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Singh H, Samkange-Zeeb F, Kolschen J, Herrmann R, Hübner W, Barnils NP, Brand T, Zeeb H, Schüz B. Interventions to promote health literacy among working-age populations experiencing socioeconomic disadvantage: systematic review. Front Public Health 2024; 12:1332720. [PMID: 38439762 PMCID: PMC10909862 DOI: 10.3389/fpubh.2024.1332720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/05/2024] [Indexed: 03/06/2024] Open
Abstract
Background Experiencing financial insecurity and being underserved is often associated with low health literacy, i.e., the ability to identify, obtain, interpret and act upon health information, which may result in poor health outcomes. Little is known about effective interventions for promoting health literacy among underserved populations. The objective of this systematic review is to summarize the literature on such interventions and identify characteristics that differentiate more effective interventions. Methods Following PRISMA guidelines we searched the databases SCOPUS, Pubmed, Web of Science core collection and CINAHL. We included primary studies with a quantitative study design and control groups testing interventions to increase health literacy or health knowledge in underserved populations between 18 and 65 years. Where possible, we converted effect sizes into Cohen's d and compared mean differences of intervention and control groups. Albatross plots were created to summarize the results according to different health literacy and health knowledge outcomes. Results We screened 3,696 titles and abstracts and 206 full texts. In total, 86 articles were analyzed, of which 55 were summarized in seven albatross plots. The majority of the studies (n = 55) were conducted in the United States and had a randomized controlled study design (n = 44). More effective intervention approaches assessed needs of participants through focus group discussions prior to conducting the intervention, used bilingual educational materials, and included professionals fluent in the first languages of the study population as intervention deliverers. Additionally, the use of educational materials in video and text form, fotonovelas and interactive group education sessions with role playing exercises were observed to be effective. Discussion Although the outcomes addressed in the included studies were heterogeneous, effective intervention approaches were often culturally sensitive and developed tailored educational materials. Interventions aiming to promote health literacy in underserved populations should hence consider applying similar approaches.Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=323801, PROSPERO registration ID: CRD42022323801.
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Affiliation(s)
- Himal Singh
- Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
| | - Florence Samkange-Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Jonathan Kolschen
- Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
| | - Ruben Herrmann
- Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
| | - Wiebke Hübner
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Núria Pedrós Barnils
- Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
| | - Tilman Brand
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Benjamin Schüz
- Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
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Park SH, Lee H. Comparing the effects of home visits and telenursing on blood glucose control: A systematic review of randomized controlled trials. Int J Nurs Stud 2023; 148:104607. [PMID: 37839308 DOI: 10.1016/j.ijnurstu.2023.104607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 08/26/2023] [Accepted: 09/11/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Home visits have often been performed for diabetes management, but with the increased use of the internet and smartphones, people are opting for telenursing as the main method for monitoring and controlling diabetes. OBJECTIVE This study compares the effects of home visits and telenursing on diabetes management. METHODS Four electronic databases (MEDLINE, Embase, Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature) were used as data sources. Glycated hemoglobin (HbA1c), fasting blood sugar, and two-hour post-prandial glucose levels were used as outcome measures. A subgroup analysis was performed based on the type of diabetes and follow-up. RESULTS Of 1890 studies, 24 (2801 participants) were selected and meta-analyzed. The nursing interventions provided during nursing visits or telenursing mainly included education on diabetes and blood sugar control. It was seen that HbA1c decreased with a weighted mean difference of -0.66 (95 % confidence interval -0.82 to -0.51, p < .001) % in home visits and -0.56 (95 % confidence interval -0.81 to -0.31, p < .001) % in telenursing. The fasting blood sugar reported only in telenursing was reduced by a weighted mean difference of -14.23 (95 % confidence interval 27.59 to -0.88, p = .04) mg/dL and two-hour post-prandial glucose was reduced with a mean difference of -15.84 (95 % confidence interval -24.45 to -7.24, p = .003) mg/dL. Furthermore, low heterogeneity was found among the studies. In a subgroup analysis of diabetes type, HbA1c in home visits was reduced by -0.86 % in type 1 diabetes and -0.62 % in type 2 diabetes, while in telenursing, the reductions were -0.65 % and -0.53 %, respectively. Fasting blood glucose was reduced by -6.08 mg/dL and -18.50 mg/dL, respectively, whereas two-hour postprandial blood sugar was reduced by -14.49 mg/dL and -30.30 mg/dL, respectively, in telenursing. In the subgroup analysis of the follow-up period, HbA1c during home visits decreased by -0.63 % at 10 to 16 weeks, -0.73 % at 24 to 36 weeks, and -0.64 % at 52 weeks or more, while in telenursing, the reductions were -0.80 %, -0.44 %, and -0.07 %, respectively. Home visits were not statistically significant between 10 and 16 weeks, whereas telenursing was not significant at 52 weeks or more. CONCLUSIONS Despite telenursing reducing HbA1c slightly less than home visits, evidence from this systematic review suggests that telenursing is a similarly effective approach for controlling blood glucose levels in patients with diabetes. Telenursing is a nursing intervention that can be used as an alternative to home visits for patients requiring diabetes management.
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Affiliation(s)
- Seong-Hi Park
- School of Nursing, Soonchunhyang University, Asan, Republic of Korea
| | - Heashoon Lee
- Department of Nursing, Hannam University, Daejeon, Republic of Korea.
