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Moraes SDQ, Paiva Neto FTD, Loch MR, Fermino RC, Rech CR. Characteristics and counseling strategies for physical activity used by primary health care professionals. CIENCIA & SAUDE COLETIVA 2024; 29:e00692023. [PMID: 38198320 DOI: 10.1590/1413-81232024291.00692023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 04/17/2023] [Indexed: 01/12/2024] Open
Abstract
This study aim to describe the characteristics and strategies of counseling for physical activity used by Primary Health Care (PHC) professionals. A survey was carried out with 587 (85.4% women) health professionals who work in PHC in Florianopolis, in the state of Santa Catarina, southern Brazil. Counseling carried out in the last 12 months was considered. Operational aspects related to counseling practices and strategies used for counseling were evaluated. The frequency of physical activity guidance was 86.2% (95%CI = 83.2-88.8%). Counseling was characterized as a brief practice, carried out in individual consultations, aimed at adults and the older adults and people with morbidities. The most used strategy was to guide users to participate in physical activity groups at the Health Center (89.5%) and in relation to the 5As method, giving some "advice" was the most used strategy (99.0%) and the least used. used was to follow strategies (22.6%). Counseling for physical activity has been based on a brief practice, carried out in individual consultations and focused on people with morbidities and on adults and the elderly. The strategies used do not seem to cover the full care of the advised users.
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Affiliation(s)
- Sheylane de Queiroz Moraes
- Programa de Pós-Graduação em Educação Física, Universidade Federal de Santa Catarina. Campus Universitário, Prédio Administrativo do Centro de Desportos, Trindade. 88040-900 Florianópolis SC Brasil.
| | | | - Mathias Roberto Loch
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Estadual de Londrina. Londrina PR Brasil
| | - Rogério César Fermino
- Programa de Pós-Graduação em Educação Física, Universidade Federal Tecnológica do Paraná. Curitiba PR Brasil
| | - Cassiano Ricardo Rech
- Programa de Pós-Graduação em Educação Física, Universidade Federal de Santa Catarina. Campus Universitário, Prédio Administrativo do Centro de Desportos, Trindade. 88040-900 Florianópolis SC Brasil.
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Hills S, Terry D, Gazula S, Browning C. Practice nurses' communication with people living with type 2 diabetes: A scoping review. PATIENT EDUCATION AND COUNSELING 2022; 105:2664-2670. [PMID: 35393227 DOI: 10.1016/j.pec.2022.03.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/05/2022] [Accepted: 03/27/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To identify the key characteristics of practice nurses' communication with people living with Type 2 Diabetes (T2D) where lifestyle activities are discussed. METHODS A scoping review of the peer-reviewed literature was conducted. Reflexive thematic analysis was used to identify key themes that emerged. The PRISMA-ScR checklist was followed. RESULTS 25 studies were retained in the final review. Nurses who were committed to engaging in lifestyle discussions created supportive environments and built rapport to enable change conversations. However, this was present in just 20% of the studies. In most studies, (60%) nurses continued to use traditional health education communication styles, had little understanding of behaviour change theories, lacked skills in behaviour change counselling and were reluctant to engage in behaviour change discussions with people with T2D . CONCLUSIONS Nurses require a deeper understanding of behavioural change theories and skills in behavioural counselling. PRACTICE IMPLICATIONS Practice nurses have a unique opportunity to facilitate T2D remission by engaging in evidence-based behaviour change communication. A behaviour change training intervention is needed that recognises the environment of practice nurse consultations. It needs to be pragmatic and fully consider the enablers and barriers to addressing behaviour change in both the nurse and the person with T2D.
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Affiliation(s)
- Sharon Hills
- Federation University Australia, Institute of Health and Wellbeing, PO Box 663, Ballarat, VIC 3353, Australia.
| | - Daniel Terry
- Federation University Australia, Institute of Health and Wellbeing, PO Box 663, Ballarat, VIC 3353, Australia.
| | - Swapnali Gazula
- Federation University Australia, Institute of Health and Wellbeing, PO Box 663, Ballarat, VIC 3353, Australia.
| | - Colette Browning
- Federation University Australia, Institute of Health and Wellbeing, PO Box 663, Ballarat, VIC 3353, Australia; Australia Research School of Population Health, Australian National University; Health Innovation and Transformation Centre, Federation University.
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Lindström J, Aittola K, Pölönen A, Hemiö K, Ahonen K, Karhunen L, Männikkö R, Siljamäki-Ojansuu U, Tilles-Tirkkonen T, Virtanen E, Pihlajamäki J, Schwab U. Formation and Validation of the Healthy Diet Index (HDI) for Evaluation of Diet Quality in Healthcare. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2362. [PMID: 33670967 PMCID: PMC7967771 DOI: 10.3390/ijerph18052362] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/13/2021] [Accepted: 02/22/2021] [Indexed: 12/17/2022]
Abstract
Lack of tools to evaluate the quality of diet impedes dietary counselling in healthcare. We constructed a scoring for a validated food intake questionnaire, to measure the adherence to a healthy diet that prevents type 2 diabetes (T2D). The Healthy Diet Index (HDI) consists of seven weighted domains (meal pattern, grains, fruit and vegetables, fats, fish and meat, dairy, snacks and treats). We studied the correlations of the HDI with nutrient intakes calculated from 7-day food records among 52 men and 25 women, and associations of HDI with biomarkers and anthropometrics among 645 men and 2455 women. The HDI correlated inversely with total fat (Pearson's r = -0.37), saturated fat (r = -0.37), monounsaturated fat (r = -0.37), and the glycaemic index of diet (r = -0.32) and positively with carbohydrates (r = 0.23), protein (r = 0.25), fibre (r = 0.66), magnesium (r = 0.26), iron (r = 0.25), and vitamin D (r = 0.27), (p < 0.05 for all). In the linear regression model adjusted for BMI and age, HDI is associated inversely with waist circumference, concentrations of fasting and 2-h glucose and triglycerides in men and women, total and LDL cholesterol in women, and fasting insulin in men (p < 0.05 for all). The HDI proved to be a valid tool to measure adherence to a health-promoting diet and to support individualised dietary counselling.
