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Thiagesan R, Gopichandran V, Soundari H, Kosalram K. Lived experiences of diabetes self-management among persons with disabilities in rural Tamil Nadu - a case study approach. BMC PRIMARY CARE 2024; 25:342. [PMID: 39289601 PMCID: PMC11409530 DOI: 10.1186/s12875-024-02581-4] [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: 04/11/2024] [Accepted: 08/21/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND People with disabilities have numerous challenges in diabetes self-management. Poor self-management leads to the worsening of disability and secondary complications of diabetes. This study was conducted to explore the challenges in diabetes self-management and the factors influencing diabetes self-management among people with disabilities. METHODS We conducted 16 case studies among people with physical, neurological, visual, hearing, and multiple disabilities who were affected by diabetes. We adopted a thematic content analysis approach to analyse the data. RESULTS People with disabilities have challenges in adopting healthy diets as they are unable to purchase and consume fruits and vegetables which are costly, unavailable, and inaccessible. They have difficulty in doing physical activity due to lack of inclusive public spaces which are inaccessible, lack of motivation, and dependence on others for their mobility. Irregular drug supply in the public health system and unaffordable cost of drugs hamper adherence to medications. Laboratories are inaccessible to people with disabilities thus preventing monitoring of blood sugars. They have poor quality of life, life with pain and mental health issues, which prevent adoption of self-management behaviors. The intersectionality of age and gender with disability worsens self-management behaviors. Inaccessible health system, poor quality of health care and insensitive health care providers further complicate self-management. CONCLUSION This study documents the challenges faced by persons with disabilities in practicing diabetes self management. There is a need for public health policy and planning that is inclusive of persons with disabilities to make access to diabetes care universal.
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Affiliation(s)
- Rajeswaran Thiagesan
- Centre for Applied Research, The Gandhigram Rural Institute - Deemed to be University, Gandhigram, Dindigul, Tamil Nadu, 624302, India
| | - Vijayaprasad Gopichandran
- Independent Community Health Consultant, Freelance, 24 Jaishankar Street, West Mambalam, Chennai, 600033, India.
| | - Hilaria Soundari
- Centre for Applied Research, The Gandhigram Rural Institute - Deemed to be University, Gandhigram, Dindigul, Tamil Nadu, 624302, India
| | - Kalpana Kosalram
- School of Public Health, SRM Medical College & Hospital, SRM Institute of Science and Technology, SRM Nagar, Potheri, Chengalpattu, 603203, India
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Ma D, Zhou J, Zuo M. Information Seeking and Receiving of Older Adults with Diabetes in the Online Health Community: An Information Need Contextualization Perspective. HEALTH COMMUNICATION 2024:1-12. [PMID: 38736037 DOI: 10.1080/10410236.2024.2349314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Online health communities (OHCs) are important online health communication channels for older adults with diabetes to access health information. When seeking health information, they often disclose a variety of contextual information (e.g., socio-economic situations) in their questions. Selective contextual information disclosure is a type of communication strategy for users in OHCs to elicit replies from others. In this study, we adopted text analysis to investigate what contextual information older adults with diabetes disclose to articulate their information needs and used the fixed-effect Poisson model to examine the relationships between different types of contextual information disclosure and informational support receipt. Our analyses were based on a dataset of 4,505 questions and corresponding replies from an online diabetes community. The results showed that cognitive information is the most frequently disclosed contextual information, while older adults tend to disclose demographic information in their questions less. Providing demographic and situational details in questions can enhance informational support receiving, resulting in an increased number of informational supports. However, disclosing cognitive, affective, informational channels, or support information does not significantly affect the informational support receiving. These findings can contribute to extending our existing understanding of information seekers' communication strategies in OHCs.
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Affiliation(s)
- Dan Ma
- School of Management Science and Engineering, Southwestern University of Finance and Economics
- Research Institute of Smart Senior Care, School of Information, Renmin University of China
| | - Jilei Zhou
- Research Institute of Smart Senior Care, School of Information, Renmin University of China
| | - Meiyun Zuo
- Research Institute of Smart Senior Care, School of Information, Renmin University of China
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Untari EK, Andayani TM, Yasin NM, Asdie RH. A Review of Patient's Knowledge and Practice of Diabetic Foot Self-Care. Malays J Med Sci 2024; 31:33-50. [PMID: 38456109 PMCID: PMC10917598 DOI: 10.21315/mjms2024.31.1.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 05/04/2023] [Indexed: 03/09/2024] Open
Abstract
Since diabetic foot ulcers (DFUs) are common among diabetes patients, it is essential to increase patients' knowledge and self-care practices to ensure early recognition and management and reduce amputation risk. Therefore, the goal of this review was to identify the range and level of knowledge of people with DFUs and the type of self-care they undertake. A literature review was conducted using the electronic databases PubMed and Google scholar with 'diabetic foot', 'self-care', 'practice' and 'behaviour' as searching keywords. The identification and selection process were conducted to sort the eligible papers through the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The criteria are the original papers describing knowledge and practice in DFU; reporting knowledge and practice in their non-intervention studies; writing in English language; and publishing between years 2016 and 2022. The eligible papers were assessed using the strength of reporting observational studies in epidemiology (STROBE) checklist for appraising their quality. Twenty-two papers of 2,073 titles met the inclusion criteria and included in the review. The lowest and the highest quality score of included papers based on STROBE checklist are 11 and 26, respectively. The included papers showed various levels of knowledge from good to poor, which prominent the highest percentage are 88% (good knowledge) and 84.8% (poor knowledge). The majority of the foot-care activities found in the reviewed papers involved the following steps: washing, drying, applying moisturiser and trimming nails routinely. Those activity should be followed by checking the feet with a mirror for ulcers, looking for ingrown nails, choosing appropriate footwear, not walking barefoot and routinely consulting a healthcare provider. The knowledge levels were found variable and acceptable. Daily foot care, choosing the right footwear, foot activity and regular health checks should all be used to manage diabetes.
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Affiliation(s)
- Eka Kartika Untari
- Doctoral Graduate Program, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Pharmacy Department, Medical Faculty of Tanjungpura University, Pontianak, Indonesia
| | - Tri Murti Andayani
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | - Rizka Humardewayanti Asdie
- Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada - Dr. Sardjito General Hospital, Yogyakarta, Indonesia
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Wu S, Wang L, He Y, Shi F, Zhuang H, Mei L, Qian Y. Effects of different mind-body exercises on glucose and lipid metabolism in patients with type 2 diabetes: A network meta-analysis. Complement Ther Clin Pract 2023; 53:101802. [PMID: 37769432 DOI: 10.1016/j.ctcp.2023.101802] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/10/2023] [Accepted: 09/22/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND This study aims to compare the relative effectiveness of different forms of mind-body exercise in improving glycolipid metabolism in patients with T2DM using a network meta-analysis. METHODS The relevant literature was systematically searched in Cochrane Library, Embase, PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang database and VIP Chinese Science. A network meta-analysis was conducted using a random-effects model within a frequentist framework. RESULTS A total of 52 studies with 6 modalities of mind-body exercise involving 4024 patients were included. Compared with controls, all exercise modalities except Yijinjing significantly improved patients' fasting blood glucose (MDs ranged from -0.72(95% CI: -1.20,-0.25) in dance to -2.06(95% CI: -2.59,-1.54) in yoga), glycated hemoglobin (MDs ranged from -0.62 (95% CI: -0.96) in taijiquan to -0.27,-0.27) in Pilates to -1.18(95% CI: 1.80,-0.57)), total cholesterol (MDs ranged from -0.73(95% CI: -1.29,-0.17) in Pilates to -0.41(95% CI: -0.62,-0.19) in Tai Chi), triglycerides (MDs ranged from -0.56 in Pilates (95% CI: -1.07,-0.04) for Pilates to -0.38 (95% CI: -0.67,-0.10)) for dance; only Tai Chi Chuan (MD:0.12 95% CI:0.04,0.20) and Baduanjin (MD:0.14 95% CI:0.06,0.22) significantly increased high-density lipoprotein cholesterol levels in patients; only yoga(MD: 0.78 95%CI: 1.20,-0.37) and Tai Chi Chuan(MD: 0.32 95%CI: 0.60,-0.04) significantly decreased high-density lipoprotein cholesterol levels in patients. CONCLUSION All mind-body exercises help to improve blood glucose and lipid levels in T2DM patients, but the ranking of relative effectiveness needs to be rationalized. Our study suggests that T2DM patients should choose appropriate mind-body exercises according to their conditions and stick to them for a long time under their healthcare professionals' guidance to achieve effective diabetes control.
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Affiliation(s)
- Sijun Wu
- School of Physical Education, Wuhan University of Technology, Wuhan, 430070, China.
| | - Lin Wang
- School of Physical Education, Wuhan University of Technology, Wuhan, 430070, China.
| | - Yuxuan He
- School of Physical Education, Wuhan University of Technology, Wuhan, 430070, China.
| | - Fengrui Shi
- School of Physical Education, Wuhan University of Technology, Wuhan, 430070, China.
| | - Huiqi Zhuang
- School of Physical Education, Wuhan University of Technology, Wuhan, 430070, China.
| | - Linqi Mei
- School of Physical Education, Hubei University, Wuhan, 430062, China.
| | - Youling Qian
- School of Physical Education, Hubei Minzu University, Enshi, 445000, China.
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Ahmad F, Joshi SH. Self-Care Practices and Their Role in the Control of Diabetes: A Narrative Review. Cureus 2023; 15:e41409. [PMID: 37546053 PMCID: PMC10402910 DOI: 10.7759/cureus.41409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 07/05/2023] [Indexed: 08/08/2023] Open
Abstract
Diabetes mellitus (DM) is a long-standing, continuously growing metabolic ailment in which levels of glucose in the blood increase due to a total (DM of type 1) or incomplete (DM of type 2) decrease in the level of the hormone insulin. Diabetes mellitus affects a large number of individuals worldwide, and as more people develop the disease, the burden will double from what it is now. The requirements of people suffering from diabetes are not only confined to the control of blood glucose; there is also a need to prevent disabilities, side effects, and difficulties in rehabilitation. Studies suggest that seven self-care practices for individuals suffering from this disease have shown good outcomes. Those practices include assessment of sugar levels in the blood, consuming healthy foods, remaining physically active, taking medications regularly and on time, maintaining healthy behavior, and decreasing risk factors. All of these practices collectively have shown good results in maintaining blood glucose levels, decreasing side effects, and increasing life expectancy in people with diabetes mellitus. Those who have DM and practice self-care have shown positive results by reducing the complications of DM, decreasing its progression, and leading to a huge reduction in the burden due to DM. Despite these positive changes, people sticking to these self-care practices are very few, specifically when we see broad and chronic changes. There are many positive contributing factors, such as social factors, demographic factors, and various socio-economic factors, but the role of physicians in increasing the practices associated with personal care for people with this disease is crucial and most important for the desired outcome. Keeping in mind the burden and multidimensional nature of the disorder, proper systematic and combined efforts are needed to increase these self-care practices in patients with diabetes to reduce any chronic side effects and complications.
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Affiliation(s)
- Farhan Ahmad
- Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shiv H Joshi
- Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Visscher BB, Heerdink ER, Rademakers J. Usability of an animated diabetes information tool for patients with different health literacy levels: a qualitative study. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2023; 31:46-54. [PMID: 36472953 DOI: 10.1093/ijpp/riac098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Most currently available medication self-management support tools do not meet the needs of patients with limited health literacy. Recently, tools that are better tailored to the needs of patients with limited health literacy have been developed. This study aimed to assess the usability of an animated diabetes information tool by patients with diabetes with limited and adequate health literacy levels. METHODS Participants with limited and adequate health literacy levels were selected based on three health literacy questions in a screening interview, and asked to use the tool three times a week, after which individual semistructured interviews were conducted. The interview topics were based on the technology acceptance model (i.e. perceived ease of use, perceived usefulness, and intention to use). Twenty-five patients with diabetes were included in the study. KEY FINDINGS All participants perceived the tool as easy to use due to a clear overview of topics and only personalized information being provided. Those with limited health literacy indicated that they had learned from the tool and had the intention to continue using it in the future. These participants also expressed the need for the tool to be more actively offered by healthcare professionals, while participants with adequate health literacy expressed the need for more in-depth information. CONCLUSION The tailored self-management support tool was perceived as usable by all participants. To better serve them, the tool could be further improved by addressing the additional needs of people with limited as well as adequate health literacy.