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Konnyu KJ, Yogasingam S, Lépine J, Sullivan K, Alabousi M, Edwards A, Hillmer M, Karunananthan S, Lavis JN, Linklater S, Manns BJ, Moher D, Mortazhejri S, Nazarali S, Paprica PA, Ramsay T, Ryan PM, Sargious P, Shojania KG, Straus SE, Tonelli M, Tricco A, Vachon B, Yu CH, Zahradnik M, Trikalinos TA, Grimshaw JM, Ivers N. Quality improvement strategies for diabetes care: Effects on outcomes for adults living with diabetes. Cochrane Database Syst Rev 2023; 5:CD014513. [PMID: 37254718 PMCID: PMC10233616 DOI: 10.1002/14651858.cd014513] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND There is a large body of evidence evaluating quality improvement (QI) programmes to improve care for adults living with diabetes. These programmes are often comprised of multiple QI strategies, which may be implemented in various combinations. Decision-makers planning to implement or evaluate a new QI programme, or both, need reliable evidence on the relative effectiveness of different QI strategies (individually and in combination) for different patient populations. OBJECTIVES To update existing systematic reviews of diabetes QI programmes and apply novel meta-analytical techniques to estimate the effectiveness of QI strategies (individually and in combination) on diabetes quality of care. SEARCH METHODS We searched databases (CENTRAL, MEDLINE, Embase and CINAHL) and trials registers (ClinicalTrials.gov and WHO ICTRP) to 4 June 2019. We conducted a top-up search to 23 September 2021; we screened these search results and 42 studies meeting our eligibility criteria are available in the awaiting classification section. SELECTION CRITERIA We included randomised trials that assessed a QI programme to improve care in outpatient settings for people living with diabetes. QI programmes needed to evaluate at least one system- or provider-targeted QI strategy alone or in combination with a patient-targeted strategy. - System-targeted: case management (CM); team changes (TC); electronic patient registry (EPR); facilitated relay of clinical information (FR); continuous quality improvement (CQI). - Provider-targeted: audit and feedback (AF); clinician education (CE); clinician reminders (CR); financial incentives (FI). - Patient-targeted: patient education (PE); promotion of self-management (PSM); patient reminders (PR). Patient-targeted QI strategies needed to occur with a minimum of one provider or system-targeted strategy. DATA COLLECTION AND ANALYSIS We dual-screened search results and abstracted data on study design, study population and QI strategies. We assessed the impact of the programmes on 13 measures of diabetes care, including: glycaemic control (e.g. mean glycated haemoglobin (HbA1c)); cardiovascular risk factor management (e.g. mean systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), proportion of people living with diabetes that quit smoking or receiving cardiovascular medications); and screening/prevention of microvascular complications (e.g. proportion of patients receiving retinopathy or foot screening); and harms (e.g. proportion of patients experiencing adverse hypoglycaemia or hyperglycaemia). We modelled the association of each QI strategy with outcomes using a series of hierarchical multivariable meta-regression models in a Bayesian framework. The previous version of this review identified that different strategies were more or less effective depending on baseline levels of outcomes. To explore this further, we extended the main additive model for continuous outcomes (HbA1c, SBP and LDL-C) to include an interaction term between each strategy and average baseline risk for each study (baseline thresholds were based on a data-driven approach; we used the median of all baseline values reported in the trials). Based on model diagnostics, the baseline interaction models for HbA1c, SBP and LDL-C performed better than the main model and are therefore presented as the primary analyses for these outcomes. Based on the model results, we qualitatively ordered each QI strategy within three tiers (Top, Middle, Bottom) based on its magnitude of effect relative to the other QI strategies, where 'Top' indicates that the QI strategy was likely one of the most effective strategies for that specific outcome. Secondary analyses explored the sensitivity of results to choices in model specification and priors. Additional information about the methods and results of the review are available as Appendices in an online repository. This review will be maintained as a living systematic review; we will update our syntheses as more data become available. MAIN RESULTS We identified 553 trials (428 patient-randomised and 125 cluster-randomised trials), including a total of 412,161 participants. Of the included studies, 66% involved people living with type 2 diabetes only. Participants were 50% female and the median age of participants was 58.4 years. The mean duration of follow-up was 12.5 months. HbA1c was the commonest reported outcome; screening outcomes and outcomes related to cardiovascular medications, smoking and harms were reported infrequently. The most frequently evaluated QI strategies across all study arms were PE, PSM and CM, while the least frequently evaluated QI strategies included AF, FI and CQI. Our confidence in the evidence is limited due to a lack of information on how studies were conducted. Four QI strategies (CM, TC, PE, PSM) were consistently identified as 'Top' across the majority of outcomes. All QI strategies were ranked as 'Top' for at least one key outcome. The majority of effects of individual QI strategies were modest, but when used in combination could result in meaningful population-level improvements across the majority of outcomes. The median number of QI strategies in multicomponent QI programmes was three. Combinations of the three most effective QI strategies were estimated to lead to the below effects: - PR + PSM + CE: decrease in HbA1c by 0.41% (credibility interval (CrI) -0.61 to -0.22) when baseline HbA1c < 8.3%; - CM + PE + EPR: decrease in HbA1c by 0.62% (CrI -0.84 to -0.39) when baseline HbA1c > 8.3%; - PE + TC + PSM: reduction in SBP by 2.14 mmHg (CrI -3.80 to -0.52) when baseline SBP < 136 mmHg; - CM + TC + PSM: reduction in SBP by 4.39 mmHg (CrI -6.20 to -2.56) when baseline SBP > 136 mmHg; - TC + PE + CM: LDL-C lowering of 5.73 mg/dL (CrI -7.93 to -3.61) when baseline LDL < 107 mg/dL; - TC + CM + CR: LDL-C lowering by 5.52 mg/dL (CrI -9.24 to -1.89) when baseline LDL > 107 mg/dL. Assuming a baseline screening rate of 50%, the three most effective QI strategies were estimated to lead to an absolute improvement of 33% in retinopathy screening (PE + PR + TC) and 38% absolute increase in foot screening (PE + TC + Other). AUTHORS' CONCLUSIONS There is a significant body of evidence about QI programmes to improve the management of diabetes. Multicomponent QI programmes for diabetes care (comprised of effective QI strategies) may achieve meaningful population-level improvements across the majority of outcomes. For health system decision-makers, the evidence summarised in this review can be used to identify strategies to include in QI programmes. For researchers, this synthesis identifies higher-priority QI strategies to examine in further research regarding how to optimise their evaluation and effects. We will maintain this as a living systematic review.