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Affiliation(s)
- Jaana Lindström
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
| | - Kirsikka Aittola
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland
| | - Auli Pölönen
- Division 1, Tampere University Hospital, 33520 Tampere, Finland
| | - Katri Hemiö
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
| | - Kirsti Ahonen
- Clinical Nutrition Unit, Tampere University Hospital, 33520 Tampere, Finland
| | - Leila Karhunen
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland
| | - Reija Männikkö
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland
- Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, 70029 Kuopio, Finland
| | | | - Tanja Tilles-Tirkkonen
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland
| | - Eeva Virtanen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
| | - Jussi Pihlajamäki
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland
- Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, 70029 Kuopio, Finland
| | - Ursula Schwab
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland
- Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, 70029 Kuopio, Finland
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Translating developmental origins of health and disease in practice: health care providers' perspectives. J Dev Orig Health Dis 2020; 12:404-410. [PMID: 32631476 DOI: 10.1017/s2040174420000483] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Currently, there is limited knowledge on how health care providers perceive and understand the Developmental Origins of Health and Disease (DOHaD), which may impact how they inform patients and their families throughout the perinatal period. This qualitative descriptive study explored if and how health care providers counsel on in utero programming and future health outcomes with parents, both preconception and during pregnancy. One-on-one, semi-structured interviews were conducted with 23 health care providers from varying health disciplines including obstetrics and gynaecology, midwifery, paediatrics, endocrinology and internal medicine. Audiotaped interviews were transcribed verbatim and analysed using inductive thematic analysis. Three themes were identified: Knowledge about DOHaD, Counselling on DOHaD in Practice Settings and Impact of DOHaD on Health. Health care providers not only expressed excitement over the potential health benefits of DOHaD counselling but also indicated barriers to knowledge translation, including a lack of knowledge among providers and a disconnect between basic scientists and practitioners. All health care providers expressed concerns on how and when to introduce the concept of DOHaD when counselling patients and called for the development of practice guidelines. Counselling on DOHaD needs to be framed in a way that is empowering, minimising the potential of coercion and guilt. More interaction and collaboration are needed between health care providers and researchers to identify strategies to support knowledge translation generated from DOHaD research into practice settings.
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Selçuk‐Tosun A, Zincir H. The effect of a transtheoretical model–based motivational interview on self‐efficacy, metabolic control, and health behaviour in adults with type 2 diabetes mellitus: A randomized controlled trial. Int J Nurs Pract 2019; 25:e12742. [DOI: 10.1111/ijn.12742] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/31/2018] [Accepted: 04/14/2019] [Indexed: 11/28/2022]
Affiliation(s)
| | - Handan Zincir
- Faculty of Health SciencesErciyes University Kayseri Turkey
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Stuij M, Elling A, Abma TA. Conflict between diabetes guidelines and experienced counselling in sports and physical activity. An exploratory study. Eur J Public Health 2018; 27:157-159. [PMID: 28177436 DOI: 10.1093/eurpub/ckw156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Tineke A Abma
- Department of Medical Humanities, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Westland H, Schröder CD, de Wit J, Frings J, Trappenburg JCA, Schuurmans MJ. Self-management support in routine primary care by nurses. Br J Health Psychol 2017; 23:88-107. [DOI: 10.1111/bjhp.12276] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 08/31/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Heleen Westland
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; The Netherlands
| | - Carin D. Schröder
- Center of Excellence in Rehabilitation Medicine; Brain Center Rudolf Magnus; University Medical Center Utrecht; The Netherlands
- De Hoogstraat Rehabilitation; Utrecht The Netherlands
| | - Jessica de Wit
- Center of Excellence in Rehabilitation Medicine; Brain Center Rudolf Magnus; University Medical Center Utrecht; The Netherlands
- De Hoogstraat Rehabilitation; Utrecht The Netherlands
| | - Judith Frings
- Faculty of Health; University of Applied Sciences Utrecht; The Netherlands
| | - Jaap C. A. Trappenburg
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; The Netherlands
| | - Marieke J. Schuurmans
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; The Netherlands
- Faculty of Health; University of Applied Sciences Utrecht; The Netherlands
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Thepwongsa I, Muthukumar R, Kessomboon P. Motivational interviewing by general practitioners for Type 2 diabetes patients: a systematic review. Fam Pract 2017; 34:376-383. [PMID: 28486622 DOI: 10.1093/fampra/cmx045] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Motivational interviewing (MI) is an effective tool to help clinicians with facilitating behavioural changes in many diseases and conditions. However, different forms of MI are required in different health care settings and for different clinicians. Although general practitioners (GPs) play a major role in Type 2 diabetes management, the effects of MI delivered by GPs intended to change the behaviours of their Type 2 diabetes patients and GP outcomes, defined as GP knowledge, satisfaction and practice behaviours, have not been systematically reviewed. METHODS An electronic search was conducted through Cochrane Library, Scopus, ProQuest, Wiley Online Library, Ovid MEDLINE, PubMed, CINAHL, MEDLINE Complete and Google Scholar from the earliest date of each database to 2017. Reference lists from each article obtained were reviewed. Measured changes in GP satisfaction, knowledge, and practice behaviours, and patient outcomes were recorded. RESULTS Eight out of 1882 studies met the criteria for inclusion. Six studies examined the effects of MI on Type 2 diabetes patient outcomes, only one of which examined its effects on GP outcomes. Two-thirds of the studies (4/6) found a significant improvement in at least one of the following patient outcomes: total cholesterol, low-density lipoproteins, fasting blood glucose, HbA1c, body mass index, blood pressure, waist circumference and physical activity. The effects of MI on GP outcomes yielded mixed results. CONCLUSIONS Few studies have examined evidence for the effectiveness of MI delivered by GPs to Type 2 diabetes patients. Evidence to support the effectiveness of MI on GP and patient outcomes is weak. Further quality studies are needed to examine the effects of MI on GP and patient outcomes.
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Affiliation(s)
- Isaraporn Thepwongsa
- Department of Community Medicine, Faculty of Medicine, Khon Kaen University, Thailand
| | | | - Pattapong Kessomboon
- Department of Community Medicine, Faculty of Medicine, Khon Kaen University, Thailand
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Anchala R, Gudlavalleti ASV, Gudlavalleti MVS, Singh V, Shukla R, Jotheeswaran AT, Babu RG, Ramachandra SS, Sagar J, Bandyopadhyay S, Ballabh HP, Gilbert CE. Human resources, patient load, and infrastructure at institutions providing diabetic care in India: The India 11-city 9-state study. Indian J Endocrinol Metab 2016; 20:S11-S18. [PMID: 27144131 PMCID: PMC4847444 DOI: 10.4103/2230-8210.179769] [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] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND There is a lack of information on the practice patterns and available human resources and services for screening for eye complications among persons with diabetes in India. OBJECTIVES The study was undertaken to document existing health care infrastructure and practice patterns for managing diabetes and screening for eye complications. METHODS This cross-sectional, hospital-based survey was conducted in 11 cities where public and private diabetic care providers were identified. Both multispecialty and standalone diabetic care facilities were included. A semi-structured questionnaire was administered to senior representative(s) of each institution to evaluate parameters using the World Health Organization health systems framework. RESULTS We interviewed physicians in 73 hospitals (61.6% multispecialty hospitals; 38.4% standalone clinics). Less than a third reported having skilled personnel for direct ophthalmoscopy. About 74% had provision for glycated hemoglobin testing. Only a third had adequate vision charts. Printed protocols on management of diabetes were available only in 31.5% of the facilities. Only one in four facilities had a system for tracking diabetics. Half the facilities reported having access to records from the treating ophthalmologists. Direct observation of the services provided showed that reported figures in relation to availability of patient support services were overestimated by around 10%. Three fourths of the information sheets and half the glycemia monitoring cards contained information on the eye complications and the need for a regular eye examination. CONCLUSIONS The study highlighted existing gaps in service provision at diabetic care centers in India.