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Affiliation(s)
| | - Eibert R Heerdink
- University of Applied Sciences Utrecht, Utrecht, The Netherlands.,Division Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Jany Rademakers
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.,CAPHRI (Care and Public Health Research Institute), Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
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Kamarli Altun H, Özyildirim C, Koç Ş, Aksoy HN, Sağir B, Bozkurt MS, Karasu H. The factors associated with orthorexia nervosa in type 2 diabetes and their effect on diabetes self-management scores. Eat Weight Disord 2023; 28:22. [PMID: 36809582 PMCID: PMC9944002 DOI: 10.1007/s40519-023-01552-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 02/10/2023] [Indexed: 02/23/2023] Open
Abstract
PURPOSE This study aimed to determine the factors affecting the ORTO-R scores in individuals with T2DM and to investigate their effect on diabetes self-management. METHODS The study included 373 individuals with type 2 diabetes between the ages of 18-65 who applied to Akdeniz University Hospital Endocrinology and Metabolic Diseases Polyclinic between January and May 2022. A questionnaire including sociodemographic data, information about diabetes, and nutritional habits, and the ORTO-R and Type 2 Diabetes Self-Management Scales were used to collect data. Linear regression analysis was performed to determine the factors affecting ORTO-R. RESULTS The linear regression analysis showed that age, gender, education level, and duration of diabetes affected ORTO-R scores in patients with type 2 diabetes. Body mass index, comorbidities (cardiovascular diseases, kidney diseases and hypertension), diabetes-related complications, diabetes treatment method and dieting had no significant contribution to the model (p > 0.05). We also found that education level, comorbidities, diabetes-related complications, diabetes treatment method, dieting, and BMI can affect diabetes self-management. CONCLUSION It should be kept in mind that type 2 diabetes are at risk of orthorexia nervosa (ON) in terms of various aspects such as age, gender, education level and duration of diabetes. Since the factors affecting the risk of ON and the factors affecting diabetes self-management are intertwined, orthorexic tendencies should be kept under control while trying to increase self-management in these patients. In this respect, developing individual recommendations according to the psychosocial characteristics of patients may be an effective approach. LEVEL OF EVIDENCE Level V, cross-sectional study.
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Affiliation(s)
- Hülya Kamarli Altun
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Akdeniz University, Dumlupinar Boulevard, Campus, 07058, Antalya, Türkiye
| | - Caner Özyildirim
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Akdeniz University, Dumlupinar Boulevard, Campus, 07058, Antalya, Türkiye.
| | - Şeyma Koç
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Akdeniz University, Dumlupinar Boulevard, Campus, 07058, Antalya, Türkiye
| | - Hatice Nur Aksoy
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Akdeniz University, Dumlupinar Boulevard, Campus, 07058, Antalya, Türkiye
| | - Beyza Sağir
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Akdeniz University, Dumlupinar Boulevard, Campus, 07058, Antalya, Türkiye
| | - Merve Sefa Bozkurt
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Akdeniz University, Dumlupinar Boulevard, Campus, 07058, Antalya, Türkiye
| | - Hakan Karasu
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Akdeniz University, Dumlupinar Boulevard, Campus, 07058, Antalya, Türkiye
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Paudel G, Vandelanotte C, Dahal PK, Biswas T, Yadav UN, Sugishita T, Rawal L. Self-care behaviours among people with type 2 diabetes mellitus in South Asia: A systematic review and meta-analysis. J Glob Health 2022; 12:04056. [PMID: 35916498 PMCID: PMC9346342 DOI: 10.7189/jogh.12.04056] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background The burden of Type 2 Diabetes Mellitus (T2DM) in South Asian countries is increasing rapidly. Self-care behaviour plays a vital role in managing T2DM and preventing complications. Research on self-care behaviours among people with T2DM has been widely conducted in South Asian countries, but there are no systematic reviews that assess self-care behaviour among people with T2DM in South Asia. This study systematically assessed the studies reporting self-care behaviours among people with T2DM in South-Asia. Methods Adhering to the PRISMA guidelines, we searched six bibliographic databases (Scopus, PubMed, CINAHL, Embase, Web of Science, and PsychInfo) to identify the relevant articles published between January 2000 through March 2022. Eligibility criteria included all observational and cross-sectional studies reporting on the prevalence of self-care behaviours (ie, diet, physical activity, medication adherence, blood glucose monitoring, and foot care) conducted in South Asian countries among people with T2DM. Results The database search returned 1567 articles. After deduplication (n = 758) and review of full-text articles (n = 192), 92 studies met inclusion criteria and were included. Forward and backward reference checks were performed on included studies, which resulted in an additional 18 articles. The pooled prevalence of adherence to blood glucose monitoring was 65% (95% CI = 49-80); 64% for medication adherence (95% CI = 53-74); 53% for physical activity (95% CI = 39-66); 48% for diet (95% CI = 38-58); 42% for foot care (95% CI = 30-54). About a quarter of people with T2DM consumed alcohol (25.2%, IQR = 13.8%-38.1%) and were using tobacco products (18.6%, IQR = 10.6%-23.8%). Conclusions Our findings suggest that the prevalence of self-care behaviours among people with T2DM in South Asia is low. This shows an urgent need to thoroughly investigate the barriers to the practising of self-care and design and implement interventions to improve diabetes self-care behaviour among people with T2DM in South Asia.
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Affiliation(s)
- Grish Paudel
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney, Australia
| | - Corneel Vandelanotte
- Appleton Institute, Physical Activity Research Group, Central Queensland University, Rockhampton, Australia
| | - Padam K Dahal
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney, Australia
| | - Tuhin Biswas
- The Australian Research Council Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Queensland, Australia
| | - Uday N Yadav
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia.,Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Tomohiko Sugishita
- Section of Global Health, Division of Public Health, Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan
| | - Lal Rawal
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney, Australia.,Appleton Institute, Physical Activity Research Group, Central Queensland University, Rockhampton, Australia.,Translational Health Research Institute (THRI), Western Sydney University, Sydney Australia
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Socio-cognitive determinants affecting insulin adherence/non-adherence in late adolescents and young adults with type 1 diabetes: a systematic review protocol. J Diabetes Metab Disord 2022; 21:1207-1215. [PMID: 35673417 PMCID: PMC9167269 DOI: 10.1007/s40200-022-01054-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 05/09/2022] [Indexed: 11/04/2022]
Abstract
Objective This systematic review aims to investigate the key socio-cognitive determinants associated with adherence/non-adherence to insulin treatment in late adolescents and young adults in the age range of 17–24 years with T1D. Methods A pre-specified search strategy will be used to search for studies in the electronic databases and citation indexes: PubMed, EMBASE, Web of Science, and PsycINFO. Two researchers will screen the title and the abstract independently, then will read and critically appraise the full text of each included study. A third independent reviewer will resolve disagreements in data extraction until consensus. Data will be extracted using the Population, Exposure, Outcomes, Study characteristics framework. Study selection will follow the updated guideline for reporting systematic reviews (PRISMA 2020) and will take place from 15 October 2021 to 1 January 2022. The methodological quality and risk of bias of the observational studies will be assessed by the JBI Critical Appraisal Checklist for Cohort and JBI Critical Appraisal Checklist for Analytical Cross Sectional Studies. Results A qualitative narrative synthesis will present the characteristics and the quality of studies and the outcomes of concern. Conclusion Based on the contemporary literature, this review will synthesize the evidence on the socio-cognitive determinants associated with adherence/non-adherence to insulin treatment in late adolescents and young adults in the age range of 17–24 years with T1D. The findings will help design patient-centered interventions to promote adherence to insulin in this age group, guide patients’ consultations and diabetes self-management education (DSME) programs. Protocol registration: PROSPERO ID: CRD42021233074.
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Assessing predictors of self-management intentions in people with type 2 diabetes. BMC Health Serv Res 2022; 22:370. [PMID: 35313871 PMCID: PMC8935112 DOI: 10.1186/s12913-022-07731-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 02/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background Type 2 diabetes mellitus (T2D) is slowly turning into an international health emergency, evidenced by accelerated growth in prevalence rates worldwide. Experts have now called for greater integration of self-management interventions in clinical practice in light of these worrisome trends, supplanting the prevailing notion of a “glucocentric” approach. In this pilot study designed to complement a novel assessment program currently in development, we describe a concise screening tool designed to stratify the intention to follow through on self-management practices in people with T2D. Methods A cross-sectional survey was conducted at 3 regional primary care clinics. Individuals with T2D having the following characteristics were recruited into the study: (i) individuals with T2D between 18 and 65 years, (ii) fluent in English and, and iii) having been diagnosed with T2D for at least 2 years. We assessed the relevance of components in the Theory of Planned Behaviour (TPB) within the context of self-management behaviour in T2D. Participants were requested to complete a questionnaire containing questions related to intention, attitudes subjective norm and perceived behavioural control. Based on their responses, the psychometric properties of the scale were then evaluated using both reliability and validity analysis. Results The Cronbach α value for all direct measures of TPB was excellent: intention to adhere to self-management practices (0.98), attitude towards self-management behaviour (0.87), subjective norm (0.83), and perceived behaviour control (0.66). The correlation between intentions and all 3 constructs of TPB was excellent (p < 0.01). Structural equation modeling helped determine attitudes and subjective norms as important predictors of intentions to follow through self-management practices. Conclusions By first understanding the dimensions that influence intentions associated with self-management behaviour, clinicians have the opportunity to “triage” individuals with T2D who require greater involvement to bring about better self-care practices. Thus, our research attempts to bridge this gap by devising a psychometric tool suited to a regional setting which allows for an improved person-centered communication between clinicians and patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07731-x.
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Schmitt A, Kulzer B, Ehrmann D, Haak T, Hermanns N. A Self-Report Measure of Diabetes Self-Management for Type 1 and Type 2 Diabetes: The Diabetes Self-Management Questionnaire-Revised (DSMQ-R) – Clinimetric Evidence From Five Studies. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 2:823046. [PMID: 36994332 PMCID: PMC10012087 DOI: 10.3389/fcdhc.2021.823046] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 12/17/2021] [Indexed: 11/13/2022]
Abstract
AimsMeasurement tools to evaluate self-management behavior are useful for diabetes research and clinical practice. The Diabetes Self-Management Questionnaire (DSMQ) was introduced in 2013 and has become a widely used tool. This article presents a revised and updated version, DSMQ-R, and evaluates its properties in assessing self-management practices in type 1 diabetes (T1D) and type 2 diabetes (T2D).MethodsThe DSMQ-R is a multidimensional questionnaire with 27 items regarding essential self-management practices for T1D and T2D (including diabetes-adjusted eating, glucose testing/monitoring, medication taking, physical activity and cooperation with the diabetes team). For the revised form, the original items were partially amended and the wording was updated; eleven items were newly added. The tool was applied as part of health-related surveys in five clinical studies (two cross-sectional, three prospective) including a total of 1,447 people with T1D and T2D. Using this data base, clinimetric properties were rigorously tested.ResultsThe analyses showed high internal and retest reliability coefficients for the total scale and moderate to high coefficients for the subscales. Reliability coefficients for scales including the new items were consistently higher. Correlations with convergent criteria and related variables supported validity. Responsiveness was supported by significant short to medium term changes in prospective studies. Significant associations with glycemic outcomes were observed for DSMQ-R-assessed medication taking, glucose monitoring and eating behaviors.ConclusionsThe results support good clinimetric properties of the DSMQ-R. The tool can be useful for research and clinical practice and may facilitate the identification of improvable self-management practices in individuals.
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Affiliation(s)
- Andreas Schmitt
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Diabetes Center Mergentheim (DZM), Bad Mergentheim, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- *Correspondence: Andreas Schmitt,
| | - Bernhard Kulzer
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Diabetes Center Mergentheim (DZM), Bad Mergentheim, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
| | - Dominic Ehrmann
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Diabetes Center Mergentheim (DZM), Bad Mergentheim, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
| | - Thomas Haak
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Diabetes Center Mergentheim (DZM), Bad Mergentheim, Germany
| | - Norbert Hermanns
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Diabetes Center Mergentheim (DZM), Bad Mergentheim, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
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Syed W, Menaka M, Parimalakrishnan S, Yamasani VV. A study on diabetes-related self-care plan and its determinants among diabetes patients in a Warangal region, Telangana, India. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902022e21266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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13
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McHugh S, O'Neill K, Kearney PM. Timely testing: who needs to do what differently to improve adherence to guideline-recommended glycaemic monitoring? BMJ Qual Saf 2021; 30:694-696. [PMID: 33863838 DOI: 10.1136/bmjqs-2021-013082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 12/21/2022]
Affiliation(s)
- Sheena McHugh
- School of Public Health, University College Cork, Cork, Ireland
| | - Kate O'Neill
- School of Public Health, University College Cork, Cork, Ireland
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Wibisono AH, Kurniasih D, Sumartiyah E, Putri RN, Kurnia DA, Gultom Y, Dahlia D. Developing the hypoglycemia-nursing early warning score system (Hy-NEWSS): A pilot study. J Public Health Res 2021; 10. [PMID: 33855390 PMCID: PMC8129759 DOI: 10.4081/jphr.2021.2145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/11/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Severe hypoglycemia occurs in 6% of type 2 DM patients with a 6 to 7% mortality rate. Amidst the COVID-19 pandemic, there has been a higher rate of fatality among diabetes patients, at least 22% of COVID-19 deaths in Wuhan, China. Furthermore, the condition impairs physiological defense against recurrent hypoglycemia in the future. Accordingly, the innovation in this study aims to prevent severe hypoglycemia among type 2 patients through early risk screening, the use of preventative protocols, and patient and family empowerment. This intervention bundle is called Hypoglycemia-Nursing Early Warning Score System (Hy-NEWSS). Design and Methods: The innovation was implemented in inpatient and outpatient settings, within two weeks with the following sequence: i) internal training, ii) Hy-NEWSS implementation, iii) outcomes evaluation. Results: Of the twenty-eight patients involved in the study, 3 patients (19%) had a high risk of hypoglycemia, while the remaining had a low risk for the condition. However, at the end of the study there was no event of severe hypoglycemia (0%), and only 1 event (6.33%) of mild hypoglycemia. The results also showed that the accuracy of nurses in implementing the protocols was 93% and that during the evaluation, 95.62% of the responses of the nurses from the inpatient and outpatient settings were positive. Finally, the scores of the sensitivity and specificity evaluation were 99% and 88%, respectively. Conclusion: It may be concluded from this initial study that Hy-NEWSS is effective in preventing severe hypoglycemia, accurate in identifying patient risk level for the condition, and has high applicability to be implemented in hospital settings. Significance for public health Hypoglycemia is a deteriorating problem and affects type 2 diabetes patients in both hospital and community settings. Furthermore, its incidence was reported to be significantly higher in patients undertaking insulin therapy, especially those suffering from other chronic comorbidities. Currently, there is no standardized prevention protocol for hypoglycemia. Therefore, this study describes an initial effort in developing an evidence-based intervention bundle to prevent the condition.