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Affiliation(s)
- Kristin J Konnyu
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Sharlini Yogasingam
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Johanie Lépine
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Katrina Sullivan
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Alun Edwards
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Michael Hillmer
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Sathya Karunananthan
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada
| | - John N Lavis
- McMaster Health Forum, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Stefanie Linklater
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Braden J Manns
- Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Canada
| | - David Moher
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Sameh Mortazhejri
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Samir Nazarali
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Canada
| | - P Alison Paprica
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Timothy Ramsay
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Peter Sargious
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Kaveh G Shojania
- University of Toronto Centre for Patient Safety, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Sharon E Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital and University of Toronto, Toronto, Canada
| | - Marcello Tonelli
- Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Canada
| | - Andrea Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital and University of Toronto, Toronto, Canada
- Epidemiology Division and Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Queen's University, Kingston, Canada
| | - Brigitte Vachon
- School of Rehabilitation, Occupational Therapy Program, University of Montreal, Montreal, Canada
| | - Catherine Hy Yu
- Department of Medicine, St. Michael's Hospital, Toronto, Canada
| | - Michael Zahradnik
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Thomas A Trikalinos
- Departments of Health Services, Policy, and Practice and Biostatistics, Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Noah Ivers
- Department of Family and Community Medicine, Women's College Hospital, Toronto, Canada
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Ojewale LY, Oluwatosin OA. Family-integrated diabetes education for individuals with diabetes in South-west Nigeria. Ghana Med J 2022; 56:276-284. [PMID: 37575630 PMCID: PMC10416295 DOI: 10.4314/gmj.v56i4.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023] Open
Abstract
Objectives This study aimed to determine the effects of family-integrated diabetes education on diabetes knowthe ledge of patients and family members, as well as its impact on patients' glycosylated haemoglobin (A1C). Design The design was a two-group Pretest Posttest quasi-experimental. Setting The study took place at the diabetes clinics of two tertiary hospitals in southwestern Nigeria. Participants People Living with Diabetes (PLWD) and family members aged 18 years and over and without cognitive impairment were placed, as clusters, into either a control group (CG) or an intervention group (IG) The CG comprised 88 patients and 88 family members while IG comprised 82 patients and 82 family members. Of these, 78 and 74 patients completed the study in CG and IG, respectively. Interventions PLWD in IG along with their family members were given an educational intervention on diabetes management and collaborative support with an information booklet provided. This was followed by three (3) complimentary Short Messaging Service (SMS). Main outcome measures A1C and diabetes knowledge. Results Over half (52.4%) and about a fifth (18.2%) of family members and patients, respectively, had never had diabetes education. There was a statistically significant increase in the knowledge of patients and family members in IG. Unlike CG, the A1C of patients in IG improved significantly at three and six-month post-intervention, (p<0.01). Regression showed an independent effect of family members' knowledge on IG's A1C. Conclusions Improved family members' diabetes knowledge positively impacted patients' glucose level. There is a need to integrate family members into diabetes care better. Funding African Doctoral Dissertation Research Fellowship (ADDRF) award offered by the Africa Population and Health Research Center (APHRC) in partnership with the International Development Research Centre.
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Affiliation(s)
- Lucia Y Ojewale
- Department of Nursing, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Oyeninhun A Oluwatosin
- Department of Nursing, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
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Hangaard S, Laursen SH, Andersen JD, Kronborg T, Vestergaard P, Hejlesen O, Udsen FW. The Effectiveness of Telemedicine Solutions for the Management of Type 2 Diabetes: A Systematic Review, Meta-Analysis, and Meta-Regression. J Diabetes Sci Technol 2021; 17:794-825. [PMID: 34957864 DOI: 10.1177/19322968211064633] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous systematic reviews have aimed to clarify the effect of telemedicine on diabetes. However, such reviews often have a narrow focus, which calls for a more comprehensive systematic review within the field. Hence, the objective of the present systematic review, meta-analysis, and meta-regression is to evaluate the effectiveness of telemedicine solutions versus any comparator without the use of telemedicine on diabetes-related outcomes among adult patients with type 2 diabetes (T2D). METHODS This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We considered telemedicine randomized controlled trials (RCT) including adults (≥18 years) diagnosed with T2D. Change in glycated hemoglobin (HbA1c, %) was the primary outcome. PubMed, EMBASE, and the Cochrane Library Central Register of Controlled Trials (CENTRAL) were searched on October 14, 2020. An overall treatment effect was estimated using a meta-analysis performed on the pool of included studies based on the mean difference (MD). The revised Cochrane risk-of-bias tool was applied and the certainty of evidence was graded using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. RESULTS The final sample of papers included a total of 246, of which 168 had sufficient information to calculate the effect of HbA1c%. The results favored telemedicine, with an MD of -0.415% (95% confidence interval [CI] = -0.482% to -0.348%). The heterogeneity was great (I2 = 93.05%). A monitoring component gave rise to the higher effects of telemedicine. CONCLUSIONS In conclusion, telemedicine may serve as a valuable supplement to usual care for patients with T2D. The inclusion of a telemonitoring component seems to increase the effect of telemedicine.
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Affiliation(s)
- Stine Hangaard
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg, Denmark
| | - Sisse H Laursen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Department of Nursing, University College of Northern Denmark, Aalborg, Denmark
| | - Jonas D Andersen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Thomas Kronborg
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg, Denmark
| | - Peter Vestergaard
- Steno Diabetes Center North Denmark, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ole Hejlesen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Flemming W Udsen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Zhang H, Zhang Q, Luo D, Cai X, Li R, Zhang Y, Lu Y, Liu J, Gu J, Li M. The effect of family-based intervention for adults with diabetes on HbA1c and other health-related outcomes: Systematic review and meta-analysis. J Clin Nurs 2021; 31:1488-1501. [PMID: 34888968 DOI: 10.1111/jocn.16082] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/11/2021] [Accepted: 10/03/2021] [Indexed: 01/17/2023]
Abstract
AIMS AND OBJECTIVES To evaluate the effectiveness of family-based intervention for adults with diabetes on glycosylated haemoglobin and other health-related outcomes. BACKGROUND The impact of family-based intervention on adults with diabetes has been evaluated in various studies, but there is uncertainty about their effect on health-related outcomes for adults with diabetes. DESIGN A systematic review and meta-analysis of randomised controlled trials. METHODS A review was performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Six relevant databases were searched from inception to 5 March 2021. Heterogeneity between studies was quantified by using Higgins' I2 test. Sensibility and subgroup analyses were used to explore potential heterogeneity. RESULTS The review included 23 studies (3,114 participants). Family-based intervention had a significant effect on improving glycosylated haemoglobin levels, body mass index, blood pressure, fasting glucose, diabetes self-care, diabetes self-efficacy, diabetes distress and positive family support. Non-significant results were obtained for blood lipid, body weight, depression and negative family support. In particular, subgroup analyses indicated that family-based intervention in Asian regions was more effective in improving glycosylated haemoglobin levels than in other areas. CONCLUSION Family-based intervention may improve diabetes control, diabetes self-care, psychological well-being and positive family support in adults with diabetes and is especially effective in Asian regions. Given the limitations in current studies, further studies are recommended to combine family theory with family-based intervention, and to examine the effectiveness of such intervention for family members. RELEVANCE TO CLINICAL PRACTICE This review and meta-analysis provides evidence that family-based intervention can improve positive family support, which has a good effect on diabetes control and psychological well-being in adults with diabetes, and it is especially effective in Asian regions. Findings suggested that unreinforced participation by family members and integrating flexible strategies into family-based intervention may be equally effective.