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Affiliation(s)
- Raghupathy Anchala
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
| | - Aashrai Sai Venkat Gudlavalleti
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
| | - Murthy V. S. Gudlavalleti
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Vivek Singh
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
| | - Rajan Shukla
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
| | - A. T. Jotheeswaran
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
| | - R. Giridhara Babu
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
| | - Srikrishna S. Ramachandra
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
| | - Jayanti Sagar
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
| | - Souvik Bandyopadhyay
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
| | - Hira Pant Ballabh
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
| | - Clare E. Gilbert
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
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Marques-Vidal P, Vollenweider P, Grange M, Guessous I, Waeber G. Dietary intake of subjects with diabetes is inadequate in Switzerland: the CoLaus study. Eur J Nutr 2016; 56:981-989. [PMID: 26744301 DOI: 10.1007/s00394-015-1146-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 12/22/2015] [Indexed: 12/16/2022]
Abstract
PURPOSE To characterize the dietary intake of subjects aged 40-80 years according to self-reported diabetes and presence of an anti-diabetic diet. METHODS Cross-sectional study conducted between 2009 and 2012 on 4289 participants (2274 women) living in Lausanne. RESULTS Of the 299 (7 %) participants with self-reported diabetes, only 151 (51 %) reported an anti-diabetic diet. Compared to participants not reporting diabetes, participants with self-reported diabetes (with or without a diet) had a higher consumption of artificial sweeteners (0.3 ± 0.7 vs. 0.4 ± 0.8 and 0.8 ± 1.0 times/day) and a lower consumption of honey/jam (mean ± standard deviation: 0.5 ± 0.5 vs. 0.4 ± 0.4 and 0.4 ± 0.4 times/day) or sugar (0.6 ± 0.9 vs. 0.4 ± 0.7 and 0.2 ± 0.5 times/day) for participants not reporting diabetes, participants with self-reported diabetes not on a diet and on a diet, respectively. Compared to participants not on a diet, participants on a diet had a higher consumption of vegetables (1.8 ± 1.3 vs. 1.4 ± 1.0 portions/day), while no differences were found regarding all other food groups and nutrients. Participants with self-reported diabetes on a diet had a higher consumption of meat (5.6 ± 3.6 vs. 4.8 ± 2.9 portions/week) and a lower consumption of simple carbohydrates (21.0 ± 7.9 vs. 23.5 ± 8.4 % total energy intake) than participants not reporting diabetes. CONCLUSION People with diabetes eat less simple carbohydrates, but do not comply with current advice on fish, nuts, fruits and vegetables. Improvement of the dietary intake in persons with diabetes in Switzerland is needed.
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Affiliation(s)
- Pedro Marques-Vidal
- Department of Internal Medicine, BH10-642, Internal Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| | - Peter Vollenweider
- Department of Internal Medicine, BH10-642, Internal Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Matthieu Grange
- Department of Internal Medicine, BH10-642, Internal Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Idris Guessous
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Biopôle 2, 1010, Lausanne, Switzerland.,Unit of Population Epidemiology, Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Gérard Waeber
- Department of Internal Medicine, BH10-642, Internal Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
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Nymberg P, Drevenhorn E. Patients’ experience of a nurse-led lifestyle clinic at a Swedish health centre. Scand J Caring Sci 2015; 30:349-55. [DOI: 10.1111/scs.12254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 05/12/2015] [Indexed: 12/01/2022]
Affiliation(s)
| | - Eva Drevenhorn
- Department of Health Sciences; Faculty of Medicine; University of Lund; Lund Sweden
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Jandorf S, Siersma V, Køster-Rasmussen R, Olivarius NDF, Waldorff FB. The impact of patients' involvement in cooking on their mortality and morbidity: a 19-year follow-up of patients diagnosed with type 2 diabetes mellitus. Scand J Prim Health Care 2015; 33:33-9. [PMID: 25592166 PMCID: PMC4377735 DOI: 10.3109/02813432.2015.1001940] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 11/30/2014] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE This study explored the impact of involvement in cooking on long-term morbidity and mortality among patients newly diagnosed with type 2 diabetes mellitus (T2DM). DESIGN AND SUBJECTS Data are from the population-based study Diabetes Care in General Practice. In baseline questionnaires, 1348 patients newly diagnosed with T2DM gave information on how frequently they consumed a warm main meal and how often they cooked it themselves. The selected patients were followed up for 19 years in the Danish National Patient Registry and the Danish Register of Causes of Death. MAIN OUTCOME MEASURES This study analysed the association between involvement in cooking and each of seven pre-specified outcomes was analysed in Cox regression models with stepwise adjustment for possible confounders and mediators. RESULTS 92% of the patients with T2DM consumed a warm main meal ≥ five times per week. Among these, women who cooked for themselves less than once a week had a higher risk of diabetes-related deaths (HR 1.86 [95% CI 1.03-3.35], p = 0.039) and stroke (HR 2.47 [95% CI 1.08-5.65], p = 0.033), after adjustment for confounders. For men, infrequent cooking was not related to increased risk for the outcomes investigated. CONCLUSIONS In patients newly diagnosed with T2DM and with a regular intake of warm main meals, infrequent involvement in cooking was associated with an increased risk of diabetes-related death and stroke for women, but not for men. General practitioners should pay special attention to managing diabetes treatment in female patients newly diagnosed with T2DM who report infrequent involvement in cooking.
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Affiliation(s)
- Sofie Jandorf
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Køster-Rasmussen
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Niels De Fine Olivarius
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Frans Boch Waldorff
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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van Dillen SME, Hiddink GJ. To what extent do primary care practice nurses act as case managers lifestyle counselling regarding weight management? A systematic review. BMC FAMILY PRACTICE 2014; 15:197. [PMID: 25491594 PMCID: PMC4269898 DOI: 10.1186/s12875-014-0197-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 11/17/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND In this review study, we are the first to explore whether the practice nurse (PN) can act as case manager lifestyle counselling regarding weight management in primary care. METHODS Multiple electronic databases (MEDLINE, PsycINFO) were searched to identify relevant literature after 1995. Forty-five studies fulfilled the inclusion criteria. In addition, all studies were judged on ten quality criteria by two independent reviewers. RESULTS Especially in the last three years, many studies have been published. The majority of the studies were positive about PNs' actual role in primary care. However, several studies dealt with competency issues, including disagreement on respective roles. Thirteen studies were perceived as high quality. Only few studies had a representative sample. PNs' role in chronic disease management is spreading increasingly into lifestyle counselling. Although PNs have more time to provide lifestyle counselling than general practitioners (GPs), lack of time still remains a barrier. In some countries, PNs were rather ambiguous about their role, and they did not agree with GPs on this. CONCLUSION The PN can play the role of case manager lifestyle counselling regarding weight management in primary care in the UK, and wherever PNs are working under supervision of a GP and a primary health care team is already developed with agreement on roles. In countries in which a primary health care team is still in development and there is no agreement on respective roles, such as the USA, it is still the question whether the PN can play the case manager role.