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Affiliation(s)
| | | | - Eti Sumartiyah
- Nursing Department, RSUPN Dr Cipto Mangunkusumo, Jakarta.
| | | | | | - Yunisar Gultom
- Nursing Department, RSUPN Dr Cipto Mangunkusumo, Jakarta.
| | - Debie Dahlia
- Faculty of Nursing, University of Indonesia, Depok.
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Benham JL, Booth JE, Dunbar MJ, Doucette S, Boulé NG, Kenny GP, Prud'homme D, Sigal RJ. Significant Dose-Response between Exercise Adherence and Hemoglobin A1c Change. Med Sci Sports Exerc 2021; 52:1960-1965. [PMID: 32175973 DOI: 10.1249/mss.0000000000002339] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The Diabetes Aerobic and Resistance Exercise trial found that aerobic training and resistance training alone each reduced hemoglobin A1c (HbA1c) compared with nonexercising controls, and combined aerobic and resistance training caused greater HbA1c reduction than either training type alone. Our objective was to determine whether a dose-response relationship existed between frequency of exercise training and HbA1c change, and whether this varied by exercise modality or participant characteristics. METHODS Post hoc analysis of data from 185 Diabetes Aerobic and Resistance Exercise trial participants with type 2 diabetes randomized to aerobic, resistance or combined training thrice weekly. Dose-response relationships between adherence (percent of prescribed training sessions completed) and HbA1c change were assessed with linear regression. RESULTS Median overall adherence was 84.9% (interquartile range, 74.4%-93.6%). Higher exercise adherence was associated with greater HbA1c reduction; a 20% increase in adherence (e.g., an additional two sessions per month) was associated with a 0.15% (2 mmol·mol) decrease in HbA1c (β = -0.0076, R = -0.170, P = 0.021). Significant dose-response relationships were identified for aerobic (β = -0.0142, R = -0.313, P = 0.016) and combined training (β = -0.0109, R = -0.259, P = 0.041), but not resistance training (β = 0.0068, R = 0.153, P = 0.233). Dose-response relationships in all training groups combined were significant in subgroups younger than 55 yr (β = -0.0113, R = -0.286, P = 0.005), males (β = -0.0123, R = -0.234, P = 0.010), and baseline HbA1c ≥7.5% (58 mmol·mol) (β = -0.013, R = -0.263, P = 0.011). CONCLUSIONS There was a dose-response relationship between adherence to prescribed exercise and HbA1c reduction suggesting that glycemic control is improved more in individuals with type 2 diabetes with a higher training volume. Dose-response relationships existed for aerobic and combined training but not resistance training. These findings support aerobic and combined exercise prescriptions outlined in clinical practice guidelines.
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Affiliation(s)
| | - Jane E Booth
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, CANADA
| | | | - Steve Doucette
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, CANADA
| | - Normand G Boulé
- Faculty of Kinesiology, Sport, and Recreation, Alberta Diabetes Institute, University of Alberta, Edmonton, AB, CANADA
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Alexandre K, Vallet F, Peytremann-Bridevaux I, Desrichard O. Identification of diabetes self-management profiles in adults: A cluster analysis using selected self-reported outcomes. PLoS One 2021; 16:e0245721. [PMID: 33481883 PMCID: PMC7822269 DOI: 10.1371/journal.pone.0245721] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 01/06/2021] [Indexed: 11/18/2022] Open
Abstract
The present study describes adult diabetes self-management (DSM) profiles using self-reported outcomes associated with the engagement in diabetes care activities and psychological adjustment to the disease. We used self-reported data from a community-based cohort of adults with diabetes (N = 316) and conducted a cluster analysis of selected self-reported DSM outcomes (i.e., DSM behaviors, self-efficacy and perceived empowerment, diabetes distress and quality of life). We tested whether clusters differed according to sociodemographic, clinical, and care delivery processes variables. Cluster analysis revealed four distinct DSM profiles that combined high/low levels of engagement in diabetes care activities and good/poor psychological adjustment to the disease. The profiles were differently associated with the variables of perceived financial insecurity, taking insulin treatment, having depression, and the congruence of the care received with the Chronic Care Model. The results could help health professionals gain a better understanding of the different realities facing people living with diabetes, identify patients at risk of poor outcomes related to their DSM, and lead to the development of profile-specific DSM interventions.
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Affiliation(s)
- Ketia Alexandre
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Fanny Vallet
- Faculté de Psychologie et des Sciences de l’Education, University of Geneva, Geneva, Switzerland
| | | | - Olivier Desrichard
- Faculté de Psychologie et des Sciences de l’Education, University of Geneva, Geneva, Switzerland
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17
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Effects of Fasting-Mimicking Diet and Specific Meal Replacement Foods on Blood Glucose Control in Patients with Type 2 Diabetes: A Randomized Controlled Trial. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:6615295. [PMID: 33376581 PMCID: PMC7744181 DOI: 10.1155/2020/6615295] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 11/16/2020] [Accepted: 11/24/2020] [Indexed: 12/12/2022]
Abstract
Type 2 diabetes represents a serious societal health problem due to the vulnerability to cardiovascular events. Diet therapy is the most basic treatment for type 2 diabetes. The present study was conducted to study the effect of a fasting-mimicking diet and specific meal replacement foods on blood glucose control in patients with type 2 diabetes. Our study included 100 patients with type 2 diabetes who underwent a physical examination which were enrolled and randomly assigned as 50 patients each to the test group (with low energy-specific meal replacement meals during a fasting-mimicking diet) and the control group (with specific meal replacement foods given normal adult doses). After 4 months, efficacy indicators which were fasting blood glucose, 2-hour postprandial venous blood glucose, and glycosylated haemoglobin of the experimental group were all lower than those of the control group (P < 0.05); observation indicators that include body mass index, waist circumference, blood lipids (triglyceride, cholesterol, and low-density lipoprotein), and blood pressure levels were all lower than the control group, and high-density lipoprotein levels were all higher than the control group (all P < 0.05). Both groups of fasting blood glucose, 2-hour postprandial venous blood glucose, and blood pressure had a relatively stable downward trend, but the experimental group had a more significant decline. In conclusion, the study revealed that a fasting-mimicking diet and specific meal replacement foods can safely and effectively reduce weight and improve metabolic syndrome in patients with type 2 diabetes.
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Bukhsh A, Goh BH, Zimbudzi E, Lo C, Zoungas S, Chan KG, Khan TM. Type 2 Diabetes Patients' Perspectives, Experiences, and Barriers Toward Diabetes-Related Self-Care: A Qualitative Study From Pakistan. Front Endocrinol (Lausanne) 2020; 11:534873. [PMID: 33329377 PMCID: PMC7729167 DOI: 10.3389/fendo.2020.534873] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 08/25/2020] [Indexed: 01/03/2023] Open
Abstract
Objective: This study aimed to qualitatively explore perspectives, practices, and barriers to self-care practices (eating habits, physical activity, self-monitoring of blood glucose, and medicine intake behavior) in urban Pakistani adults with type 2 diabetes mellitus (T2DM). Methods: Pakistani adults with T2DM were recruited from the outpatient departments of two hospitals in Lahore. Semistructured interviews were conducted and audiorecorded until thematic saturation was reached. Two researchers thematically analyzed the data independently using NVivo® software with differences resolved by a third researcher. Results: Thirty-two Pakistani adults (aged 35-75 years, 62% female) participated in the study. Six themes were identified from qualitative analysis: role of family and friends, role of doctors and healthcare, patients' understanding about diabetes, complication of diabetes and other comorbidities, burden of self care, and life circumstances. A variable experience was observed with education and healthcare. Counseling by healthcare providers, family support, and fear of diabetes-associated complications are the key enablers that encourage study participants to adhere to diabetes-related self-care practices. Major barriers to self care are financial constraints, physical limitations, extreme weather conditions, social gatherings, loving food, forgetfulness, needle phobia, and a hectic job. Conclusion: Respondents identified many barriers to diabetes self care, particularly related to life situations and diabetes knowledge. Family support and education by healthcare providers were key influencers to self-care practices among Pakistani people with diabetes.
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Affiliation(s)
- Allah Bukhsh
- School of Pharmacy, Monash University, Subang Jaya, Malaysia
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Bey-Hing Goh
- School of Pharmacy, Monash University, Subang Jaya, Malaysia
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
- Biofunctional Molecule Exploratory Research Group, School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
- Malaysia School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Edward Zimbudzi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Nephrology, Monash Health, Melbourne, VIC, Australia
| | - Clement Lo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Monash Diabetes, Monash Health, Melbourne, VIC, Australia
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Kok-Gan Chan
- Division of Genetics and Molecular Biology, Faculty of Science, Institute of Biological Sciences, University of Malaya, Kuala Lumpur, Malaysia
- Guangdong Provincial Key Laboratory of Marine Biology, Institute of Marine Sciences, Shantou University, Shantou, China
| | - Tahir Mehmood Khan
- School of Pharmacy, Monash University, Subang Jaya, Malaysia
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
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Zimbudzi E, Kerr PG. The impact of the Christmas holiday effect on interdialytic weight gain in hemodialysis patients: A multicenter observational retrospective cohort study. Hemodial Int 2020; 25:257-264. [PMID: 33145982 DOI: 10.1111/hdi.12901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/10/2020] [Accepted: 10/20/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The 3-day interdialytic interval (IDI) is associated with high interdialytic weight gain (IDWG), but little is known about the effect of public or religious holidays on IDWG. Consequently, we evaluated the impact of the "Christmas holiday effect" on IDWG of hemodialysis patients. METHODS A retrospective cohort study of adult hemodialysis patients (over 18 years) was conducted across five dialysis units in Australia. Demographic and clinical data were collected from electronic medical records. IDWG was established for three time points; regular 3-day IDI, 2-day IDI preceding the Christmas holiday and a 3-day IDI that included the Christmas holiday. Paired t-tests and logistic regression were used to compare differences in mean IDWG before and after the Christmas holiday and to examine factors associated with high IDWG, respectively. FINDINGS Two hundred and fifty-two patients, 69% of whom were male, with mean (SD) age of 65.4 ± 15.3 years, were studied. Most had end-stage kidney disease due to diabetes (44%), and they had been on hemodialysis for a median of 25.5 (IQR, 60-10) months. There was a significant increase in absolute IDWG (MD 0.21 kg, 95% CI -0.07 to 0.36; P = 0.004) and relative IDWG (MD 0.3%, 95% CI 0.10-0.40; P = 0.01) after the holiday 3-day IDI compared with the regular 3-day IDI. Older age (OR 0.12; 95% CI 0.02-0.55) and a unit increase in hemoglobin (OR 0.94; 95% CI 0.89-0.99) were associated with lower odds of high relative IDWG while speaking a language other than English increased the odds for high relative IDWG (OR 5.03; 95% CI 1.12-22.65). CONCLUSION Absolute and relative IDWG increased significantly after the Christmas holiday. Individualizing dialysis needs may improve outcomes for these patients.