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Affiliation(s)
- Huijing Zhang
- School of Nursing, Peking University, Beijing, China
| | - Qi Zhang
- School of Nursing, Peking University, Beijing, China
| | - Dan Luo
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xue Cai
- Nursing Department, ZhongDa Hospital Southeast University, Nanjing, China
| | - Ruxue Li
- School of Nursing, Peking University, Beijing, China
| | - Yating Zhang
- School of Nursing, Peking University, Beijing, China
| | - Yanhui Lu
- School of Nursing, Peking University, Beijing, China
| | - Jiajia Liu
- School of Nursing, Peking University, Beijing, China
| | - Jiaxin Gu
- School of Nursing, Peking University, Beijing, China
| | - Mingzi Li
- School of Nursing, Peking University, Beijing, China
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Kuo HJ, Chang NT, Tien YW, Chou YJ, Shun SC. Determinants of Quality of Life in Individuals With a Dual Diagnosis of Resectable Pancreatic Cancer and Diabetes Mellitus. Oncol Nurs Forum 2021; 48:390-402. [PMID: 34142999 DOI: 10.1188/21.onf.390-402] [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: 11/17/2022]
Abstract
OBJECTIVES To explore the associations among clinical characteristics, fatigue, diabetes mellitus (DM) self-care activities, and quality of life (QOL) in individuals with resectable pancreatic cancer and DM. SAMPLE & SETTING 57 individuals with resectable pancreatic cancer and DM from an outpatient pancreatic surgical department in Taiwan were included in the final analysis. METHODS & VARIABLES A cross-sectional, correlational design was used. QOL, fatigue, and DM self-care were measured by the European Organisation for Research and Treatment of Cancer QOL Questionnaire-Core 30, the Fatigue Symptom Inventory, and the Summary of Diabetes Self-Care Activities. RESULTS Participants who had a shorter duration of DM and higher levels of fatigue (including intensity, duration, and interference) reported lower QOL scores. Participants who performed more DM self-care activities and physical activity per week had higher QOL scores. Fatigue, DM self-care activities, and DM duration were significant factors related to QOL. IMPLICATIONS FOR NURSING Shorter DM duration, increased fatigue, and fewer DM self-care activities were determinants of worse QOL in individuals with resectable pancreatic cancer and DM.
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Lambert S, Schaffler JL, Ould Brahim L, Belzile E, Laizner AM, Folch N, Rosenberg E, Maheu C, Ciofani L, Dubois S, Gélinas-Phaneuf E, Drouin S, Leung K, Tremblay S, Clayberg K, Ciampi A. The effect of culturally-adapted health education interventions among culturally and linguistically diverse (CALD) patients with a chronic illness: A meta-analysis and descriptive systematic review. PATIENT EDUCATION AND COUNSELING 2021; 104:1608-1635. [PMID: 33573916 DOI: 10.1016/j.pec.2021.01.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/14/2020] [Accepted: 01/16/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To review the effectiveness of health education interventions adapted for culturally and linguistically diverse (CALD) populations with a chronic illness. METHODS A systematic review and meta-analysis were conducted. Eligible studies were identified across six databases. Data were extracted and intervention effect was summarized using standardized mean difference. If there were insufficient data for meta-analysis, a descriptive summary was included. Modifying effects of intervention format, length, intensity, provider, self-management skills taught, and behavioral change techniques (BCTs) utilized were examined. RESULTS 58 studies were reviewed and data were extracted for 36 outcomes. Most interventions used multiple modes of delivery and were facilitated by bilingual health care professionals (HCPs). On average, interventions included 5.19 self-management skills and 4.82 BCTs. Interventions were effective in reducing BMI, cholesterol, triglycerides, blood glucose, HbA1C, and depression, and in increasing knowledge. Effectiveness was influenced partly by provider, with HCPs favored over lay providers or paraprofessionals in increasing knowledge; however, the opposite was noted for HbA1c. CONCLUSIONS Health education interventions are effective among CALD populations, particularly at improving objective, distal outcomes (e.g., anthropometric measures). These interventions may be equally effective in improving proximal patient-reported outcomes (PROs); however, diversity in PROs limited analyses. PRACTICE IMPLICATIONS Core outcome sets (COS) are needed to further investigate and compare health education intervention effectiveness on PROs.
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Affiliation(s)
- Sylvie Lambert
- Ingram School of Nursing, McGill University, Montréal, Canada; St. Mary's Research Centre, Montréal, Canada.
| | | | - Lydia Ould Brahim
- Ingram School of Nursing, McGill University, Montréal, Canada; St. Mary's Research Centre, Montréal, Canada
| | | | | | - Nathalie Folch
- Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | | | - Christine Maheu
- Ingram School of Nursing, McGill University, Montréal, Canada
| | - Luisa Ciofani
- The Research Institute of the McGill University Health Centre, Montréal, Canada
| | - Sylvie Dubois
- Faculty of Nursing, Université de Montréal, Montréal, Canada
| | | | - Susan Drouin
- The Research Institute of the McGill University Health Centre, Montréal, Canada
| | - Katerina Leung
- Ingram School of Nursing, McGill University, Montréal, Canada
| | - Sarah Tremblay
- Ingram School of Nursing, McGill University, Montréal, Canada
| | | | - Antonio Ciampi
- Ingram School of Nursing, McGill University, Montréal, Canada; St. Mary's Research Centre, Montréal, Canada
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9
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Anderson G, Casasanta D, Motta PC, Sacco E, Cocchieri A, Damiani G, Rega ML. Diabetic education in nursing: A Rodgers' evolutionary concept analysis. Nurs Forum 2021; 56:986-992. [PMID: 34076893 DOI: 10.1111/nuf.12620] [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: 11/24/2020] [Revised: 05/01/2021] [Accepted: 05/17/2021] [Indexed: 11/27/2022]
Abstract
AIM This concept analysis aims to clarify the concept of diabetic education in nursing to provide guidance for the further conceptualization and clarification of diabetic education in nursing. BACKGROUND Patient education is a fundamental component of diabetes care. Nurses have taken up a major role in educating people with diabetes to manage their conditions. However, the exact meaning of diabetic education in nursing remains challenging. DESIGN Rodgers' evolutionary method of concept analysis was performed to explore the concept of diabetic education in nursing. DATA SOURCE We conducted a literature search on Cumulative Index to Nursing and Allied Health Literature (CINAHL), MedLine, and PsycInfo for works published until October 2020 using "patient education," "diabetes," and "nursing" as key terms. RESULTS The concept analysis revealed that key attributes of diabetic education in nursing include patient-centered and interactive approaches, planning, and problem solving. Antecedents related to individuals with diabetes are their backgrounds, needs, and motivations, while the antecedents related to nurses are experience and attitude. Finally, three different consequences of the concept emerged: an increase in knowledge and skills, a behavioral change, and the improvement of clinical outcomes.