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Affiliation(s)
- Sonja M E van Dillen
- Strategic Communication, Section Communication, Philosophy and Technology, Centre for Integrative Development (CPT-CID), Wageningen University, P.O. Box 8130, 6700 EW, Wageningen, the Netherlands.
| | - Gerrit J Hiddink
- Strategic Communication, Section Communication, Philosophy and Technology, Centre for Integrative Development (CPT-CID), Wageningen University, P.O. Box 8130, 6700 EW, Wageningen, the Netherlands.
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Ebrahim Z, De Villiers A, Ahmed T. Factors influencing adherence to dietary guidelines: a qualitative study on the experiences of patients with type 2 diabetes attending a clinic in Cape Town. JOURNAL OF ENDOCRINOLOGY METABOLISM AND DIABETES OF SOUTH AFRICA 2014. [DOI: 10.1080/16089677.2014.11073604] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Z Ebrahim
- Division of Human Nutrition, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town
| | - A De Villiers
- Division of Human Nutrition, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town
| | - T Ahmed
- Division of Human Nutrition, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town
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van Dillen SME, Noordman J, van Dulmen S, Hiddink GJ. Quality of weight-loss counseling by Dutch practice nurses in primary care: an observational study. Eur J Clin Nutr 2014; 69:73-8. [PMID: 24986823 DOI: 10.1038/ejcn.2014.129] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 05/06/2014] [Accepted: 05/26/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVE To assess the quality of weight-loss counseling provided by Dutch primary care practice nurses (PNs) to overweight and obese patients including both PNs' compliance with the Five A's Model for behavioral counseling in primary care, and the use of different communication styles. In addition, relationships between PN/patient characteristics (including Five A's) and communication styles will be examined. SUBJECTS/METHODS In this observational study, 100 videotaped real-life consultations, collected in 2010/2011, were viewed using an observational checklist. Selection of consultations was based on PNs' registration of patient's complaint. The quality of weight-loss counseling was assessed by the Five A's Model (sequence of evidence-based practice behaviors that are effective for helping patients to change health behaviors) and by PNs' communication styles. Moreover, several PN and patient characteristics were registered. Descriptive statistics and logistic regression analysis were conducted with significance set at P<0.05. RESULTS PNs most frequently arranged follow-up, assessed the risk and current behavior and advised. However, they rarely assisted in addressing barriers and securing support. For weight or physical activity, most PNs used a motivational communication style. In discussions of nutrition, they mostly used an informational communication style. Moreover, PNs used a combination of communication styles. PN characteristics, including their behavior concerning the Five A's, were stronger related to communication styles than patient characteristics. CONCLUSIONS PNs reasonably complied with the Five A's Model. The quality of PNs' weight-loss counseling might be increased by routinely providing assistance in addressing barriers and securing support, and routinely reaching agreement with collaboratively set goals.
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Affiliation(s)
- S M E van Dillen
- Strategic Communication, Section Communication, Philosophy and Technology-Centre for Integrative Development (CPT-CID), Wageningen University, Wageningen, The Netherlands
| | | | - S van Dulmen
- 1] NIVEL, Utrecht, The Netherlands [2] Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands [3] Department of Health Sciences, Buskerud and Vestfold University College, Drammen, Norway
| | - G J Hiddink
- Strategic Communication, Section Communication, Philosophy and Technology-Centre for Integrative Development (CPT-CID), Wageningen University, Wageningen, The Netherlands
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Mulder BC, Lokhorst AM, Rutten GEHM, van Woerkum CMJ. Effective Nurse Communication With Type 2 Diabetes Patients. West J Nurs Res 2014; 37:1100-31. [DOI: 10.1177/0193945914531077] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Many type 2 diabetes mellitus patients have difficulties reaching optimal blood glucose control. With patients treated in primary care by nurses, nurse communication plays a pivotal role in supporting patient health. The twofold aim of the present review is to categorize common barriers to nurse–patient communication and to review potentially effective communication methods. Important communication barriers are lack of skills and self-efficacy, possibly because nurses work in a context where they have to perform biomedical examinations and then perform patient-centered counseling from a biopsychosocial approach. Training in patient-centered counseling does not seem helpful in overcoming this paradox. Rather, patient-centeredness should be regarded as a basic condition for counseling, whereby nurses and patients seek to cooperate and share responsibility based on trust. Nurses may be more successful when incorporating behavior change counseling based on psychological principles of self-regulation, for example, goal setting, incremental performance accomplishments, and action planning.
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Matthews L, Kirk A, Mutrie N. Insight from health professionals on physical activity promotion within routine diabetes care. PRACTICAL DIABETES 2014. [DOI: 10.1002/pdi.1844] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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van Dillen SME, Noordman J, van Dulmen S, Hiddink GJ. Examining the content of weight, nutrition and physical activity advices provided by Dutch practice nurses in primary care: analysis of videotaped consultations. Eur J Clin Nutr 2013; 68:50-6. [PMID: 24169459 DOI: 10.1038/ejcn.2013.219] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 09/12/2013] [Accepted: 09/24/2013] [Indexed: 01/03/2023]
Abstract
BACKGROUND/OBJECTIVE To examine the content of Dutch practice nurses' (PNs') advices about weight, nutrition and physical activity to overweight and obese patients. SUBJECTS/METHODS A 100 videotaped real-life PN consultations (The Netherlands, 2010/2011) with overweight or obese patients were selected. An observational checklist was developed to assess frequency and content. Personalization of advices was scored, as also the guidelines on which PNs based their advices. Content analysis was used to identify different categories of advices. RESULTS About one quarter of advices concerned weight, over two-thirds nutrition and one-third physical activity. Lose weight, eat less fat and be more physically active in general were the main categories for each type of advice. Despite high clarity of advices, lower scores were found for specificity and personalization. Very few nutrition advices were provided in combination with physical activity advices. CONCLUSIONS Weight advices often related to the patient's complaint. PNs seldom set a concrete weight goal. Although benefits of physical activity were discussed, often no practical advices were provided about how to achieve this. Integrated lifestyle advice was not common: advices about nutrition and physical activity were fragmented throughout the consultation. Obesity prevention needs more emphasis in PNs' educational programs.