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Affiliation(s)
- Edward Zimbudzi
- Department of Nephrology, Monash Health, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peter G Kerr
- Department of Nephrology, Monash Health, Melbourne, Victoria, Australia.,School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
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20
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Pavithra H, Akshaya KM, Nirgude AS, Balakrishna AG. Factors associated with awareness and practice about foot care among patients admitted with diabetes mellitus: A cross sectional research from a medical college hospital of southern India. Nepal J Epidemiol 2020; 10:897-904. [PMID: 33042593 PMCID: PMC7538014 DOI: 10.3126/nje.v10i3.29213] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 09/20/2020] [Accepted: 09/28/2020] [Indexed: 11/18/2022] Open
Abstract
Background Diabetes Mellitus (DM) causes micro and macro vascular complications. One of the complications of DM is diabetic foot that results in amputations and decreased quality of life. The aim of this study was to assess the awareness and practice about foot care and associated factors among admitted patients in a teaching hospital of coastal Karnataka, India. Material and Methods A cross-sectional study was conducted in a medical college hospital after obtaining institutional ethics approval from 24th December 2016 to 21st January 2017. Adults with diabetes (N=317) admitted in the hospital were interviewed with a validated structured questionnaire for awareness and practice regarding foot care. The scores obtained were further graded into good and poor. Data was analyzed with SPSS version 22 for descriptive statistics. Bivariate logistic and linear regressions were used to determine the association between variables and awareness/practice scores. Results Mean age of the participants was 56.98 (±10.54) years with males constituting the majority (63.4%). Good awareness and practice scores were observed among 69.1% and 41.6% participants, respectively. Good awareness scores were associated with male patients (p=0.027), currently not married (p=0.044), below poverty line socioeconomic status (p=0.014) and presence of foot ulcer (p=0.021). Good practice scores was associated with secondary schooling (p=0.003) and receiving insulin (p=0.045). Moderate correlation with coefficient 0.493 (p<0.001) was observed between awareness and practice scores. Conclusion Seven and four out of 10 study participants had good awareness and practice scores about foot care, respectively. A tailor-made health education module addressing the lacunae identified in the awareness and practice domains needs to be provided to the patients with diabetes mellitus.
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Affiliation(s)
- H Pavithra
- Department of Community Medicine, Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru, Karnataka, India, 575018
| | - Kibballi Madhukeshwar Akshaya
- Department of Community Medicine, Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru, Karnataka, India, 575018
| | - Abhay Subashrao Nirgude
- Department of Community Medicine, Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru, Karnataka, India, 575018
| | - A G Balakrishna
- Department of Community Medicine, Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru, Karnataka, India, 575018
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Christensen NI, Drejer S, Burns K, Lundstrøm SL, Hempler NF. A Qualitative Exploration of Facilitators and Barriers for Diabetes Self-Management Behaviors Among Persons with Type 2 Diabetes from a Socially Disadvantaged Area. Patient Prefer Adherence 2020; 14:569-580. [PMID: 32210542 PMCID: PMC7073429 DOI: 10.2147/ppa.s237631] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 01/30/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Enhancing diabetes self-management (DSM) in patients with type 2 diabetes (T2D) can reduce the risk of complications, enhance healthier lifestyles, and improve quality of life. Furthermore, vulnerable groups struggle more with DSM. AIM To explore barriers and facilitators related to DSM in vulnerable groups through the perspectives of patients with T2D and healthcare professionals (HCPs). METHODS Data were collected through three interactive workshops with Danish-speaking patients with T2D (n=6), Urdu-speaking patients with T2D (n=6), and HCPs (n=16) and analyzed using systematic text condensation. RESULTS The following barriers to DSM were found among members of vulnerable groups with T2D: 1) lack of access to DSM support, 2) interference and judgment from one's social environment, and 3) feeling powerless or helpless. The following factors facilitated DSM among vulnerable persons with T2D: 1) a person-centered approach, 2) peer support, and 3) practical and concrete knowledge about DSM. Several barriers and facilitators expressed by persons with T2D, particularly those who spoke Danish, were also expressed by HCPs. CONCLUSION Vulnerable patients with T2D preferred individualized and practice-based education tailored to their needs. More attention should be paid to training HCPs to handle feelings of helplessness and lack of motivation among vulnerable groups, particularly among ethnic minority patients, and to tailor care to ethnic minorities.
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Affiliation(s)
| | - Sabina Drejer
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Karin Burns
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
- Department of Endocrinology and Cardiology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Sanne Lykke Lundstrøm
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Nana Folmann Hempler
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Correspondence: Nana Folmann Hempler Tel +45 40 732 591 Email
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Swarna Nantha Y, Haque S, Paul Chelliah AA. The internal realities of individuals with type 2 diabetes - a functional framework of self-management practices via Grounded Theory approach. PLoS One 2019; 14:e0225534. [PMID: 31770421 PMCID: PMC6879143 DOI: 10.1371/journal.pone.0225534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 11/05/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND An upward trend is observed in the prevalence of Type 2 diabetes (T2D) in South-East Asian and Western Pacific regions. These patterns incur a costly health burden to developing nations around the world. A clear understanding of the mechanics behind self-management practices of T2D patients might help overcome this impasse. This information can help unlock specific problem areas that warrant specific intervention. We aim to uncover prevailing T2D self-management habits and its deviations from optimal behaviour. METHODS We adopted a Grounded Theory approach to guide in-depth interviews (IDI) with T2D patients and healthcare providers (HCP) at a regional primary care clinic in Malaysia. Twenty-four T2D patients and 10 HCPs were recruited through purposive sampling to examine their inner psychological narratives related to self-management practices. 2 focus group discussions (FGD) were conducted as a part of the data triangulation process. RESULTS A functional framework for self-management practices in T2D patients was developed. Self-management behavior was characterized by 2 major processes- 1) helpful and, 2) unhelpful practices. Self-efficacy, taking responsibility and being rational define helpful behaviour in these patients. On the other hand, unhelpful traits (neglect, poor restraint, and experimentation) often trigger violations with regards to medication compliance and therapeutic lifestyle changes. CONCLUSIONS We outlined a roadmap that navigates through the positive and negative mindset in relation to self-management practices of T2D patients. These results highlight the importance of devising individualized strategies by taking into account the personal challenges, emotions, and motivations that define the inner self of the patient.
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Affiliation(s)
- Yogarabindranath Swarna Nantha
- Primary Care Research Initiative And Methods Education Department (PRIMED), Seremban Primary Health Care Clinic, Seremban, Malaysia
- Non-Communicable Disease Department, Seremban Primary Health Care Clinic, Seremban, Malaysia
- Department of Psychology, Monash University Malaysia, Subang Jaya, Malaysia
| | - Shamsul Haque
- Department of Psychology, Monash University Malaysia, Subang Jaya, Malaysia
| | - Azriel Abisheg Paul Chelliah
- Primary Care Research Initiative And Methods Education Department (PRIMED), Seremban Primary Health Care Clinic, Seremban, Malaysia
- Non-Communicable Disease Department, Seremban Primary Health Care Clinic, Seremban, Malaysia
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Swarna Nantha Y, Haque S, Swarna Nantha H. The development of an integrated behavioural model of patient compliance with diabetes medication: a mixed-method study protocol. Fam Pract 2019; 36:581-586. [PMID: 30534941 PMCID: PMC6781935 DOI: 10.1093/fampra/cmy119] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There has been a shift in worldwide disease burden from infections to non-communicable diseases, especially type 2 diabetes (T2D). Behavioural change and self-management are key to optimal T2D control. Several universal models of diabetic care have been proposed to help explain the dimensions of T2D self-care such as medication adherence, physical activity, diet and patient-doctor interaction. These models do not allow an objective and quantifiable measurement of the problems faced by patients in terms of medication compliance. OBJECTIVE To create a comprehensive conceptual model of behavioural change related to T2D medication compliance. METHODS A cross-sectional study will be conducted at a regional primary care clinic using a mixed-method technique. First, a Grounded Theory qualitative inquiry will be used to investigate predictors of medication adherence in T2D patients. Consequently, the elements derived from the interview will be incorporated into the Theory of Planned Behaviour framework to generate an integrated behavioural model. This model will then be used to quantify the factors related to compliance with medication amongst T2D patients. DISCUSSION The framework developed here could help in the design of policies to optimize T2D control by identifying lapses in patients' intake of diabetic medications. This can be done by exploring the patients' fundamental and unarticulated belief system via a naturalistic approach adopted in this study. The properties of the framework can be replicated in other settings to serve as a benchmark for quality improvement in T2D patient care.
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Affiliation(s)
- Yogarabindranath Swarna Nantha
- Seremban Primary Health Care Clinic, Jalan Rasah, Seremban
- Non-Communicable Disease Department, Seremban Primary Health Care Clinic, Jalan Rasah, Seremban, Malaysia
| | - Shamsul Haque
- Department of Psychology, Monash University Malaysia
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Mogre V, Johnson NA, Tzelepis F, Shaw JE, Paul C. A systematic review of adherence to diabetes self‐care behaviours: Evidence from low‐ and middle‐income countries. J Adv Nurs 2019; 75:3374-3389. [DOI: 10.1111/jan.14190] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 07/20/2019] [Accepted: 08/05/2019] [Indexed: 01/15/2023]
Affiliation(s)
- Victor Mogre
- School of Medicine and Public Health University of Newcastle Callaghan New South Wales Australia
- Department of Health Professions Education School of Medicine and Health Sciences University for Development Studies Tamale Ghana
| | - Natalie A. Johnson
- School of Medicine and Public Health University of Newcastle Callaghan New South Wales Australia
- Hunter Medical Research Institute New Lambton New South Wales Australia
| | - Flora Tzelepis
- School of Medicine and Public Health University of Newcastle Callaghan New South Wales Australia
- Hunter Medical Research Institute New Lambton New South Wales Australia
- Hunter New England Population Health Hunter New England Local Health District Wallsend New South Wales Australia
| | | | - Christine Paul
- School of Medicine and Public Health University of Newcastle Callaghan New South Wales Australia
- Hunter Medical Research Institute New Lambton New South Wales Australia
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Sugiharto S, Hsu YY. The Diabetes Self-Care Calendar for people with type 2 diabetes mellitus in rural Indonesia: a pilot study. J Res Nurs 2019; 25:594-601. [PMID: 34394678 DOI: 10.1177/1744987119860550] [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] Open
Abstract
Background Diabetes self-care reminders are widely applied to improve self-care among diabetes patients. Unfortunately, there is a lack of self-care reminders for diabetes patients who live in rural areas of developing countries with limited resources. Aims The study evaluated the feasibility of the Diabetes Self-Care Calendar as a reminder tool for self-care. Methods The study was conducted in a community health centre in Pekalongan Regency, Indonesia. The Diabetes Self-Care Calendar was developed as a reminder tool following the American Association of Diabetes Educator self-care guidelines. The feasibility of the calendar was evaluated using the quality assessment questionnaire that assessed accessibility, acceptability, effectiveness, efficiency and appropriateness. The participants' qualitative feedback was organised into themes. Results A total of 10 patients with type 2 diabetes mellitus participated in the study. The quality of the calendar was evaluated in terms of accessibility (m = 9.5; range = 0 - 10), acceptability (m = 9.7; range = 0 - 10), effectiveness (m = 9.3; range = 0 - 10), efficiency (m = 9; range = 0 - 10) and appropriateness (m = 9; range = 0 - 10). The feasibility of the calendar was m = 9.3 (range = 9 to 9.7). Three themes emerged based on the participants' qualitative feedback included family involvement, calendar portability and calendar design. Conclusions The findings suggest the Diabetes Self-Care Calendar is feasible as a reminder tool for type 2 diabetes mellitus patients who live in rural areas.
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Affiliation(s)
- Sh Sugiharto
- Lecturer, Faculty of Health Sciences, Department of Nursing, University of Muhammadiyah Pekajangan Pekalongan, Indonesia
| | - Yu-Yun Hsu
- Professor, Department of Nursing, National Cheng Kung University
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Burford SJ, Park S, Dawda P. Small Data and Its Visualization for Diabetes Self-Management: Qualitative Study. JMIR Diabetes 2019; 4:e10324. [PMID: 31411137 PMCID: PMC6711032 DOI: 10.2196/10324] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 05/03/2019] [Accepted: 06/04/2019] [Indexed: 11/13/2022] Open
Abstract
Background As digital healthcare expands to include the use of mobile devices, there are opportunities to integrate these technologies into the self-management of chronic disease. Purpose built apps for diabetes self-management are plentiful and vary in functionality; they offer capability for individuals to record, manage, display, and interpret their own data. The optimal incorporation of mobile tablets into diabetes self-care is little explored in research, and guidelines for use are scant. Objective The purpose of this study was to examine an individual’s use of mobile devices and apps in the self-management of type 2 diabetes to establish the potential and value of this ubiquitous technology for chronic healthcare. Methods In a 9-month intervention, 28 patients at a large multidisciplinary healthcare center were gifted internet connected Apple iPads with preinstalled apps and given digital support to use them. They were invited to take up predefined activities, which included recording their own biometrics, monitoring their diet, and traditional online information seeking. Four online surveys captured the participants’ perceptions and health outcomes throughout the study. This article reports on the qualitative analysis of the open-ended responses in all four surveys. Results Using apps, participants self-curated small data sets that included their blood glucose level, blood pressure, weight, and dietary intake. The dynamic visualizations of the data in the form of charts and diagrams were created using apps and participants were able to interpret the impact of their choices and behaviors from the diagrammatic form of their small personal data sets. Findings are presented in four themes: (1) recording personal data; (2) modelling and visualizing the data; (3) interpreting the data; and (4) empowering and improving health. Conclusions The modelling capability of apps using small personal data sets, collected and curated by individuals, and the resultant graphical information that can be displayed on tablet screens proves a valuable asset for diabetes self-care. Informed by their own data, individuals are well-positioned to make changes in their daily lives that will improve their health.