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Affiliation(s)
- Gloria Anderson
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Daniela Casasanta
- Department of Occupational Medicine Unit, UdR & HTA Research Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Paolo Carlo Motta
- Department of Public Health, University of Brescia vl., Brescia, Italy
| | - Eugenio Sacco
- Azienda Ospedaliera-Universitaria Sant'Andrea, Rome, Italy
| | - Antonello Cocchieri
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianfranco Damiani
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Luisa Rega
- School of Nursing, Università Cattolica del Sacro Cuore, Rome, Italy
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10
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Wuri Kartika A, Widyatuti W, Rekawati E. The effectiveness of home-based nursing intervention in the elderly with recurrent diabetic foot ulcers: A case report. J Public Health Res 2021; 10:2162. [PMID: 33855395 PMCID: PMC8129742 DOI: 10.4081/jphr.2021.2162] [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: 02/08/2021] [Accepted: 03/11/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Inadequate glycemic control usually leads to peripheral neuropathy, vasculopathy, and foot deformities that leads to diabetic foot ulcer (DFU), and a 10-years history of diabetes and inadequate self-management increases the risk of reoccurring DFU. A home-based intervention program, which includes Diabetes Self-Management Education (DSME) and wound care is the most likely approach, to engage families and overcoming the barriers in self-care management. The aim of this study is to provide an overview on the effectiveness of home-based nursing intervention in the elderly patients with reoccurring diabetic foot ulcers. DESIGN AND METHOD In this study, a case study approach was used that presented a case related to self-management and wound care in elderly patients with reoccurring DFU. The intervention was carried out by the community health nurses for eight weeks with home visit. RESULTS Significant changes were reported in diabetes self-management practices, blood glucose level, and wound healing. The Diabetes Self-Management Questionnaire (DSMQ) score increased from 5,62 to 8,54 and the Summary of Diabetes Self-Care Activities (SDSCA) score increased from 3,2 to 6. The Bates Jansen Examination score decreased from 24 and 26 to 17 and 14 in six weeks. CONCLUSIONS The results confirm that family-based interventions program are effective in improving glycemic control and wound healing. Community nursing is believed to prevent an increase in self-management behavior to prevent recurring DFU and maintain a healthy life-style about diabetes self-management education.
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Affiliation(s)
| | - Widyatuti Widyatuti
- Community Health Nursing Department, Faculty of Nursing, Universitas Indonesia, Depok.
| | - Etty Rekawati
- Community Health Nursing Department, Faculty of Nursing, Universitas Indonesia, Depok.
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11
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Ploylearmsang C, Tongsiri S, Pirikannont M, Srisaknok T. Effects of Home-Based Care Inter-Professional Education on Students' Outcomes: Mahasarakham University Experiences. MEDICAL SCIENCE EDUCATOR 2021; 31:677-685. [PMID: 33643683 PMCID: PMC7894233 DOI: 10.1007/s40670-021-01244-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/05/2021] [Indexed: 06/12/2023]
Abstract
This mixed-method research aimed to implement inter-professional education (IPE) as a training process for producing and shaping health and social sciences professionals in three faculties: Medicine, Pharmacy, and Architecture, Urban Design and Creative Arts in Mahasarakham University (MSU), Thailand. Two hundred thirty-two students who registered as second-year students in the 2015 academic year, and third-year students in the 2016 academic year, and fifty patients in six catchment areas of the Faculty of Medicine Hospital, MSU, participated in the study. Six steps of IPE implementation were involved. They were conducted by twenty-four teachers from three faculties, twelve health volunteers in six communities, and five municipality officers. After the IPE activities, students showed significant improvement in their attitudes towards collaborative teamwork. Their performance with regard to IPE home-based care for medical patients improved substantially from year 2 to year 3 (73.4% and 80.9%, p = 0.001). Patients and community representatives were satisfied with students' home visits, and scored them at > 80%. The after-action review among all of the teachers provided information about their views on IPE projects and their recommendations with respect to inter-professional education. IPE schemes can produce beneficial effects for students, teachers, and patients in the community. As a study result of MSU experience, we recommended IPE for higher education institutions.
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Affiliation(s)
- Chanuttha Ploylearmsang
- Social Pharmacy Research Unit, Faculty of Pharmacy, Mahasarakham University, Mahasarakham, 44150 Thailand
| | - Sirinart Tongsiri
- Faculty of Medicine, Mahasarakham University, Mahasarakham, 44000 Thailand
| | - Mathee Pirikannont
- Faculty of Architecture Urban design and Creative Arts, Mahasarakham University, Mahasarakham, 44150 Thailand
| | - Tharinee Srisaknok
- Social Pharmacy Research Unit, Faculty of Pharmacy, Mahasarakham University, Mahasarakham, 44150 Thailand
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12
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Balcha Hailu F, Hjortdahl P, Moen A. Effect of locally-contextualized nurse-led diabetes self-management education on psychosocial health and quality of life: A controlled before-after study. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2021. [DOI: 10.1016/j.ijans.2021.100325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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13
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Polhuis CMM, Bouwman LI, Vaandrager L, Soedamah-Muthu SS, Koelen MA. Systematic review of salutogenic-oriented lifestyle randomised controlled trials for adults with type 2 diabetes mellitus. PATIENT EDUCATION AND COUNSELING 2020; 103:764-776. [PMID: 31711677 DOI: 10.1016/j.pec.2019.10.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 10/18/2019] [Accepted: 10/19/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Describe the characteristics (development, intensity, deliverers, setting, strategies) and assess the effect of salutogenic-oriented lifestyle interventions on physical and psychosocial health outcomes in adults with type 2 diabetes mellitus (T2DM). METHOD PubMed, Scopus and PsycINFO were systematically searched for randomised controlled trials (RCTs) published up to August 2019 that complied with predefined salutogenic criteria: the participant as a whole, the participant's active involvement and the participant's individual learning process. Characteristics of the salutogenic-oriented interventions with and without significant results were compared and qualitatively summarised. RESULTS Twenty-eight RCTs were identified. Salutogenic oriented interventions that significantly improved both physical and psychosocial health were characterized by being based on formative research, culturally targeted, and delivered in 10-20 sessions in group settings, whereas salutogenic oriented interventions that neither improved physical or psychosocial health significantly were characterized by being individually tailored and delivered in less than 10 group sessions in individual settings. CONCLUSIONS This systematic review suggests that salutogenic-oriented lifestyle interventions are effective for physical and psychosocial health in the short term. More research is needed to determine how intervention characteristics moderate (long-term) effectiveness. PRACTICE IMPLICATIONS The results provide a basis for purposefully developing effective salutogenic interventions for adults with T2DM.