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Affiliation(s)
- S M E van Dillen
- Strategic Communication, Section Communication, Philosophy and Technology-Centre for Integrative Development (CPT-CID), Wageningen University, Wageningen, The Netherlands
| | | | - S van Dulmen
- 1] NIVEL, Utrecht, The Netherlands [2] Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands [3] Department of Health Sciences, Buskerud University College, Drammen, Norway
| | - G J Hiddink
- Strategic Communication, Section Communication, Philosophy and Technology-Centre for Integrative Development (CPT-CID), Wageningen University, Wageningen, The Netherlands
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Boström E, Isaksson U, Lundman B, Lehuluante A, Hörnsten Å. Patient-centred care in type 2 diabetes - an altered professional role for diabetes specialist nurses. Scand J Caring Sci 2013; 28:675-82. [DOI: 10.1111/scs.12092] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 09/24/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Eva Boström
- Department of Nursing; Umeå University; Umeå Sweden
| | - Ulf Isaksson
- Department of Nursing; Umeå University; Umeå Sweden
| | | | | | - Åsa Hörnsten
- Department of Nursing; Umeå University; Umeå Sweden
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Jansink R, Braspenning J, Keizer E, van der Weijden T, Elwyn G, Grol R. No identifiable Hb1Ac or lifestyle change after a comprehensive diabetes programme including motivational interviewing: a cluster randomised trial. Scand J Prim Health Care 2013; 31:119-27. [PMID: 23659710 PMCID: PMC3656395 DOI: 10.3109/02813432.2013.797178] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To study the effectiveness of a comprehensive diabetes programme in general practice that integrates patient-centred lifestyle counselling into structured diabetes care. Design and setting. Cluster randomised trial in general practices. INTERVENTION Nurse-led structured diabetes care with a protocol, record keeping, reminders, and feedback, plus training in motivational interviewing and agenda setting. SUBJECTS Primary care nurses in 58 general practices and their 940 type 2 diabetes patients with an HbA1c concentration above 7%, and a body mass index (BMI) above 25 kg/m². Main outcome measures. HbA1c, diet, and physical activity (medical records and patient questionnaires). RESULTS Multilevel linear and logistic regression analyses adjusted for baseline outcomes showed that despite active nurse participation in the intervention, the comprehensive programme was no more effective than usual care after 14 months, as shown by HbA1c levels (difference between groups = 0.13; CI 20.8-0.35) and diet (fat (difference between groups = 0.19; CI 20.82-1.21); vegetables (difference between groups = 0.10; CI-0.21-0.41); fruit (difference between groups = 20.02; CI 20.26-0.22)), and physical activity (difference between groups = 21.15; CI 212.26-9.97), or any of the other measures of clinical parameters, patient's readiness to change, or quality of life. CONCLUSION A comprehensive programme that integrated lifestyle counselling based on motivational interviewing principles integrated into structured diabetes care did not alter HbA1c or the lifestyle related to diet and physical activity. We thus question the impact of motivational interviewing in terms of its ability to improve routine diabetes care in general practice.
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Affiliation(s)
- Renate Jansink
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
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Hörnsten Å, Lindahl K, Persson K, Edvardsson K. Strategies in health-promoting dialogues--primary healthcare nurses' perspectives--a qualitative study. Scand J Caring Sci 2013; 28:235-44. [PMID: 23594185 DOI: 10.1111/scs.12045] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 03/20/2013] [Indexed: 11/27/2022]
Abstract
AIM AND OBJECTIVES The aim of this study was to describe dialogic strategies about health and lifestyle used by primary healthcare nurses (PHNs) in the Västerbotten Intervention Programme (VIP) in Sweden. BACKGROUND The VIP offers all citizens aged 40, 50 and 60 in Västerbotten County an individual health check-up followed by a health-promoting dialogue with a specialist PHN. Inconsistencies in previous reports of the effects of lifestyle counselling and health promotion suggest that it is important to study dialogues about health and lifestyle to understand health-promoting strategies and to highlight aspects important to improving their effects. METHOD In 2010, we conducted in-depth interviews with ten experienced PHNs working with the VIP at eight healthcare centres in Västerbotten County, Sweden. Qualitative content analysis was used to illuminate the nurses' strategies in health-promoting dialogues. The Regional Ethics Board (Dno 06-126M) approved the study. RESULTS The PHNs used various strategies in dialogues about health and lifestyle that fell under the five themes 'Guiding patients vs. pressuring them; Adjusting to patients vs. directing the conversation; Inspiring confidence vs. instilling fear; Motivating and supporting patients vs. demanding responsibility; and lastly, Introducing emotionally charged subjects or avoiding them'. CONCLUSIONS The results of this study may add knowledge about the difficulties and opportunities in health counselling. In the discussion, we suggest professional reflection as a means to increase knowledge and awareness about the self and context in the process of health counselling.
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Affiliation(s)
- Åsa Hörnsten
- Department of Nursing, Umeå University, Umeå, Sweden
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Hnatiuk J, Duhamel TA, Katz A, Ready AE. Physical Activity Supports Provided by Healthcare Providers to Patients with Type 2 Diabetes. Can J Diabetes 2012. [DOI: 10.1016/j.jcjd.2012.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Salmela SM, Vähäsarja K, Villberg J, Vanhala M, Saaristo T, Lindström J, Oksa H, Korpi-Hyövälti E, Niskanen L, Keinänen-Kiukaanniemi S, Poskiparta M. The reporting of previous lifestyle counseling by persons at high risk of Type 2 diabetes. PATIENT EDUCATION AND COUNSELING 2012; 87:178-185. [PMID: 21943790 DOI: 10.1016/j.pec.2011.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Revised: 08/01/2011] [Accepted: 08/26/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To assess (i) whether the reporting of counseling previously received is associated with high-risk individuals' agreement to participate in lifestyle intervention, (ii) whether the reporting of previous counseling differed within such a high-risk group, and (iii) the associations between lifestyles and previous lifestyle counseling. METHODS Cross-sectional data were drawn from 10149 adults at high risk of Type 2 diabetes, who were participating in a Finnish national diabetes prevention project (FIN-D2D). Bivariate analysis and multivariate logistic regression were used. RESULTS In relation to the reporting of previous counseling, no difference was found between persons who had agreed and persons who had not agreed to participate in the lifestyle intervention. Persons who were more educated or who had dyslipidemia or diabetes were more likely than the others to report previous counseling. A generally healthy lifestyle, or certain health behaviors (being a non-smoker or eating large amounts of fruit and vegetables) may make the reporting of previous counseling more likely. CONCLUSION The results raise questions about the amount and quality of the previously received lifestyle counseling. PRACTICE IMPLICATIONS There is a need for sustainable lifestyle counseling structures, within vigorously implemented diabetes prevention projects, if long-lasting lifestyle changes are to be achieved.