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Affiliation(s)
- Sally Jane Burford
- News & Media Research Centre, Faculty of Arts and Design, University of Canberra, Canberra, Australia
| | - Sora Park
- News & Media Research Centre, Faculty of Arts and Design, University of Canberra, Canberra, Australia
| | - Paresh Dawda
- News & Media Research Centre, Faculty of Arts and Design, University of Canberra, Canberra, Australia
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Adu MD, Malabu UH, Malau-Aduli AEO, Malau-Aduli BS. Mobile application intervention to promote self-management in insulin-requiring type 1 and type 2 diabetes individuals: protocol for a mixed methods study and non-blinded randomized controlled trial. Diabetes Metab Syndr Obes 2019; 12:789-800. [PMID: 31213866 PMCID: PMC6538012 DOI: 10.2147/dmso.s208324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 04/29/2019] [Indexed: 11/30/2022] Open
Abstract
Background: Mobile applications (apps) have proven to be useful in supporting diabetes self-care, but non-consideration of users' needs and non-inclusion of educational features are reasons for low continual use. Well-designed mobile apps that meet the needs of diabetes patients and provide ongoing self-management education and support are required. It was hypothesized that apps designed with such features can improve a range of measures including clinical outcomes, knowledge of diabetes, medication adherence, perceived ability for self-management, and quality-of-life. This may eventually facilitate a more robust and cost-effective approach for improving skills and motivation for the management of diabetes. Methods: This project will be conducted in two phases. It will initially employ a mixed methods study design to investigate the self-management needs and perceptions of diabetes patients on the use of mobile apps to support diabetes self-management. Results of the mixed methods study will inform the content and design of an app which will be employed as an intervention tool in a 12-month parallel randomized controlled trial (RCT). The RCT will compare outcomes in relation to standard-of-care alone with standard-of-care plus a mobile phone diabetes app among 150 insulin-requiring types 1 and 2 diabetes patients. The primary outcome measures are clinical parameters such as hemoglobin A1c (HbA1c), lipids, urine albumin-to-creatinine ratio, blood pressure, frequency in events of emergency hyperglycemia and hypoglycemia. Secondary outcomes include knowledge of diabetes, medication intake and adherence, perception of self-care, and quality-of-life. Discussion: Results from this study will provide empirical evidence on the usefulness of a mobile app developed based on self-management needs analysis of diabetic patients. The long-term goal is to harness knowledge gained from this study to provide evidenced-based data, which promote the scale-up or adoption of mobile applications that provide regular, ongoing education and self-management support to people living with diabetes. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12618000065291, Registered on 17 January, 2018 (prospectively registered).
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Affiliation(s)
- Mary D Adu
- College of Medicine and Dentistry, James Cook University, Townsville, QLD4811, Australia
| | - Usman H Malabu
- College of Medicine and Dentistry, James Cook University, Townsville, QLD4811, Australia
| | - Aduli EO Malau-Aduli
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD4811, Australia
| | - Bunmi S Malau-Aduli
- College of Medicine and Dentistry, James Cook University, Townsville, QLD4811, Australia
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Mogre V, Johnson NA, Tzelepis F, Paul C. Attitudes towards, facilitators and barriers to the provision of diabetes self-care support: A qualitative study among healthcare providers in Ghana. Diabetes Metab Syndr 2019; 13:1745-1751. [PMID: 31235088 DOI: 10.1016/j.dsx.2019.03.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 03/26/2019] [Indexed: 11/17/2022]
Abstract
STATEMENT OF THE PROBLEM Self-care support provided by healthcare providers (HCPs) is critical to diabetes self-care. However, a number of barriers prevent HCPs from providing self-care support to people with diabetes. We explored attitudes towards, barriers and facilitators of the provision of diabetes self-care support among Ghanaian HCPs. METHODS Fourteen semi-structured interviews were conducted among HCPs recruited from three diabetes clinics in Tamale, Ghana. All interviews were digitally recorded and transcribed verbatim. Transcripts were coded and analysed thematically. RESULTS HCPs reported a sense of responsibility and urgency to provide self-care education to diabetes patients; while believing it was the patients' responsibility to self-care for their diabetes condition. Accordingly, HCPs perceived their role to be limited to information sharing rather than behaviour change interventions. Facilitators to the provision of self-care support included patients' motivation, and team work among healthcare professionals. Barriers that hindered self-care support included language barriers and poor inter-professional collaboration. Furthermore, HCPs discussed that they felt inadequately trained to provide self-care support. Healthcare-system-related barriers were inadequate office space, lack of professional development programmes, high patient numbers, inadequate staff numbers, inadequate health insurance and a lack of sufficient supplies and equipment in the hospital. CONCLUSION HCPs attitudes were generally favourable towards supporting self-care, albeit with a focus on information provision rather than behaviour change. Training in effective strategies for providing self-care support are needed, and better use of the resources that are available.
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Affiliation(s)
- Victor Mogre
- Department of Health Professions Education and Innovative Learning, School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana; School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia.
| | - Natalie A Johnson
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia; Hunter Medical Research Institute, Locked Bag 1000, New Lambton, New South Wales, 2305, Australia
| | - Flora Tzelepis
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia; Hunter Medical Research Institute, Locked Bag 1000, New Lambton, New South Wales, 2305, Australia; Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales, 2287, Australia
| | - Christine Paul
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia; Hunter Medical Research Institute, Locked Bag 1000, New Lambton, New South Wales, 2305, Australia
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Doubova SV, Infante C, Villagrana-Gutiérrez GL, Martínez-Vega IP, Pérez-Cuevas R. Adequate health literacy is associated with better health outcomes in people with type 2 diabetes in Mexico. PSYCHOL HEALTH MED 2019; 24:853-865. [PMID: 30706719 DOI: 10.1080/13548506.2019.1574356] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study evaluates the health literacy of people with type 2 diabetes and its association with health outcomes. We conducted a cross-sectional survey in two family medicine clinics of the Mexican Institute of Social Security that included 778 diabetic patients >19 years of age. The Spanish version of the European Health Literacy questionnaire served to measure health literacy. Multiple logistic regressions were performed to determine the association between the independent variable (health literacy) and dependent variables (good self-rated health, glycemic control, and diabetes-related hospitalizations) after controlling for conceptually relevant patient's characteristics. Only 17.6% of patients had adequate health literacy; while, the remaining percentage showed inadequate (23%), or problematic (59.4%) health literacy. After adjusting for the patients' characteristics, those with adequate health literacy had 4.66 (95%CI: 2.26-9.61) times the odds of good self-rated health compared to those with inadequate literacy. Patients with adequate health literacy had 0.65 (95%CI: 0.49-0.86) times the odds of hospitalization due to diabetes compared to those with inadequate literacy. Compared to inadequate health literacy, problematic literacy was associated with increased odds of glycemic control. In conclusion, healthcare providers should actively address the health literacy needs of patients to increase good self-rated health, glucose control and reduce hospitalizations.
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Affiliation(s)
- Svetlana V Doubova
- a Epidemiology and Health Services Research Unit , CMN Siglo XXI, Mexican Institute of Social Security , Mexico City , Mexico
| | - Claudia Infante
- b Instituto de Investigaciones Sociales , Universidad Nacional Autónoma de México. Circuito Mario de la Cueva s/n. Ciudad de la Investigación en Humanidades, Ciudad Universitaria , Mexico City , Mexico
| | | | - Ingrid Patricia Martínez-Vega
- a Epidemiology and Health Services Research Unit , CMN Siglo XXI, Mexican Institute of Social Security , Mexico City , Mexico
| | - Ricardo Pérez-Cuevas
- d National Institute of Public Health , Health Systems Research Center , Cuernavaca City , Mexico
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Rucci P, Messina R, Ubiali A, Rochira A, van der Bijl J, Mancini T, Fantini MP, Pagotto U. Does self-efficacy in diabetes management differ by type of diabetes and gender? Results from network analysis. J Health Psychol 2018; 26:156-167. [PMID: 30295514 DOI: 10.1177/1359105318804866] [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] [Indexed: 11/17/2022] Open
Abstract
This study aims to analyze the correlations and relevance of self-efficacy items in 411 patients with diabetes using network analysis. We found that the self-efficacy items structure is consistent between genders and types of diabetes. However, the strength of item correlations was significantly higher in type 2 diabetes. The items central to the network were following a regular diet in type 2 diabetes and adjusting diet when ill in type 1 diabetes. No significant gender differences were found. Knowledge of the most central aspects of self-efficacy and their interconnections can help clinicians to target psychoeducational interventions aimed at empowering patients.
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Affiliation(s)
- Paola Rucci
- Department of Biomedical and Neuromotor Sciences, Section of Hygiene and Biostatistics, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Rossella Messina
- Department of Biomedical and Neuromotor Sciences, Section of Hygiene and Biostatistics, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Andrea Ubiali
- School of Hygiene and Preventive Medicine, University of Bologna, Bologna, Italy
| | - Andrea Rochira
- School of Hygiene and Preventive Medicine, University of Bologna, Bologna, Italy
| | - Jaap van der Bijl
- Inholland University of Applied Sciences, Amsterdam, The Netherlands
| | - Tatiana Mancini
- Endocrine-Metabolic Disease Care Unit, Department of Internal Medicine, Istituto Sicurezza Sociale, Cailungo, San Marino, Republic of San Marino
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, Section of Hygiene and Biostatistics, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Uberto Pagotto
- Endocrinology Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Alma Mater Studiorum-University of Bologna, Bologna, Italy
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Ausili D, Rossi E, Rebora P, Luciani M, Tonoli L, Ballerini E, Androni S, Vellone E, Riegel B, Di Mauro S. Socio-demographic and clinical determinants of self-care in adults with type 2 diabetes: a multicentre observational study. Acta Diabetol 2018; 55:691-702. [PMID: 29623431 DOI: 10.1007/s00592-018-1135-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/26/2018] [Indexed: 10/17/2022]
Abstract
AIMS To describe self-care as defined by the Middle Range Theory of Self-Care of Chronic Illness and to identify clinical and socio-demographic determinants in a T2DM population. METHODS A multicentre observational cross-sectional study was conducted involving 540 adults with a confirmed diagnosis of T2DM from six outpatient diabetes services in Italy. Socio-demographic and clinical data were collected from medical records. The Self-Care of Diabetes Inventory (SCODI) was used to measure self-care maintenance, monitoring, management, and confidence dimensions. For each separate scale, scores were standardized 0-100 with higher SCODI scores indicating better self-care; a score ≥ 70 is adequate. Multiple quantile regression models were performed to identify determinants of each self-care dimension. RESULTS Self-care maintenance (median = 81.3) and self-care confidence (median = 79.5) were adequate in most of the subjects. Self-care monitoring was adequate in only half of the sample (median = 70.6). Self-care management was poor (median = 59.4). Lower self-care maintenance was associated with lower self-care confidence (p < 0.001). Lower self-care monitoring was associated with being male (p < 0.001), having lower self-care confidence (p < 001), and having diabetes for < 10 years (p < 0.001). Lower self-care management was associated with being male (p = 0.002), being older (p = 0.005), having a low income (p = 0.030), being employed (p = 0.008), having missed diabetes education in the last year (p = 0.002), and lower self-care confidence (p < 0.0001). Lower self-care confidence was associated with having diabetes for < 10 years (p = 0.008), and having at least one comorbid condition (p = 0.006). CONCLUSIONS Determinants of self-care maintenance, monitoring, management and confidence include both clinical and socio-demographic variables. Modifiable determinants such as self-care confidence and diabetes self-care management education could be used to tailor interventions to improve diabetes self-care.
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Affiliation(s)
- Davide Ausili
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20099, Monza, Italy.
| | - Emanuela Rossi
- Centre of Biostatistics for Clinical Epidemiology, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Paola Rebora
- Centre of Biostatistics for Clinical Epidemiology, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Michela Luciani
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20099, Monza, Italy
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | | | - Silvia Androni
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20099, Monza, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | - Stefania Di Mauro
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20099, Monza, Italy
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Abstract
Persons with diabetes might experience significant benefits through regular exercise. Not unlike the general population, those with diabetes could also lack motivation to participate in an exercise program. Often, those treating persons with diabetes lack training and/or interest in exercise prescription and are therefore unable to provide the needed information and encouragement. In many cases, reluctance to exercise could result from an inability to find an enjoyable exercise activity. Attempts to find activities that, not only provide effective aerobic challenges, but are also enjoyable to participate in are fraught with difficulty. Three electronic databases were searched in January 2017. Evidence for the merits of exercise for those with diabetes was robust. Numerous reports have addressed the degree of noncompliance to exercise recommendations and the barriers reported for this nonadherence. Additional studies concluded that most medical providers are deficient in formal training in the prescription of an exercise program. Newer studies are evaluating the effects of exercise and vitamin D supplementation and their interplay with diabetic peripheral neuropathy and ulceration. Exercise confers remarkable benefits to those with diabetes; however, the challenges to compelling patients with diabetes to exercise are formidable. An improved focus on exercise prescription and related motivation during provider training must be undertaken.
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Affiliation(s)
- David W Jenkins
- Professor, Arizona School of Podiatric Medicine, College of Health Sciences, Midwestern University, Glendale, AZ.