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Affiliation(s)
- C M M Polhuis
- Health and Society, Wageningen University, Wageningen, The Netherlands.
| | - L I Bouwman
- Health and Society, Wageningen University, Wageningen, The Netherlands
| | - L Vaandrager
- Health and Society, Wageningen University, Wageningen, The Netherlands
| | - S S Soedamah-Muthu
- Center of Research on Psychological and Somatic disorders (CORPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands; Institute for Food, Nutrition and Health, University of Reading, Reading, United Kingdom
| | - M A Koelen
- Health and Society, Wageningen University, Wageningen, The Netherlands
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15
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Kuo HJ, Huang YC, García AA. Fatigue, Pain, Sleep Difficulties, and Depressive Symptoms in Mexican Americans and Chinese Americans with Type 2 Diabetes. J Immigr Minor Health 2020; 22:895-902. [DOI: 10.1007/s10903-020-01001-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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16
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Wang YC, Wang C, Shih PW, Tang PL. Analysis of the relationship between lifestyle habits and glycosylated hemoglobin control based on data from a Health Management Plan. Nutr Res Pract 2020; 14:218-229. [PMID: 32528629 PMCID: PMC7263898 DOI: 10.4162/nrp.2020.14.3.218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/20/2019] [Accepted: 12/17/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND/OBJECTIVES Type 2 Diabetes mellitus (T2DM) is a hereditary disease that is also strongly dependent on environmental factors, lifestyles, and dietary habits. This study explored the relationship between lifestyle habits and glycosylated hemoglobin management in T2DM patients to provide empirical outcomes to improve T2DM management and patient health literacy. SUBJECTS/METHODS This study enrolled 349 diabetic patients with more than 5 care visits to a Diabetes Mellitus care network under the Health Management Plan led by Taiwan Department of Health (DOH). Based on relevant literature, an Outpatient Record Form of Diabetes Mellitus Care was designed and lipid profile tests were conducted for data collection and analysis. RESULTS When modeling the data, the results showed that the odds for HbA1c > 7.5% in T2DM patients duration over 10 years was 3.785 (P = 0.002) times that in patients with disease duration of fewer than 3 years. The odds of HbA1c > 7.5% in illiterate patients was 3.128 (P = 0.039) times that in patients with senior high school education or above. The odds of HbA1c > 7.5% in patients with other chronic illness was 2.207 (P = 0.019) times that in participants without chronic illness. Among 5 beneficial lifestyle habits, the odds of HbA1c > 7.5% in patients with 2 or 3 good habits were 3.243 (P = 0.003) and 3.424 (P = 0.001) times that in patients with more than 3 good habits, respectively. CONCLUSION This empirical outcome shows that maintaining a good lifestyle improves T2DM management and patients' knowledge, motivation, and ability to use health information. Patients with longer disease duration, education, or good lifestyle habits had optimal HbA1c management than those in patients who did not. Thus, effective self-management and precaution in daily life and improved health literacy of diabetic patients are necessary to increase the quality of T2DM care.
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Affiliation(s)
- Ya-Chun Wang
- Nutrition and Food Service Department, Kaohsiung Veterans General Hospital, Kaohsiung City 81362, Taiwan (ROC).,Department of Food Science and Nutrition, Meiho University, Pingtung 91202, Taiwan (ROC)
| | - Chi Wang
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung City 81362, Taiwan (ROC)
| | - Ping-Wen Shih
- Nutrition and Food Service Department, Kaohsiung Veterans General Hospital, Kaohsiung City 81362, Taiwan (ROC)
| | - Pei-Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung City 81362, Taiwan (ROC).,Department of Health-Business Administration, Fooyin University, Kaohsiung City 83102, Taiwan (ROC).,College of Nursing, Kaohsiung Medical University, Kaohsiung City 80708, Taiwan (ROC)
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17
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Hildebrand JA, Billimek J, Lee JA, Sorkin DH, Olshansky EF, Clancy SL, Evangelista LS. Effect of diabetes self-management education on glycemic control in Latino adults with type 2 diabetes: A systematic review and meta-analysis. PATIENT EDUCATION AND COUNSELING 2020; 103:266-275. [PMID: 31542186 PMCID: PMC8087170 DOI: 10.1016/j.pec.2019.09.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 08/01/2019] [Accepted: 09/07/2019] [Indexed: 05/13/2023]
Abstract
PURPOSE This systematic review and meta-analysis evaluated the effectiveness of diabetes self-management education (DSME) in reducing glycosylated hemoglobin (A1C) levels in adult Latinos with type 2 diabetes (T2DM). METHODS Five databases were searched for DSME randomized controlled trials or quasi-experimental trials published between January 1997 and March 2019. A random effects model was utilized to calculate combined effect sizes. Subgroup analyses were performed to explore possible sources of heterogeneity between studies. RESULTS Twenty-three unique studies met criteria for this systematic review and of these, 18 were included in the meta-analysis. Pooled estimate effect of DSME on A1C from the random effect model was -0.240 (95% confidence interval = -0.345, -0.135, p < 0.001). There was moderate heterogeneity (Cochrane Q=30.977, P=0.020, I^2 = 45.121) between the studies. Subgroup analyses demonstrated greater A1C reductions in studies with intervention duration ≤6 months, initial A1C baseline values >8.0 [69 mmol/mol], and team-based approach. CONCLUSIONS Meta-analysis results showed that culturally tailored DSME interventions significantly reduce AIC in Latinos with T2DM despite the heterogeneity across the studies. IMPLICATIONS The heterogeneity in the study methodologies reinforce the need for additional studies to better understand DSME interventions to reduce disparities in Latino adults with T2DM.