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Affiliation(s)
- Sanna M Salmela
- Research Centre for Health Promotion, Faculty of Sport and Health Sciences, Department of Health Sciences, University of Jyväskylä, Finland.
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De Greef K, Deforche B, Tudor-Locke C, De Bourdeaudhuij I. Increasing physical activity in Belgian type 2 diabetes patients: a three-arm randomized controlled trial. Int J Behav Med 2011; 18:188-98. [PMID: 21052886 DOI: 10.1007/s12529-010-9124-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pedometer-based physical activity programs have been typically delivered in a group format by a behavioral expert. An alternative strategy that builds on existing interactions is delivery through individual consultation by a general practitioner (GP). These two delivery strategies have not been directly compared. PURPOSE To compare effectiveness of a 12-week physical activity (PA) intervention for type 2 diabetes patients delivered by a trained GP via an individual consultation or as group delivery by a behavioral expert. METHOD Sixty-seven primary care participants (mean age = 67.4 years, 70% male) from three Belgian general practices were randomized into three different treatment arms: (1) individual consultation (n = 22) with three PA contacts with the patient's GP; (2) group counseling (n = 21) with three PA group sessions delivered by a behavioral expert; and (3) a control arm (n = 24) receiving no intervention. Participant inclusion criteria were ≤80 years; 25-35 kg/m²; ≤12% HbA1c and reporting no PA limitations. Outcome measures were pedometer-determined steps/day, self-reported PA, and health parameters (weight, body mass index, waist circumference, total cholesterol, fasting glucose, and HbA1c). RESULTS Group counseling participants increased 1,706 steps/day over baseline significantly (p ≤ 0.05) more than other treatment arms. Moreover, they increased their self-reported PA (+82 min/day), while control arm participants showed a decrease in PA (p ≤ 0.05). Participants of the individual consultation had a decrease in waist circumference (-1.4 cm) and HbA1c (-0.32%) and a lower increase in total cholesterol (+7.2 mg/dl) compared to the other treatment arms (all p ≤ 0.05). CONCLUSION Group counseling in type 2 diabetes patients improved PA, whereas individual consultations had an impact on some health outcomes on the short-term.
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Affiliation(s)
- Karlijn De Greef
- Department of Movement and Sports Sciences, Ghent University, Watersportlaan 2, 9000 Ghent, Belgium
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25
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Imai S, Kozai H, Naruse Y, Watanabe K, Fukui M, Hasegawa G, Obayashi H, Nakamura N, Naito Y, Yoshikawa T, Kajiyama S. Randomized controlled trial of two forms of self-management group education in Japanese people with impaired glucose tolerance. J Clin Biochem Nutr 2011; 43:82-7. [PMID: 18818757 PMCID: PMC2533723 DOI: 10.3164/jcbn.2008050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Accepted: 02/26/2008] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to determine the effectiveness of education on diabetes prevention in subjects with impaired glucose tolerance. A total of 100 subjects of impaired glucose tolerance with hemoglobin A1c (HbA1c) levels ≥5.5 to <6.1% were assigned randomly to either support or control groups. All subjects received education in 8 sessions over a 6-month period. The support group consisted of 10 members collaborating with a dietitian or a nurse who learned coping skills by employing a participant-centered approach. Participants in the support group were required to keep a diary that monitored weight, food intake and blood glucose levels, while the control group attended several lectures. Subjects assigned to the support group had a reduction in mean HbA1c levels from 5.77 ± 0.36% at baseline to 5.39 ± 0.24% at the endpoint (p<0.01). Weight, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglyceride (TG) levels also decreased (p<0.01) in the support group, whereas subjects in the control group had no observable reduction in these indices. After intervention, participants of the support group had improvements in their 2-h post-meal blood glucose levels. Support group education can be effective for improving glycemic control in participants when carried out in collaboration with educators and other team members.
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Affiliation(s)
- Saeko Imai
- Faculty of Comprehensive Rehabilitation, Osaka Prefecture University, Osaka 583-8555, Japan
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Oftedal B, Bru E, Karlsen B. Motivation for diet and exercise management among adults with type 2 diabetes. Scand J Caring Sci 2011; 25:735-44. [DOI: 10.1111/j.1471-6712.2011.00884.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Persson G, Ovhed I, Hansson EE. Simplified routines in prescribing physical activity can increase the amount of prescriptions by doctors, more than economic incentives only: an observational intervention study. BMC Res Notes 2010; 3:304. [PMID: 21078135 PMCID: PMC3000421 DOI: 10.1186/1756-0500-3-304] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2010] [Accepted: 11/15/2010] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Physical inactivity is one well-known risk factor related to disease. Physical activity on prescription (PAP) has been shown in some studies to be a successful intervention for increasing physical activity among patients with a sedentary lifestyle. The method involves motivational counselling that can be time-consuming for the prescribing doctor and might be a reason why physical activity on prescription is not used more frequently. This study might show a way to make the method of prescribing physical activity more user-friendly. The purpose is to determine whether a change in procedures increases the use of physical activity on prescription, and thus the aim of this study is to describe the methodology used. RESULTS The observational intervention study included an intervention group consisting of one Primary Health Care (PHC) clinic and a control group consisting of six PHC clinics serving 149,400 inhabitants in the County of Blekinge, Sweden.An economic incentive was introduced in both groups when prescribing physical activity on prescription. In the intervention group, a change was made to the process of prescribing physical activity, together with information and guidance to the personnel working at the clinics. Physical therapists were used in the process of carrying out the prescription, conducting the motivational interview and counselling the patient. This methodology was used to minimise the workload of the physician. The chi-2 test was used for studying differences between the two groups. PAP prescribed by doctors increased eightfold in the intervention group compared to the control group. The greatest increase of PAP was seen among physicians in the intervention group as compared to all other professionals in the control group. The economic incentive gave a significant but smaller increase of PAP by doctors. CONCLUSION By simplifying and developing PAP, this study has shown a concrete way to increase the implementation of physical activity on prescription in general practice, as opposed to what can be gained by an economic bonus system alone. This study indicates that a bonus system may not be enough to implement an evidence-based method.