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Jaam M, Awaisu A, Ibrahim MI, Kheir N. Synthesizing and Appraising the Quality of the Evidence on Factors Associated with Medication Adherence in Diabetes: A Systematic Review of Systematic Reviews. Value Health Reg Issues 2017; 13:82-91. [PMID: 29073997 DOI: 10.1016/j.vhri.2017.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Nonadherence to medications is a common phenomenon in patients with diabetes. Several studies and systematic reviews have investigated the barriers to medication adherence in diabetes. However, no study has evaluated the quality of the existing literature and synthesized the plethora of evidence with a goal to design holistic conceptual frameworks and interventions. OBJECTIVES The aims of this review were to systematically evaluate existing systematic reviews focusing on factors associated with medication adherence in diabetes in an effort to synthesize the evidence, determine their methodological quality, and identify the gaps in the current literature. METHODS Fourteen databases and gray literature sources were systematically searched through June 2016. Systematic reviews reporting factors associated with medication adherence (barriers and facilitators) in patients with diabetes were selected on the basis of predetermined criteria. Studies were appraised for quality using AMSTAR (A Measurement Tool to Assess Systematic Reviews). RESULTS Seventeen systematic reviews including 542 primary studies, most of which were cross-sectional quantitative studies, were included. All the reviews were rated as moderate to low quality and exhibited common methodological pitfalls. Factors influencing medication adherence identified were categorized as patient-, medication-, disease-, health care provider-, health care system-, and social-related factors. CONCLUSIONS Factors influencing medication adherence are multifactorial with remarkably consistent findings across the existing reviews; yet, most reviews were judged to be of low to moderate quality. Further comprehensive and well-conducted original studies and systematic reviews on this topic shall be conducted taking into consideration the drawbacks of existing ones.
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Affiliation(s)
- Myriam Jaam
- College of Pharmacy, Qatar University, Doha, Qatar
| | - Ahmed Awaisu
- College of Pharmacy, Qatar University, Doha, Qatar.
| | | | - Nadir Kheir
- College of Pharmacy, Qatar University, Doha, Qatar; School of Pharmacy, the University of Auckland, Auckland, New Zealand
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Mean Levels and Variability in Affect, Diabetes Self-Care Behaviors, and Continuously Monitored Glucose: A Daily Study of Latinos With Type 2 Diabetes. Psychosom Med 2017; 79:798-805. [PMID: 28437381 PMCID: PMC5573602 DOI: 10.1097/psy.0000000000000477] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study investigated between- and within-person associations among mean levels and variability in affect, diabetes self-care behaviors, and continuously monitored glucose in Latinos with type 2 diabetes. METHODS Fifty participants (M [SD] age = 57.8 [11.7] years, 74% women, mean [SD] glycosylated hemoglobin A1c = 8.3% [1.5%]) wore a "blinded" continuous glucose monitor for 7 days, and they responded to twice daily automated phone surveys regarding positive affect, negative affect, and self-care behaviors. RESULTS Higher mean levels of NA were associated with higher mean glucose (r = .30), greater percent hyperglycemia (r = .34) and greater percentage of out-of-range glucose (r = .34). Higher NA variability was also related to higher mean glucose (r = .34), greater percent of hyperglycemia (r = .44) and greater percentage of out-of-range glucose (r = .43). Higher positive affect variability was related to lower percentage of hypoglycemia (r = -.33). Higher mean levels of self-care behaviors were related to lower glucose variability (r = -.35). Finally, higher self-care behavior variability was related to greater percentage of hyperglycemia (r = .31) and greater percentage of out-of-range glucose (r = -.28). In multilevel regression models, within-person increases from mean levels of self-care were associated with lower mean levels of glucose (b = -7.4, 95% confidence interval [CI] = -12.8 to -1.9), lower percentage of hyperglycemia (b = -0.04, 95% CI = -0.07 to -0.01), and higher percentage of hypoglycemia (b = 0.02, 95% CI = 0.01 to 0.03) in the subsequent 10-hour period. CONCLUSIONS Near-to-real time sampling documented associations of glucose with affect and diabetes self-care that are not detectable with traditional measures.
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Asaad G, Chan CB. Food sources of sodium, saturated fat, and added sugar in the Physical Activity and Nutrition for Diabetes in Alberta (PANDA) trial. Appl Physiol Nutr Metab 2017; 42:1270-1276. [PMID: 28772082 DOI: 10.1139/apnm-2017-0266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Diabetic patients may find it difficult to achieve recommended nutrient intakes embedded within dietary guidelines. The objective of this analysis was to document total sodium, saturated fat, and added sugar intake as well as the main food sources of these nutrients in Canadian adults with type 2 diabetes before and after an intervention focused on healthy eating. Participants were enrolled in a single-arm dietary intervention trial designed to improve glycemic control and adherence to dietary recommendations. A 4-week menu plan and recipes were provided for participants along with a 6-week educational curriculum. Three repeated 24-h dietary recalls were collected at baseline and 3 months. Food sources of sodium, saturated fat, and added sugar were a secondary outcome derived from the dietary recalls. After 3 months, there was a reduction (p < 0.05) in sodium intake of 561 mg/day, which was mainly due to reduced consumption of processed meats, soups, and condiments. Significantly lower intake of processed meat contributed to -2.9 g/day saturated fat intake (p < 0.1) while added sugar intake declined by 7 g/day (p < 0.1), which was due to lower consumption of baked goods/desserts and chocolate (both p < 0.05). The intervention was beneficial for type 2 diabetes patients in terms of changing dietary habits. However, the majority of the participants still exceeded the dietary guidelines for sodium and saturated fat. In addition to the efforts of individuals and their healthcare providers, strategies to increase the nutritional quality of prepared foods could provide widespread benefits.
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Affiliation(s)
- Ghada Asaad
- a Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Catherine B Chan
- a Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB T6G 2R3, Canada.,b Department of Physiology, University of Alberta, Edmonton, AB T6G 2R3, Canada.,c Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Edmonton, AB T6G 2R3, Canada
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Harris SM, Shah P, Mulnier H, Healey A, Thomas SM, Amiel SA, Hopkins D. Factors influencing attendance at structured education for Type 1 diabetes in south London. Diabet Med 2017; 34:828-833. [PMID: 28196291 DOI: 10.1111/dme.13333] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2017] [Indexed: 11/28/2022]
Abstract
AIM To investigate the factors influencing uptake of structured education for people with Type 1 diabetes in our local population in order to understand why such uptake is low. METHODS We conducted a cross-sectional database study of adults with Type 1 diabetes in two south London boroughs, analysed according to Dose Adjustment For Normal Eating (DAFNE) attendance or non-attendance. Demographics, glycaemic control and service use, with subset analysis by ethnicity, were compared using univariate analysis. An exploratory regression model was used to identify influencing factors. RESULTS The analysis showed that 73% of adults had not attended the DAFNE programme. For non-attenders vs attenders, male gender (59 vs 48%; P = 0.002), older age (39 vs 35 years; P < 0.001), non-white ethnicity (30 vs 20%; P = 0.001) and coming from an area of social deprivation (index of multiple deprivation score 31 vs 28; P < 0.001) were associated with non-attendance. The difference in gender (88% men vs 70% women; P < 0.001) and age (43 vs 34 years) persisted in the non-white group. Regression analysis showed that higher baseline HbA1c level (odds ratio 1.96; P = 0.004), younger age (odds ratio 0.98; P = 0.001) and lower social deprivation (odds ratio 0.52; P = 0.001) was associated with attendance. CONCLUSION Socio-economic status and factors perceived as indicating greater severity of disease (HbA1c ) influence attendance at DAFNE. More work is necessary to understand the demography of non-attenders to aid future service design and alternative engagement strategies for these groups.
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Affiliation(s)
- S M Harris
- Institute of Diabetes, Endocrinology and Obesity, King's Health Partners, London, UK
- Health Innovation Network, London, UK
| | - P Shah
- Institute of Diabetes, Endocrinology and Obesity, King's Health Partners, London, UK
| | - H Mulnier
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - A Healey
- King's Health Economics and Centre for Implementation Science at Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - S M Thomas
- Institute of Diabetes, Endocrinology and Obesity, King's Health Partners, London, UK
| | - S A Amiel
- Institute of Diabetes, Endocrinology and Obesity, King's Health Partners, London, UK
- Diabetes Research Group, King's College London, London, UK
| | - D Hopkins
- Institute of Diabetes, Endocrinology and Obesity, King's Health Partners, London, UK
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Mogre V, Johnson NA, Tzelepis F, Shaw J, Paul C. Adherence to self-care behaviours and associated barriers in type 2 diabetes patients of low-and middle-income countries: a systematic review protocol. Syst Rev 2017; 6:39. [PMID: 28241863 PMCID: PMC5327551 DOI: 10.1186/s13643-017-0436-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 02/17/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Diabetes has become a global health emergency affecting high-, middle- and low-income countries. Previous systematic reviews have either focused on patients' adherence to diabetes self-care behaviours only or barriers to diabetes care (including self-care) only in the published literature and have not also analysed data separately for low- and middle-income countries (LMICs). Thus, none have focused on adherence with, and barriers to, self-care behaviours from the perspectives of both patient and providers in low- and middle-income countries (LMICs). This systematic review will evaluate the published literature on adherence to five diabetes self-care behaviours (i.e., diet, exercise, self-monitoring of blood glucose, medication taking and foot care) and associated barriers in type 2 diabetes patients in LMICs. Healthcare providers' barriers to the provision of diabetes self-care support will also be reviewed. METHODS This narrative review will be reported in accordance with the guidelines of the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P). The electronic databases, MEDLINE, EMBASE, CINAHL, SCOPUS, PsycINFO, Cochrane Library and the British Nursing Index will be searched. Qualitative and quantitative studies reporting on type 2 diabetes patients' adherence to self-care behaviours and associated barriers in LMICs will be included. Studies also reporting on barriers encountered by providers in LMICs providing diabetes care and supporting patients to adhere to self-care behaviours will also be included. Cross-sectional studies, observational cohort studies, baseline data of randomised controlled trials and qualitative studies will be eligible. Two independent reviewers will screen articles for inclusion, undertake quality assessment of included studies and execute data extraction using standardised forms. Discrepancies will be discussed to reach consensus, and another reviewer will adjudicate if the need arises. The Guidance of Narrative Synthesis in Systematic Reviews will be employed to explore relationships within and between included studies. DISCUSSION This review will provide evidence on adherence to self-care behaviours by type 2 diabetes patients in LMICs. Barriers experienced by patients in LMICs to adhere to recommended self-care behaviours will also be identified. Barriers experienced by healthcare providers in LMICs in providing self-care support patients will also be determined. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016035406.
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Affiliation(s)
- Victor Mogre
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales 2308 Australia
- Department of Health Professions Education, School of Medicine and Health Sciences, University for Development Studies, P. O. Box TL 1883, Tamale, Ghana
| | - Natalie A. Johnson
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales 2308 Australia
- Hunter Medical Research Institute, Locked bag 1000, New Lambton, New South Wales 2305 Australia
| | - Flora Tzelepis
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales 2308 Australia
- Hunter Medical Research Institute, Locked bag 1000, New Lambton, New South Wales 2305 Australia
- Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales 2287 Australia
| | - Jonathan Shaw
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria 3004 Australia
| | - Christine Paul
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales 2308 Australia
- Hunter Medical Research Institute, Locked bag 1000, New Lambton, New South Wales 2305 Australia
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Shibuta T, Waki K, Tomizawa N, Igarashi A, Yamamoto-Mitani N, Yamaguchi S, Fujita H, Kimura S, Fujiu K, Waki H, Izumida Y, Sasako T, Kobayashi M, Suzuki R, Yamauchi T, Kadowaki T, Ohe K. Willingness of patients with diabetes to use an ICT-based self-management tool: a cross-sectional study. BMJ Open Diabetes Res Care 2017; 5:e000322. [PMID: 28243450 PMCID: PMC5304261 DOI: 10.1136/bmjdrc-2016-000322] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 11/07/2016] [Accepted: 12/04/2016] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To examine the prevalence of the willingness of patients with diabetes to use a self-management tool based on information and communication technology (ICT) such as personal computers, smartphones, and mobile phones; and to examine the patient characteristics associated with that willingness. RESEARCH DESIGN AND METHODS We conducted a cross-sectional interview survey of 312 adults with diabetes at a university hospital in an urban area in Japan. Participants were classified into 2 groups: those who were willing to use an ICT-based self-management tool and those who were unwilling. Multiple logistic regression analysis was used to identify factors associated with the willingness, including clinical and social factors, current use of ICT, self-management practices, self-efficacy, and diabetes-related emotional distress. RESULTS The mean age of the 312 participants was 66.3 years (SD=11.5) and 198 (63%) were male. Most of the participants (93%) had type 2 diabetes. Although only 51 (16%) currently used ICT-based self-management tools, a total of 157 (50%) expressed the willingness to use such a tool. Factors associated with the willingness included: not having nephropathy (OR=2.02, 95% CI 1.14 to 3.58); outpatient visits once a month or more (vs less than once a month, OR=2.13, 95% CI 1.13 to 3.99); current use of personal computers and/or smartphones (OR=4.91, 95% CI 2.69 to 8.98); and having greater diabetes-related emotional distress (OR=1.10, 95% CI 1.01 to 1.20). CONCLUSIONS Approximately half of the patients showed interest in using an ICT-based self-management tool. Willing patients may expect ICT-based self-management tools to complement outpatient visits and to make self-management easier. Starting with patients who display the willingness factors might optimize programs based on such tools.