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Affiliation(s)
- Janett A Hildebrand
- University of Southern California, Suzanne Dworak-Peck School of Social Work, Department of Nursing.
| | - John Billimek
- Program in Medical Education for the Latino Community, Health Policy Research Institute, Departments of Medicine and Family Medicine, University of California, Irvine, USA
| | - Jung-Ah Lee
- Sue and Bill Gross School of Nursing, University of California, Irvine, USA
| | - Dara H Sorkin
- Department of Medicine, University of California, Irvine, USA
| | - Ellen F Olshansky
- Sue and Bill Gross School of Nursing, University of California, Irvine, USA
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18
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Mikell M, Snethen J, Kelber ST. Exploring Factors Associated with Physical Activity in Latino Immigrants. West J Nurs Res 2020; 42:680-689. [DOI: 10.1177/0193945919897547] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Latinos are at increased risk for developing chronic conditions. Regular physical activity (PA) assists in protecting adults from developing type 2 diabetes, excess weight, and heart disease, making PA important for health promotion. This cross-sectional, descriptive investigation was conducted with adults 18 years of age and older in a predominately Latino community. Perceptions of factors which influenced PA were examined. Descriptive statistics and multiple regression analysis were performed. Immigrant Latino males engaged in PA significantly more often than female participants. In Latino participants, those who engaged in walking activities were more likely to engage in both vigorous ( r = .341, p<.005) and moderate PA ( r = .317, p <.001). Self-efficacy and acculturation were significant predictors of PA. Acculturation was associated with physical activity, even after adjusting for perceived stress. Findings highlight the continued importance of self-efficacy to foster health promotion in Latino communities.
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Affiliation(s)
| | - Julia Snethen
- University of Wisconsin-Milwaukee, College of Nursing, Milwaukee, WI, USA
| | - Sheryl T. Kelber
- University of Wisconsin-Milwaukee, College of Nursing, Milwaukee, WI, USA
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Bezo BH, Huang YT, Lin CC. Factors influencing self-management behaviours among patients with type 2 diabetes mellitus in the Solomon Islands. J Clin Nurs 2020; 29:852-862. [PMID: 31823422 DOI: 10.1111/jocn.15139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/21/2019] [Accepted: 11/19/2019] [Indexed: 10/25/2022]
Abstract
AIMS AND OBJECTIVES This study aims to explore the current state of self-management behaviours among persons with type 2 diabetes mellitus in the Solomon Islands and to discuss the factors influencing these behaviours. BACKGROUND The prevalence of diabetes and diabetes complications is increasing in the Solomon Islands. However, the effective diabetes prevention and care are not provided in the country. DESIGN This is a cross-sectional study. METHODS A convenience sample of 150 persons with type 2 diabetes mellitus was recruited from a hospital in the Solomon Islands from August 2017-September 2017. Self-report questionnaires were used to measure the self-management behaviours, diabetes knowledge and illness perception. In addition, the study adhered to the EQUATOR checklist, STROBE (see Appendix S1). RESULTS The overall score for self-management was 56.9 ± 13.2 and diabetes knowledge and illness perception, as influencing factors of self-management, earned total scores of 13.3 ± 4.0 and 55.8 ± 12.0, respectively. Stepwise regression analysis identified illness perception, diabetes knowledge and smoking as significant influencing factors, explaining 20.8% of the total variance in self-management. CONCLUSIONS The level of diabetes self-management behaviours demonstrated by persons with type 2 diabetes mellitus in this study was rated as less than ideal. Diabetes knowledge and illness perception were the two main factors influencing patient self-management in the Solomon Islands. RELEVANCE TO CLINICAL PRACTICE The study addressed the current state of the self-management behaviours of persons with diabetes and discussed the factors influencing these behaviours. The findings indicated that knowledge and illness perception of diabetes were the two main factors and provided baseline information for policymakers, health planners and healthcare providers highlighting diabetes as an important issue in Solomon Islands.
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Affiliation(s)
- Benjamin Harry Bezo
- School of Nursing & Allied Health Sciences, Solomon Islands National University, Honiara, Solomon Islands.,School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Tung Huang
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Taipei, Taiwan.,Department of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chiu-Chu Lin
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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20
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Fajriyah N, Firmanti TA, Mufidah A, Septiana NT. A Diabetes Self-Management Education/Support (DSME/S) Program in Reference to the Biological, Psychological and Social Aspects of a Patient with Type 2 Diabetes Mellitus: A Systematic Review. JURNAL NERS 2019. [DOI: 10.20473/jn.v14i3.16979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: Various efforts have been made to improve the self-care management of patients with type 2 diabetes mellitus (T2DM). One of them is by using a Diabetes Self-Management Education and Support (DSME/S) program. DSME/S produces positive effects in relation to patient behavior and health status. This is a systematic review of randomized controlled trials published where the aim was to evaluate the impact of the DSME/S program in term of biological. psychological and social aspects.Methods: The articles were searched for using the PRISMA approach from within Scopus, Sage Journal, ProQuest, Google Scholar and PubMed to identify the relevant English publications on DSME over the last 5 years (2013-2018). In total, 15 studies met the inclusion criteria.Results: The articles included at least one result that covered the biological, psychological, and social aspects that are more general and relevant for T2DM patients who received the DSME program. DSME had a positive impact on T2DM, namely the reduction of HbA1c, blood glucose, LDL, cholesterol, blood pressure, weight, waist circumference, decreased distress, anxiety and increased self-efficacy and self-empowerment.Conclusion: It can increase the social and family support, improve self-management motivation, increase knowledge and improve the behavior of T2DM patients. The findings of our review showed that DSME has a positive impact on the biological, psychological and social aspects of type 2 diabetes mellitus.
