Occupational therapy in diabetic care-areas of need perceived by older adults with diabetes

Habit Formation Intervention to Improve Type 2 Diabetes Self-Management Behaviors: A Feasibility Study

IMPORTANCE

Self-management of lifestyle behaviors is the recommended focus for interventions to address Type 2 diabetes. Habit formation is an effective approach to changing personal behaviors, but evidence of success for Type 2 diabetes is limited.

OBJECTIVE

To examine the feasibility and preliminary effectiveness of occupation-based habit formation interventions for improving diabetes self-management behaviors.

DESIGN

Single-subject design with multiple participants providing 4 wk of baseline data followed by 10 wk of intervention data.

SETTING

Individual telehealth sessions.

PARTICIPANTS

Eight adults (ages 29-75 yr) with Type 2 diabetes, who had access to a telephone and who were not involved in other diabetes-related education or interventions voluntarily, enrolled into the study.

INTERVENTION

Participants engaged in 10 wk of habit formation intervention focused on four diabetes self-management domains: nutrition, blood glucose monitoring, medication management, and physical activity.

OUTCOMES AND MEASURES

Data gathered included findings on measures of diabetes self-care behaviors and habit formation.

RESULTS

There was a significant change in self-care behaviors for 6 of the 8 participants (p < .05 for 1 participant, and p < .01 for 5 participants). Group changes were statistically significant (p < .001). Habit strength significantly improved for all areas of diabetes self-management (p < .001 for nutrition, blood glucose monitoring, and medication management and p = .001 for physical activity).

CONCLUSIONS AND RELEVANCE

Findings suggest that the occupation-based intervention was feasible and showed promise for developing self-management behaviors. What This Article Adds: Habits are considered foundational to occupations, yet application of the science of habit formation is often not well understood by occupational therapists. This study considered the theoretical components of habit formation that have been neglected by prior studies and demonstrates the feasibility and preliminary effect estimates of a habit formation intervention when used with people with Type 2 diabetes.

Activity Limitations, Participation, and Quality of Life in American Indians with and without Diabetes

The objective of this study was to examine activity limitations, participation, and quality of life (QOL) in American Indians with and without diabetes. It was a cross-sectional study that included 43 participants with diabetes and 31 healthy controls. Participants received evaluations of QOL, activity and participation limitations and factors such as pain, joint motion, hand function, and depression. There were no significant differences between the two groups for past, present, or future global QOL. However, there were significant differences between the two groups for the activity and participation measures and all measures of body structure/function except for left hand strength and depression. Current health and pain, and activity limitation correlated with QOL in both groups. Joint motion and participation correlated with QOL in the group with diabetes. American Indians with diabetes had more impairments in body structure and function and limitations in activities and participation compared to American Indians without diabetes.

The lived experience of diabetes: Conceptualisation using a metaphor

Introduction

It is important for healthcare professionals to understand the reality of living with diabetes in order to better engage and enable people to self-manage. The purpose of this research was thus a preliminary exploration of the lived experience of diabetes.

Method

This qualitative study involved seven people with a diagnosis of type 1, type 2 or pre-diabetes. Data was collected via semi-structured interviews and analysed using a phenomenological approach including the use of metaphor. Findings were shared with participants using a felted metaphor of charting a course of health and wellbeing through a choppy sea. Findings: Themes explored within the elements of the metaphor included the boat (self-identity, control, balance, compliance and empowerment, emotions), the sea (physical and social environment, lifestyle, life events), the course (information gathering, change, self-action) and the boatyard (relationships with healthcare providers).

Conclusion

For those with type 1, type 2 and pre-diabetes, the elements of charting a course of health and wellbeing through a choppy sea are very much focused on the person in their own context, impacted by their environment, life stage, occupations and attitudes to diabetes self-management, all of which fall within the remit of occupational therapy.

"I see it now": Using photo elicitation to understand chronic illness self-management

BACKGROUND

How people integrate self-management into daily life remains underexamined, and such processes are difficult to elicit through traditional approaches used to understand human occupation.

PURPOSE

This paper will provide a brief overview of one visual research method, photo elicitation, that holds promise for studying self-management of health behaviours and will present findings from an analysis of how the use of photo elicitation interviews contributed additional insights into self-management beyond those generated from the data collected through the other methods used in the study.

METHOD

A qualitative, multiple-methods, multiple-case study was conducted with a purposive sample of 10 low-income women ages 40 to 64 with type 2 diabetes.

FINDINGS

The photo elicitation interviews contributed insights beyond those generated from other study methods about how individuals viewed their self-management behaviours and how occupations changed across time.

IMPLICATIONS

Photo elicitation is a valuable research method for better understanding clients' chronic illness self-management practices.

The Role of Occupational Therapy in Diabetes Self-Management Interventions

Approximately 23.6 million people in the United States are living with diabetes, a disease that is a leading cause of disabling conditions including blindness, kidney failure, amputations, heart disease, and stroke. Although these complications of diabetes can be delayed or prevented through intensive diabetes self-management (DSM), maintaining control of the disease can be burdensome and negatively impact quality of life. Occupational therapy has a largely untapped potential to assist individuals who struggle with managing diabetes in the context of everyday life, yet there is little discussion of DSM in the occupational therapy literature. The author conducts a systematic review of the existing occupational therapy literature on diabetes, examines the current state of DSM interventions, and discusses a potential role for occupational therapy using programs such as Lifestyle Redesign®.