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Affiliation(s)
- Gerthi Persson
- Blekinge Centre of Competence, Landstingets Kansli, SE-371 81 Karlskrona, Sweden
| | - Ingvar Ovhed
- Blekinge Centre of Competence, Landstingets Kansli, SE-371 81 Karlskrona, Sweden
| | - Eva Ekvall Hansson
- Lund University, Department of Clinical Sciences in Malmö/General Practice/Family Medicine, Malmö University Hospital SE-205 02 Malmö, Sweden
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Jordan DN, Jordan JL. Self-care behaviors of Filipino-American adults with type 2 diabetes mellitus. J Diabetes Complications 2010; 24:250-8. [PMID: 19615920 DOI: 10.1016/j.jdiacomp.2009.03.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Accepted: 03/28/2009] [Indexed: 11/28/2022]
Abstract
AIM To examine the diabetes self-care behaviors of Filipino-American (FA) adults with type 2 diabetes mellitus (DM). METHOD The Summary of Diabetes Self Care Activities-Revised and Expanded measure was administered to 192 (74 males and 118 females) FA adult immigrants with type 2 DM. RESULTS Older FAs (> or =65 years), females, those who were older when they immigrated, and participants diagnosed with type 2 DM longer were more likely to follow recommended medication regimens. Younger FAs (<65 years) and participants diagnosed with type 2 DM for shorter duration of time were less likely to perform blood glucose testing. Most FAs reported following their eating plans; however, those who lived in the United States (US) longer followed healthful eating plans. Likewise, females reported eating five or more servings of fruits and/or vegetables daily. Moreover, older FAs reported evenly spacing carbohydrate intake everyday. Furthermore, older participants, those with less education, participants who were older when they immigrated, and those older when diagnosed with type 2 DM ate fewer foods high in fats. As to physical activity, FA males and participants with higher education exercised more frequently. CONCLUSION Younger FAs were less likely to perform optimum type 2 DM self-care behaviors pertaining to diet, medication taking, and blood glucose testing compared to their older counterparts. This finding suggests an increased risk for type 2 DM comorbidities and/or complications in younger FAs, which may require more intensive treatments in later years.
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Affiliation(s)
- Deovina N Jordan
- Department of Nursing, Ronald Reagan UCLA Medical Center, Los Angeles, CA 90095-7404, USA.
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Educational differences in the diet of Finnish adults and the associations between education and the determinants and facilitators of dietary fat quality. Public Health Nutr 2010; 13:925-31. [DOI: 10.1017/s1368980010001114] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveThe aim of the study is to elucidate differences in adults’ diet by education, and to analyse the associations between dietary facilitators, education and dietary fat quality.DesignIn all, one-third of subjects from the national FINRISK health survey were invited to participate in the FINDIET 2007 Survey. A 48 h dietary interview was used for dietary data and personal background data were collected by the health survey questionnaire.SettingRepresentative sample from five regions in Finland in spring 2007.SubjectsA total of 1576 adults, participation rate 60 %.ResultsOil used in cooking differed by education. Instead perception of cardiovascular risk, or the following of a cholesterol-lowering diet, were equal across all educational categories. The diet of men with low education contained less protein and carbohydrates, more fat and more SFA and MUFA than that of highly educated men. The diet of women with low education contained less PUFA, vitamin C and vitamin E than in the highly educated category. High education remained a significant determinant for the lower intake of SFA in men, and for the higher intake of PUFA in women, after adjusting for the determinants and facilitators of dietary behaviour and age. The lower intake of SFA was also associated with following a cholesterol-lowering diet in both genders. In addition to education, the intake of unsaturated fatty acids was determined by the oil used in cooking by women, and by frequent lunches served by caterers for men.ConclusionsIn dietary behaviour, awareness and reporting of cholesterol-lowering diet seem to indicate a tendency to control the intake of saturated fat. Health messages are likely to enhance tools for increasing the intake of PUFA, in addition to reducing the intake of SFA.
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Roumen C, Blaak EE, Corpeleijn E. Lifestyle intervention for prevention of diabetes: determinants of success for future implementation. Nutr Rev 2009; 67:132-46. [DOI: 10.1111/j.1753-4887.2009.00181.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Persson M, Friberg F. The dramatic encounter: experiences of taking part in a health conversation. J Clin Nurs 2009; 18:520-8. [DOI: 10.1111/j.1365-2702.2008.02535.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rubak S, Sandbaek A, Lauritzen T, Borch-Johnsen K, Christensen B. General practitioners trained in motivational interviewing can positively affect the attitude to behaviour change in people with type 2 diabetes. One year follow-up of an RCT, ADDITION Denmark. Scand J Prim Health Care 2009; 27:172-9. [PMID: 19565411 PMCID: PMC3413190 DOI: 10.1080/02813430903072876] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To examine whether training GPs in motivational interviewing (MI) can improve type 2 diabetic patients' (1) understanding of diabetes, (2) beliefs regarding prevention and treatment, and (3) motivation for behaviour change. METHODS A randomized controlled trial including 65 GPs and 265 type 2 diabetic patients. The GPs were randomized in two groups, one with and one without MI training. Both groups received training in target-driven intensive treatment of type 2 diabetic patients. The intervention was a 1(1/2)-day residential course in MI with (1/2)-day follow-up twice during the first year. The patient data stemmed from previously validated questionnaires. MAIN OUTCOME MEASURES The Health Care Climates Questionnaire assesses the patient-doctor relationship and type of counselling. The Treatment Self-Regulation Questionnaire assesses the degree to which behaviour tends to be self-determined. The Diabetes Illness Representation Questionnaire assesses beliefs and understanding of type 2 diabetes. The Summary of Diabetes Self Care Activities assesses the extent of various self-care activities related to type 2 diabetes. RESULTS The response rate to our questionnaires was 87%. Patients in the intervention group were significantly more autonomous and motivated in their inclination to change behaviour after one year compared with the patients from the control group. Patients in the intervention group were also significantly more conscious of the importance of controlling their diabetes, and had a significantly better understanding of the possibility of preventing complications. CONCLUSION MI improved type 2 patients' understanding of diabetes, their beliefs regarding treatment aspects, their contemplation on and motivation for behaviour change. Whether our results can be sustained long term and are clinically relevant in terms of changes in risk profile advocates further research.
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Affiliation(s)
- Sune Rubak
- Department of General Practice and Research Unit of General Medical Practice, Institute of Public Health, University of Aarhus, Aarhus, Denmark.
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Adolfsson ET, Smide B, Rosenblad A, Wikblad K. Does patient education facilitate diabetic patients' possibilities to reach national treatment targets? A national survey in Swedish primary healthcare. Scand J Prim Health Care 2009; 27:91-6. [PMID: 19247874 PMCID: PMC3410468 DOI: 10.1080/02813430902759671] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To describe how patient education is arranged in Swedish primary healthcare (PHC) and to assess whether the type of patient education and individual goal setting have an impact on diabetic patients' possibilities of reaching national treatment targets. DESIGN A Swedish national survey. SETTING Swedish PHC. SUBJECTS Data from 485 primary healthcare centres (PHCCs) and 91,637 diabetic patients reported by the PHCCs to the National Diabetes Register in 2006. MAIN OUTCOME MEASURES Description of how patient education is arranged, HbA(1c), body mass index, cholesterol, blood pressure, and physical activity. RESULTS Of the PHCCs that reported how they performed the individual counselling, 50% reported checklist-driven counselling and 8% individualized counselling based on patients' needs. A total of 105 PHCCs reported that they arranged group education. Of these, 67% used pre-planned programmes and 9% individualized the programme to the patients' needs. The majority of PHCCs (96%) reported that they set individual goals (HbA(1c), blood pressure, lipids, and lifestyle). A minority of the PHCCs (27%) reported that the patients were involved in the final decision concerning their goals. Individual goal-setting facilitated patients' possibilities of reaching treatment targets. Goal-setting, list size of PHCCs, and personnel resources explained a variance of 2.1-5.7%. Neither individual counselling (checklist-driven or individualized to patients' needs) nor group education had an impact on patients' possibilities of reaching the targets. CONCLUSION The current study indicates that improvement is needed in patient education in PHC to facilitate diabetic patients' possibilities of reaching national treatment targets.