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Affiliation(s)
- Tomomi Shibuta
- School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kayo Waki
- Department of Ubiquitous Health Informatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobuko Tomizawa
- Department of Ubiquitous Health Informatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ayumi Igarashi
- School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Noriko Yamamoto-Mitani
- School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoko Yamaguchi
- Department of Ubiquitous Health Informatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideo Fujita
- Department of Ubiquitous Health Informatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shigeko Kimura
- Department of Ubiquitous Health Informatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsuhito Fujiu
- Department of Ubiquitous Health Informatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hironori Waki
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshihiko Izumida
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takayoshi Sasako
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masatoshi Kobayashi
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryo Suzuki
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, 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
| | - Kazuhiko Ohe
- Department of Biomedical Informatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Park S, Burford S, Nolan C, Hanlen L. The Role of Digital Engagement in the Self-Management of Type 2 Diabetes. HEALTH COMMUNICATION 2016; 31:1557-1565. [PMID: 27124817 DOI: 10.1080/10410236.2015.1089468] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Mobile tablet devices and applications have the potential to help type 2 diabetes patients in the self-management of their disease. However, users must be equipped with an appropriate level of digital literacy in order to use the tools and technologies effectively. This study reports from an exploratory mobile health (mHealth) pilot program that was conducted at a large, local clinic in Canberra, Australia. The research team provided digital training and support opportunities to participants as part of the longitudinal study. The aim of the research project was to examine the diverse range of participant digital literacy and how it impacted on self-management and the adoption of mHealth. Mid-study results from online surveys conducted at 2 and 5 months after enrolling 28 participants in the pilot program revealed that digital engagement is crucial to the patients' participation in mHealth activities. Support, by way of digital training, was essential to the patients' sustainable use of the devices and applications for health care.
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Affiliation(s)
- Sora Park
- a News & Media Research Center , University of Canberra
| | - Sally Burford
- a News & Media Research Center , University of Canberra
| | | | - Leif Hanlen
- c NICTA , Australian National University & University of Canberra
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Testing a Model of Self-Management of Fluid Intake in Community-Residing Long-term Indwelling Urinary Catheter Users. Nurs Res 2016; 65:97-106. [PMID: 26938358 DOI: 10.1097/nnr.0000000000000140] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Urinary tract infection and blockage are serious and recurrent challenges for people with long-term indwelling catheters, and these catheter problems cause worry and anxiety when they disrupt normal daily activities. OBJECTIVE The goal was to determine whether urinary catheter-related self-management behaviors focusing on fluid intake would mediate fluid intake-related self-efficacy toward decreasing catheter-associated urinary tract infection (CAUTI) and/or catheter blockage. METHODS The sample involved data collected from 180 adult community-living, long-term indwelling urinary catheter users. The authors tested a model of fluid intake self-management related to fluid intake self-efficacy for key outcomes of CAUTI and blockage. To account for the large number of zeros in both outcomes, a zero-inflated negative binomial (ZINB) structural equation model was tested. RESULTS Structurally, fluid intake self-efficacy was positively associated with fluid intake self-management, suggesting that higher fluid intake self-efficacy predicts more (higher) fluid intake self-management; however, fluid intake self-management was not associated with either the frequency of CAUTIs or the presence or absence of CAUTI. Fluid intake self-efficacy was positively related to fluid intake self-management, and fluid intake self-management predicted less frequency of catheter blockage, but neither fluid intake self-efficacy nor fluid intake self-management predicted the presence or absence of blockage. DISCUSSION Further research is needed to better understand determinants of CAUTI in long-term catheter users and factors which might influence or prevent its occurrence. Increased confidence (self-efficacy) and self-management behaviors to promote fluid intake could be of value to long-term urinary catheter users to decrease catheter blockage.
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Newton-John TRO, Ventura AD, Mosely K, Browne JL, Speight J. ‘Are you sure you’re going to have another one of those?’: A qualitative analysis of the social control and social support models in type 2 diabetes. J Health Psychol 2016; 22:1819-1829. [DOI: 10.1177/1359105316642005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
While there is evidence that spouses can impact the self-management of adults with type 2 diabetes mellitus, less is known about the influence of the wider social network. This qualitative study explored the perceived impact of the family as well as friends and work colleagues on type 2 diabetes mellitus self-management. A total of 25 adults with type 2 diabetes mellitus participated in semi-structured interviews regarding their social experiences of living with diabetes. Deductive thematic analysis was applied to the data. Pre-existing themes of health-related social control and social support were identified in the wider social network, with additional themes of non-involvement and unintentional undermining also emerging.
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Affiliation(s)
| | | | | | | | - Jane Speight
- Diabetes Victoria, Australia
- Deakin University, Australia
- AHP Research, UK
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Burridge LH, Foster MM, Donald M, Zhang J, Russell AW, Jackson CL. Making sense of change: patients' views of diabetes and GP-led integrated diabetes care. Health Expect 2016; 19:74-86. [PMID: 25565290 PMCID: PMC5055219 DOI: 10.1111/hex.12331] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Health system reform is directed towards better management of diabetes. However, change can be difficult, and patients' perspectives are a key aspect of implementing change. OBJECTIVE This study investigated patients' perceptions and experiences of type 2 diabetes (T2DM), self-care and engagement with GP-led integrated diabetes care. DESIGN Qualitative interviews were conducted with purposively selected patients with T2DM following their initial medical appointment in the new model of care. Normalization process theory was used to orientate the thematic analysis, to explain the work of implementing change. SETTING Two specialist GP-based complex diabetes services in primary care in Brisbane, Australia. PARTICIPANTS Intervention group patients (n = 30) in a randomized controlled trial to evaluate a model of GP-led integrated care for complex T2DM. MAIN OUTCOME MEASURES Participants' experiences and perceptions of diabetes management and a GP-led model of care. RESULTS Three themes were identified: sensibility of change, 'diabetic life' and diabetes care alliance. The imperative of change made sense, but some participants experienced dissonance between this rational view and their lived reality. Diabetes invaded life, revealing incongruities between participants' values and living with diabetes. They appreciated a flexible and personalized approach to care. DISCUSSION Participants responded to advice in ways that seemed rational within the complexities of their life context. Their diabetes partnerships with health professionals coupled providers' biomedical expertise with patients' contextual expertise. CONCLUSIONS Learning to manage relationships with various health professionals adds to patients' diabetes-related work. Providers need to adopt a flexible, interactive approach and foster trust, to enable better diabetes care.
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Affiliation(s)
- Letitia H. Burridge
- Discipline of General PracticeSchool of MedicineThe University of QueenslandHerstonQueenslandAustralia
| | - Michele M. Foster
- Social Work and Social PolicySchool of Social Work and Human ServicesThe University of QueenslandSt LuciaQueenslandAustralia
| | - Maria Donald
- Discipline of General PracticeSchool of MedicineThe University of QueenslandHerstonQueenslandAustralia
| | - Jianzhen Zhang
- Discipline of General PracticeSchool of MedicineThe University of QueenslandHerstonQueenslandAustralia
| | - Anthony W. Russell
- Department of Diabetes and EndocrinologyPrincess Alexandra HospitalWoolloongabbaQueenslandAustralia
| | - Claire L. Jackson
- Discipline of General PracticeSchool of MedicineThe University of QueenslandHerstonQueenslandAustralia
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Massamba N, Dirani A, Knoeri J, Pasquier B, Ingram A, Soubrane G. Evaluating the impact of summer vacation on the visual acuity of AMD patients treated with ranibizumab. Eye (Lond) 2015. [PMID: 26206530 DOI: 10.1038/eye.2015.128] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To evaluate the impact of traditional French summer vacation on visual acuity and spectral domain-optical coherence tomography (SD-OCT) of Wet AMD patients being treated with intravitreal Ranibizumab. METHODS This was a consecutive, comparative, single-centre, prospective analysis. All patients who were being treated with intravitreal injection of 0.5 mg ranibizumab at Cergy Pontoise Hospital, Department of Ophthalmology between July 2013 and September 2014 were included. Patients were divided into two groups: (A) patients who skipped one ranibizumab intravitreal injection during holidays, and (B) patients who received injection during their holidays. Evaluations occurred prior to traditional holiday (baseline) and 2 months later, consisting of BCVA using ETDRS, and a complete ophthalmic examination that included slit-lamp biomicroscopy, fundus examination, fluorescein angiography (FA), indocyanine green angiography (ICGA), and spectral domain-optical coherence tomography (SD-OCT). All patients were being treated with PRN anti-VEGF regimen and criteria for reinjection included a visual acuity loss >5 ETDRS letters and/or an increase of central retinal thickness, presence of subretinal fluid, intraretinal fluid, or pigment epithelium detachment. If reinjection criteria were not met, patients were advised to return in 4 weeks. RESULTS The mean visual acuity change was -0.071 ± 0.149 (LogMAR) in group A and + 0.003 ± 0.178 in group B (P = 0.041). At the second visit (2 months after preholidays visit), 61.8% of patients in group A had SRF and/or intraretinal cysts, and only 27.6% of patients in group B. There was a significant difference in the persistence of fluid between the two groups (P = 0.007, χ(2)-test). CONCLUSION This cases series demonstrated the detrimental impact of holidays on visual acuity in patients treated with ranibizumab for AMD, which, in spite of their treatment regimen, still leave in vacation. Therefore, it is important to convey the message of treatment adherence to patients, despite their need of holidays.
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Affiliation(s)
- N Massamba
- Department of Ophthalmology, Cergy Pontoise Hospital, Paris, France
| | - A Dirani
- Department of Ophthalmology, CHUV, Lausanne, Switzerland
| | - J Knoeri
- Department of Ophthalmology, Cergy Pontoise Hospital, Paris, France
| | - B Pasquier
- Department of Ophthalmology, Cergy Pontoise Hospital, Paris, France
| | - A Ingram
- Department of Ophthalmology, April Ingram Research Consultants, Kelowna, British Columbia, Canada
| | - G Soubrane
- Department of Ophthalmology, Hotel Dieu Hospital, Paris V University, Paris, France
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Veras VS, dos Santos MA, Rodriguesc FFL, Arrelias CCA, Pedersoli TAM, Zanetti ML. [Self-care among patients enrolled in a self-monitoring blood glucose program]. ACTA ACUST UNITED AC 2015; 35:42-8. [PMID: 25842779 DOI: 10.1590/1983-1447.2014.04.47820] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This cross-sectional study checks specific self-care activities of patients with diabetes mellitus enrolled in a self-monitoring blood glucose program from August to December 2012 in two Primary Health Care units in the interior of São Paulo, Brazil.The sample was composed of 74 female and male individuals, aged 18 years old or older. The Summary of Diabetes Self-Care Activities Questionnaire was used. It contains six dimensions: general diet, specific diet, physical activity, blood glucose monitoring, foot care, medication usage, plus three items about smoking. Eight out of the 15 self-care activities were within desirable levels, namely: healthy diet, not eating sweets, blood glucose testing and as frequently as recommended, drying between toes after washing feet, and taking medications (three items).The results enabled the identification of gaps in specific self-care activities among patients with diabetes mellitus.
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Adherence to hunger training using blood glucose monitoring: a feasibility study. Nutr Metab (Lond) 2015; 12:22. [PMID: 26075007 PMCID: PMC4465140 DOI: 10.1186/s12986-015-0017-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 05/29/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND "Hunger training", which aims to teach people to eat only when blood glucose is below a set target, appears promising as a weight loss strategy. As the ability of participants to adhere to the rigorous protocol has been insufficiently described, we sought to determine the feasibility of hunger training, in terms of retention in the study, adherence to measuring blood glucose, and eating only when blood glucose concentrations are below a set level of 4.7 mmol/L. METHOD We undertook a two-week feasibility study, utilising an adaptive design approach where the specific blood glucose cut-off was the adaptive feature. A blood glucose cut-off of 4.7 mmol/L (protocol A) was used for the first 20 participants. A priori we decided that if interim analysis revealed that this cut-off did not meet our feasibility criteria, the remaining ten participants would use an individualised cut-off based on their fasting glucose concentrations (protocol B). RESULTS Retention of the participants in the study was 97 % (28/29 participants), achieving our criterion of 85 %. Participants measured their blood glucose before 94 % (95 % CI 91, 98) of eating occasions (criterion 80 %). However, participants following protocol A, which used a standard blood glucose cut-off of 4.7 mmol/L, were only able to adhere to eating when blood glucose was below the prescribed level 66 % of the time, below our within-person criterion of 75 %. By contrast, those participants following protocol B (individualised cut-off) adhered to the eating protocol 84 % of the time, a significant (p = 0.010) improvement over protocol A. CONCLUSION Hunger training appears to be a feasible method, at least in the short-term, when an individualised fasting blood glucose is used to indicate that a meal can begin.
