.73 to 0.86. For the total tool a Cronbach alpha value of 0.89 was found. In the tool's internal consistency reliability total item correlation the three items that were below 0.30 were removed and the 36 items were reduced to 33 items. The tool's test-retest reliability was 0.90. According to factor analysis the tool contains five subscales of perceived susceptibility, perceived severity, perceived benefits, perceived barriers and recommended healthy behaviors.

CONCLUSION

The Health Belief Model Scale in diabetic patients was determined to be valid and reliable for use in the Turkish population.

Management of gestational diabetes from the patient's perspective ? a comparison of Swedish and Middle-Eastern born women

AIM

To explore patients' evaluation of a specialized diabetes clinic for management of women with gestational diabetes born in Sweden and the Middle East and its contribution to a decreased level of stress and improved coping capability to promote health in patients receiving care.

BACKGROUND

No studies comparing patients' perceptions of healthcare in women of different origin with gestational diabetes have been found. A perceived clinical problem in specialized diabetes care is of lower activity level in self-care in foreign- than Swedish-born women and the question is whether the healthcare organization is optimal in meeting different individuals' needs.

DESIGN

Explorative study.

METHOD

Semi-structured individual interviews by external evaluators.

PARTICIPANTS

Consecutive sample. Females with gestational diabetes, 13 born in Sweden and 14 born in the Middle East.

RESULTS

The healthcare model was perceived as functioning well. Swedish women were problem focused and information seeking. Frustration and stress were increased due to perceived delay in information concerning gestational diabetes, limited access to telephone service and lack of confidence in staff because they lacked the expected competence. Control of gestational diabetes and pregnancy by different persons led to perceived lack of holistic care. Women from the Middle East felt cared, had been given the necessary information and claimed to follow advice. Adequate information reduced respondents' anxiety and increased their control over the situation.

CONCLUSIONS

The clinic needs to be further improved by adapting programmes to persons to become problem focused by giving adequate information immediately.

RELEVANCE TO CLINICAL PRACTICE

Cultural differences in coping strategies and attitudes to gestational diabetes need to be considered. Training of staff working with gestational diabetes patients is urgently needed.