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Affiliation(s)
- Eva Thors Adolfsson
- Department of Medical Sciences, Faculty of Medicine, Uppsala University, Uppsala, Sweden.
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Shatenstein B. Impact of Health Conditions on Food Intakes Among Older Adults. ACTA ACUST UNITED AC 2008; 27:333-61. [DOI: 10.1080/01639360802265889] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Kristensen JK, Stoevring H. A follow-up study of the occurrence and consequences of HbA1c measurements in an unselected cohort of non-pharmacologically treated patients with Type 2 diabetes. Scand J Prim Health Care 2008; 26:57-62. [PMID: 18297565 PMCID: PMC3406631 DOI: 10.1080/02813430801892532] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES To describe the occurrence of HbA1c measurements among non-pharmacologically treated diabetes patients, and to evaluate whether poor blood glucose regulation (HbA1c >8%) prompted intensification of treatment. METHOD Data from the National Health Service Registry, the Regional Laboratory Database and the Danish National Hospital Registry were collected from 2002 to 2004 to identify and describe all Type 2 diabetic patients above 40 years of age in a background population of nearly 660,000 citizens in Aarhus County, corresponding to 12% of the total Danish population. RESULTS A total of 1989 had at least one HbA1c measurement, whereas 484 (20%) had no HbA1c measurement at all in 2003. Most patients had an HbA1c of less than 8%, and for 820 (41%) HbA1c was less than 6.5%, but for 316 (16%) patients, the first HbA1c measurement in 2003 was above 8%. After 6 months, patients with HbA1c above 8% had a higher probability of initiating pharmacological treatment (M; 0.64; 95% CI 0.58-0.70) (F; 0.68; 95% CI 0.58-0.77) than patients with HbA1c below 8% (M; 0.12; 95% CI 0.10-0.14) (F; 0.11; 95% CI 0.09-0.14). CONCLUSION This study indicates that poor blood glucose regulation (HbA1c >8%) prompted a shift from non-pharmacological treatment to pharmacological treatment for most patients. However, a substantial group of patients are either not monitored on a regular basis or, if monitored, their elevated measurements of HbA1c do not prompt initiation of pharmacological treatment.
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Jallinoja P, Absetz P, Kuronen R, Nissinen A, Talja M, Uutela A, Patja K. The dilemma of patient responsibility for lifestyle change: perceptions among primary care physicians and nurses. Scand J Prim Health Care 2007; 25:244-9. [PMID: 17934984 PMCID: PMC3379767 DOI: 10.1080/02813430701691778] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To explore physicians' and nurses' views on patient and professional roles in the management of lifestyle-related diseases and their risk factors. DESIGN A questionnaire study with a focus on adult obesity, dyslipidemia, high blood pressure, type 2 diabetes, and smoking. SETTING Healthcare centres in Päijät-Häme hospital district, Finland. SUBJECTS Physicians and nurses working in primary healthcare (n =220). MAIN OUTCOME MEASURES Perceptions of barriers to treatment of lifestyle-related conditions, perceptions of patients' responsibilities in self-care, experiences of awkwardness in intervening in obesity and smoking, perceptions of rushed schedules, and perceptions of health professionals' roles and own competence in lifestyle counselling. RESULTS A majority agreed that a major barrier to the treatment of lifestyle-related conditions is patients' unwillingness to change their habits. Patients' insufficient knowledge was considered as such a barrier less often. Self-care was actively encouraged. Although a majority of both physicians and nurses agreed that providing information, and motivating and supporting patients in lifestyle change are part of their tasks, only slightly more than one half estimated that they have sufficient skills in lifestyle counselling. Among nurses, those with less professional experience more often reported having sufficient skills than those with more experience. Two-thirds of the respondents reported that they had been able to help many patients to change their lifestyles into healthier ones. CONCLUSIONS The primary care professionals experienced a dilemma in patients' role in the treatment of lifestyle-related diseases: the patient was recognized as central in disease management but also, if reluctant to change, a major potential barrier to treatment.
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Vähätalo M, Rönnemaa T, Viikari J. Recognition of fasting or overall hyperglycaemia when starting insulin treatment in patients with type 2 diabetes in general practice. Scand J Prim Health Care 2007; 25:147-53. [PMID: 17846932 PMCID: PMC3379773 DOI: 10.1080/02813430701507719] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE The efficacy of various regimens of initial insulin treatment in poorly controlled type 2 diabetes was compared with regard to diurnal glucose variation. DESIGN Randomized controlled trial. Setting. Insulin therapy initiated on hospital wards, follow-up as outpatients for 12 months. SUBJECTS Fifty-two type 2 diabetic patients (HbA1c >7.5%, mean 9.8%) on maximal oral therapy. Interventions. Insulin only (IO), bedtime insulin with sulphonylurea (glipizide) (IS), or bedtime insulin with metformin (IM). MAIN OUTCOME MEASURES HbA1c and body weight. RESULTS HbA1c decreased on average by 1.8, 1.0 and 1.5 percentage points in the IO, IS, and IM groups, respectively (p always <0.025). Body weight increased, most in the IO patients (+6.2 kg), least in the IM patients (+3.4 kg). Analysing all treatment groups combined, a similar HbA1c reduction was observed in patients with overall hyperglycaemia (low fasting plasma glucose/HbA1c ratio) and in patients with fasting hyperglycaemia (high fasting plasma glucose/HbA1c ratio). Within the overall hyperglycaemia group, the IS and IM patients had smaller decreases in HbA1c (-1.5 and -1.3 percentage points, respectively) than the IO patients (-2.7 percentage points). On the other hand, within the fasting hyperglycaemia group HbA1c reductions were -1.2, -0.8 and -1.5 percentage points, in the IO, IS, and IM groups, respectively. CONCLUSION Not all poorly controlled type 2 diabetic patients should automatically be treated with an oral agent and bedtime insulin. Two daily insulin injections is a valid choice, particularly if the patient has overall hyperglycaemia.
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