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Durtschi A, Jülicher P. Assessing the value of cardiac biomarkers: going beyond diagnostic accuracy? Future Cardiol 2015; 10:367-80. [PMID: 24976474 DOI: 10.2217/fca.14.26] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In this era of scrutinized resource utilization, providers and payers are focused on the value of healthcare interventions more than ever. Cost-effectiveness evaluations are required by some health authorities and requested by others in order to guide budget allocation decisions. In the past, these evaluations did not methodologically consider laboratory diagnostics. We set out to explore the current requirements of health technology agencies that include laboratory diagnostics and describe, through a review of the literature, alternative methods for establishing the value of a biomarker or labroatory diagnostic beyond assay specifications and performance. The aim of this study was to evaluate the current use of a linked evidence approach in cost-effectiveness studies for cardiac laboratory tests in the last 5 years.
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Affiliation(s)
- Amy Durtschi
- Abbott, 100 Abbott Park Road, CP1-3NW, Abbott Park, IL 60064-6094, USA
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Wilde MH, McMahon JM, McDonald MV, Tang W, Wang W, Brasch J, Fairbanks E, Shah S, Zhang F, Chen DGD. Self-management intervention for long-term indwelling urinary catheter users: randomized clinical trial. Nurs Res 2015; 64:24-34. [PMID: 25502058 PMCID: PMC4268883 DOI: 10.1097/nnr.0000000000000071] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND People using long-term indwelling urinary catheters experience multiple recurrent catheter problems. Self-management approaches are needed to avoid catheter-related problems. OBJECTIVES The aim was to determine effectiveness of a self-management intervention in prevention of adverse outcomes (catheter-related urinary tract infection, blockage, and accidental dislodgement). Healthcare treatment associated with the adverse outcomes and catheter-related quality of life was also studied. METHODS A randomized clinical trial was conducted. The intervention involved learning catheter-related self-monitoring and self-management skills during home visits by a study nurse (twice during the first month and at 4 months-with a phone call at 2 months). The control group received usual care. Data were collected during an initial face-to-face home interview followed by bimonthly phone interviews. A total of 202 adult long-term urinary catheter users participated. Participants were randomized to treatment or control groups following collection of baseline data. Generalized estimating equations were used for the analysis of treatment effect. RESULTS In the intervention group, there was a significant decrease in reported blockage in the first 6 months (p = .02), but the effect did not persist. There were no significant effects for catheter-related urinary tract infection or dislodgment. Comparison of baseline rates of adverse outcomes with subsequent periods suggested that both groups improved over 12 months. DISCUSSION A simple-to-use catheter problems calendar and the bimonthly interviews might have functioned as a modest self-monitoring intervention for persons in both groups. A simplified intervention using a self-monitoring calendar is suggested-with optimal and consistent fluid intake likely to add value.
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Affiliation(s)
- Mary H Wilde
- Mary H. Wilde, PhD, RN, is Associate Professor; and James M. McMahon, PhD, is Associate Professor, University of Rochester School of Nursing, New York. Margaret V. McDonald, MSW, is Associate Director of Research Studies, Center for Home Care Policy and Research, Visiting Nurse Service of New York. Wan Tang, PhD, is Research Associate Professor; and Wenjuan Wang, PhD, is Postdoctoral Fellow, Department of Biostatistics and Computational Biology, University of Rochester, New York. Judith Brasch, RN, MS, is Project Nurse; and Eileen Fairbanks, RN,MS, PNP, is Health Project Coordinator, University of Rochester School of Nursing, New York. Shivani Shah, MPH, is Research Analyst, Center for Home Care Policy and Research, Visiting Nurse Service of New York. Feng Zhang, RN, BS, is MS/PhD Student, University of Rochester School of Nursing, New York. Ding-Geng (Din) Chen, PhD, is Professor, University of Rochester School of Nursing and Department of Biostatistics and Computational Biology, University of Rochester, New York
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Jahangard-Rafsanjani Z, Sarayani A, Nosrati M, Saadat N, Rashidian A, Hadjibabaie M, Ashouri A, Radfar M, Javadi M, Gholami K. Effect of a Community Pharmacist–Delivered Diabetes Support Program for Patients Receiving Specialty Medical Care. DIABETES EDUCATOR 2014; 41:127-35. [DOI: 10.1177/0145721714559132] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose The purpose of the study was to investigate the efficacy of a community pharmacist–delivered diabetes support program for patients receiving specialty medical care in a middle-income country (Iran). Methods A randomized controlled trial was conducted on 101 patients who received diabetes care from an endocrinologist. A qualified community pharmacist educated patients about medications, clinical goals, self-care activities, and self-monitoring of blood glucose. The pharmacist trained patients in the intervention group for 5 months (5 follow-up visits and 5 phone calls) and recommended physician visits when necessary. The primary outcome was A1C, and the secondary outcomes included self-care activities, medication adherence, blood pressure, and body mass index. Satisfaction and willingness to pay was assessed in the intervention group. Results Eighty-five patients completed the study, and baseline A1C was similar between groups (intervention: 7.6 ± 1.6 [59 mmol/mol] vs control: 7.5 ± 1.9 [58 mmol/mol]). No significant difference was observed between study groups at the end of the trial period; however, the amount of A1C reduction was higher in the intervention group (1.0% ± 1.5% vs 0.5% ± 1.5%). Self-care activity was improved in general diet, blood glucose monitoring, and foot care subcategories in the intervention group. Medication adherence and body mass index were significantly improved in the intervention group at the end of study. Conclusions A community pharmacist intervention improved self-care activity, medication adherence, and body mass index in patients receiving specialty medical care. Baseline A1C values and the presence of specialty medical care should be considered in the interpretation of clinical findings.
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Affiliation(s)
- Zahra Jahangard-Rafsanjani
- Clinical Pharmacy Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran (Dr Jahangard-Rafsanjani, Dr Radfar)
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran (Dr Sarayani, Dr Ashouri)
- Community and Institutional Pharmacies, Tehran University of Medical Sciences, Tehran, Iran (Dr Nosrati)
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Dr Saadat)
- Department of Health Management and Economics, School of Pubic Health, Tehran University of Medical Sciences, Tehran, Iran (Dr Rashidian)
| | - Amir Sarayani
- Clinical Pharmacy Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran (Dr Jahangard-Rafsanjani, Dr Radfar)
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran (Dr Sarayani, Dr Ashouri)
- Community and Institutional Pharmacies, Tehran University of Medical Sciences, Tehran, Iran (Dr Nosrati)
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Dr Saadat)
- Department of Health Management and Economics, School of Pubic Health, Tehran University of Medical Sciences, Tehran, Iran (Dr Rashidian)
| | - Marzieh Nosrati
- Clinical Pharmacy Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran (Dr Jahangard-Rafsanjani, Dr Radfar)
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran (Dr Sarayani, Dr Ashouri)
- Community and Institutional Pharmacies, Tehran University of Medical Sciences, Tehran, Iran (Dr Nosrati)
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Dr Saadat)
- Department of Health Management and Economics, School of Pubic Health, Tehran University of Medical Sciences, Tehran, Iran (Dr Rashidian)
| | - Navid Saadat
- Clinical Pharmacy Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran (Dr Jahangard-Rafsanjani, Dr Radfar)
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran (Dr Sarayani, Dr Ashouri)
- Community and Institutional Pharmacies, Tehran University of Medical Sciences, Tehran, Iran (Dr Nosrati)
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Dr Saadat)
- Department of Health Management and Economics, School of Pubic Health, Tehran University of Medical Sciences, Tehran, Iran (Dr Rashidian)
| | - Arash Rashidian
- Clinical Pharmacy Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran (Dr Jahangard-Rafsanjani, Dr Radfar)
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran (Dr Sarayani, Dr Ashouri)
- Community and Institutional Pharmacies, Tehran University of Medical Sciences, Tehran, Iran (Dr Nosrati)
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Dr Saadat)
- Department of Health Management and Economics, School of Pubic Health, Tehran University of Medical Sciences, Tehran, Iran (Dr Rashidian)
| | - Molouk Hadjibabaie
- Clinical Pharmacy Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran (Dr Jahangard-Rafsanjani, Dr Radfar)
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran (Dr Sarayani, Dr Ashouri)
- Community and Institutional Pharmacies, Tehran University of Medical Sciences, Tehran, Iran (Dr Nosrati)
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Dr Saadat)
- Department of Health Management and Economics, School of Pubic Health, Tehran University of Medical Sciences, Tehran, Iran (Dr Rashidian)
| | - Asieh Ashouri
- Clinical Pharmacy Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran (Dr Jahangard-Rafsanjani, Dr Radfar)
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran (Dr Sarayani, Dr Ashouri)
- Community and Institutional Pharmacies, Tehran University of Medical Sciences, Tehran, Iran (Dr Nosrati)
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Dr Saadat)
- Department of Health Management and Economics, School of Pubic Health, Tehran University of Medical Sciences, Tehran, Iran (Dr Rashidian)
| | - Mania Radfar
- Clinical Pharmacy Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran (Dr Jahangard-Rafsanjani, Dr Radfar)
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran (Dr Sarayani, Dr Ashouri)
- Community and Institutional Pharmacies, Tehran University of Medical Sciences, Tehran, Iran (Dr Nosrati)
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Dr Saadat)
- Department of Health Management and Economics, School of Pubic Health, Tehran University of Medical Sciences, Tehran, Iran (Dr Rashidian)
| | - Mohammadreza Javadi
- Clinical Pharmacy Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran (Dr Jahangard-Rafsanjani, Dr Radfar)
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran (Dr Sarayani, Dr Ashouri)
- Community and Institutional Pharmacies, Tehran University of Medical Sciences, Tehran, Iran (Dr Nosrati)
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Dr Saadat)
- Department of Health Management and Economics, School of Pubic Health, Tehran University of Medical Sciences, Tehran, Iran (Dr Rashidian)
| | - Kheirollah Gholami
- Clinical Pharmacy Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran (Dr Jahangard-Rafsanjani, Dr Radfar)
- Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran (Dr Sarayani, Dr Ashouri)
- Community and Institutional Pharmacies, Tehran University of Medical Sciences, Tehran, Iran (Dr Nosrati)
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Dr Saadat)
- Department of Health Management and Economics, School of Pubic Health, Tehran University of Medical Sciences, Tehran, Iran (Dr Rashidian)
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49
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Frisch E, Ziebolz D, Vach K, Ratka-Krüger P. Supportive post-implant therapy: patient compliance rates and impacting factors: 3-year follow-up. J Clin Periodontol 2014; 41:1007-14. [DOI: 10.1111/jcpe.12298] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2014] [Indexed: 11/29/2022]
Affiliation(s)
| | - Dirk Ziebolz
- Department of Operative Dentistry and Periodontology; University Medical Centre Leipzig
| | - Kirstin Vach
- Center for Medical Biometry and Medical Informatics; Institute for Medical Biometry and Statistics; University Medical Center Freiburg; Freiburg Germany
| | - Petra Ratka-Krüger
- Department of Operative Dentistry and Periodontology; University of Freiburg; Freiburg Germany
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50
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Kneck Å, Fagerberg I, Eriksson LE, Lundman B. Living with diabetes - development of learning patterns over a 3-year period. Int J Qual Stud Health Well-being 2014; 9:24375. [PMID: 25030359 PMCID: PMC4101455 DOI: 10.3402/qhw.v9.24375] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/24/2014] [Indexed: 11/14/2022] Open
Abstract
Background Learning involves acquiring new knowledge and skills, and changing our ways of thinking, acting, and feeling. Learning in relation to living with diabetes is a lifelong process where there is limited knowledge of how it is experienced and established over time. It was considered important to explore how learning was developed over time for persons living with diabetes. Aim The aim of the study was to identify patterns in learning when living with diabetes, from recently being diagnosed, and over a 3-year period. Materials and methods A longitudinal qualitative descriptive design was used. Thirteen participants, with both type I and type II diabetes, were interviewed at three different occasions during a 3-year period. Qualitative content analysis was used in different steps in order to distinguish patterns. Findings Five main patterns of learning were identified. Two of the patterns (I and II) were characterized by gradually becoming comfortable living with diabetes, whereas for one pattern (IV) living with diabetes became gradually more difficult. For pattern V living with diabetes was making only a limited impact on life, whereas for Pattern III there was a constant management of obstacles related to illness. The different patterns in the present study showed common and different ways of learning and using different learning strategies at different timespans. Conclusion The present study showed that duration of illness is not of importance for how far a person has come in his own learning process. A person-centered care is needed to meet the different and changing needs of persons living with diabetes in relation to learning to live with a lifelong illness.
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Affiliation(s)
- Åsa Kneck
- Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden; Division of Nursing, Department of Neurolobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden;
| | - Ingegerd Fagerberg
- Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden; Division of Nursing, Department of Neurolobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | - Lars E Eriksson
- Division of Nursing, Department of Neurolobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; School of Health Sciences, City University London, London, United Kingdom
| | - Berit Lundman
- Department of Nursing, Umeå Universitet, Umeå, Sweden
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