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Lin L, Lee B, Wang R. Effects of a Symptom Management Program for Patients With Type 2 Diabetes: Implications for Evidence‐Based Practice. Worldviews Evid Based Nurs 2019; 16:433-443. [DOI: 10.1111/wvn.12400] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Li‐Ying Lin
- Department of Nursing Kaohsiung Veterans General Hospital Kaohsiung City Taiwan
- Department of Nursing Meiho University Kaohsiung City Taiwan
| | - Bih‐O Lee
- College of Nursing Kaohsiung Medical University Kaohsiung Taiwan
- Nursing Department Kaohsiung Medical University Hospital Kaohsiung City Taiwan
| | - Ruey‐Hsia Wang
- College of Nursing Kaohsiung Medical University Kaohsiung Taiwan
- Department of Medical Research Kaohsiung Medical University Hospital Kaohsiung City Taiwan
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García AA, Bose E, Zuñiga JA, Zhang W. Mexican Americans' diabetes symptom prevalence, burden, and clusters. Appl Nurs Res 2019; 46:37-42. [PMID: 30853074 DOI: 10.1016/j.apnr.2019.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 02/01/2019] [Accepted: 02/10/2019] [Indexed: 01/05/2023]
Abstract
AIMS Type 2 diabetes mellitus (T2DM), serious and increasingly prevalent among Mexican Americans, produces symptoms related to high and low glucose levels, medication side effects, and long-term complications. This secondary analysis explored symptom prevalence, differences among symptom burden levels, and how symptoms clustered. METHODS Clinical measurements and survey data (demographic, quality of life, and the symptom subscale of the Diabetes Symptom Self-Management Inventory) collected from Mexican American adults with T2DM (n = 71) were analyzed for symptom prevalence, differences across levels of symptom burden, and symptom clusters. Agglomerative hierarchical and k-means clustering analyses were performed on a Gower matrix. Internal validation methods and rank aggregation were used to identify the best clustering method of the two techniques and to identify symptoms that clustered together. RESULTS Participants reported mean = 14 symptoms; tiredness and trouble sleeping were most prevalent. People with high symptom burden had significantly lower quality of life and perceptions of worse diabetes severity. Hierarchical clustering produced three symptom clusters: cluster 1 = 9 symptoms (e.g. intense thirstiness, dry mouth); cluster 2 = 9 symptoms (e.g., itching skin, weight gain, noise or light sensitivity); cluster 3 = 13 symptoms (e.g., nervous, headache, trouble concentrating, and memory loss). CONCLUSION Mexican Americans with T2DM report several co-occurring symptoms. Quality of life is significantly worse for people with high symptom burden. Three distinct symptom clusters were identified. Studies with larger samples are needed to further diabetes symptom science. Clinicians should assess and address patients' co-occurring symptoms as a potential means of decreasing symptom burden and improving quality of life.
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Affiliation(s)
- Alexandra A García
- The University of Texas at Austin School of Nursing, Austin, TX, United States of America; The University of Texas at Austin Dell Medical School, Austin, TX, United States of America.
| | - Eliezer Bose
- The University of Texas at Austin School of Nursing, Austin, TX, United States of America
| | - Julie A Zuñiga
- The University of Texas at Austin School of Nursing, Austin, TX, United States of America
| | - Wenhui Zhang
- The University of Texas at Austin School of Nursing, Austin, TX, United States of America
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Werbrouck A, Swinnen E, Kerckhofs E, Buyl R, Beckwée D, De Wit L. How to empower patients? A systematic review and meta-analysis. Transl Behav Med 2018; 8:660-674. [DOI: 10.1093/tbm/iby064] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Amber Werbrouck
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Rehabilitation Research (RERE), Vrije Universiteit Brussel, Brussel, Belgium
| | - Eva Swinnen
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Rehabilitation Research (RERE), Vrije Universiteit Brussel, Brussel, Belgium
| | - Eric Kerckhofs
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Rehabilitation Research (RERE), Vrije Universiteit Brussel, Brussel, Belgium
| | - Ronald Buyl
- Department of Biostatistics and Medical Informatics, Vrije Universiteit Brussel, Brussel, Belgium
| | - David Beckwée
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Rehabilitation Research (RERE), Vrije Universiteit Brussel, Brussel, Belgium
- Frailty in Ageing Research Department, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - Liesbet De Wit
- Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium
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Wagner J, Armeli S, Tennen H, Bermudez-Millan A, Pérez-Escamilla R. Effects of stress management and relaxation training on the relationship between diabetes symptoms and affect among Latinos. Psychol Health 2018; 33:1172-1190. [PMID: 29857776 DOI: 10.1080/08870446.2018.1478975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Stress management and relaxation (SMR) interventions can reduce symptoms of chronic disease and associated distress. However, there is little evidence that such interventions disrupt associations between symptoms and affect. This study examined whether SMR dampened the link between symptoms of hyperglycemia and proximal levels of affect. We predicted that during periods of increased hyperglycemia, individuals receiving SMR training, relative to controls, would demonstrate smaller increases in negative affect. DESIGN Fifty-five adult Latinos with type 2 diabetes were randomised to either one group session of diabetes education (DE-only; N = 23) or diabetes education plus eight group sessions of SMR (DE + SMR; N = 32). After treatment, participants reported five diabetes symptoms and four affective states twice daily for seven days using a bilingual telephonic system. RESULTS Mean age = 57.8 years, mean A1c = 8.4%, and ¾ was female with less than a high school education. Individuals receiving DE + SMR, compared to DE-only, showed a weaker positive within-person association between daily diabetes symptoms and nervous affect. Groups also differed on the association between symptoms and enthusiasm. Age moderated these associations in most models with older individuals showing less affect reactivity to symptoms. CONCLUSIONS Findings provide partial support for theorised mechanisms of SMR.
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Affiliation(s)
- Julie Wagner
- a Division of Behavioral Sciences and Community Health and Department of Psychiatry , UConn Schools of Dental Medicine and Medicine , Farmington , CT , USA
| | - Stephen Armeli
- b Department of Psychology , Farleigh Dickinson University , Taeneck , NJ , USA
| | - Howard Tennen
- c Department of Community Medicine , UConn School of Medicine , Farmington , CT , USA
| | | | - Rafael Pérez-Escamilla
- d Department of Social and Behavioral Sciences , Yale School of Public Health , New Haven , CT , USA
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Terens N, Vecchi S, Bargagli AM, Agabiti N, Mitrova Z, Amato L, Davoli M. Quality improvement strategies at primary care level to reduce inequalities in diabetes care: an equity-oriented systematic review. BMC Endocr Disord 2018; 18:31. [PMID: 29843692 PMCID: PMC5975519 DOI: 10.1186/s12902-018-0260-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/16/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND There is evidence that disparities exist in diabetes prevalence, access to diabetes care, diabetes-related complications, and the quality of diabetes care. A wide range of interventions has been implemented and evaluated to improve diabetes care. We aimed to review trials of quality improvement (QI) interventions aimed to reduce health inequities among people with diabetes in primary care and to explore the extent to which experimental studies addressed and reported equity issues. METHODS Pubmed, EMBASE, CINAHL, and the Cochrane Library were searched to identify randomized controlled studies published between January 2005 and May 2016. We adopted the PROGRESS Plus framework, as a tool to explore differential effects of QI interventions across sociodemographic and economic factors. RESULTS From 1903 references fifty-eight randomized trials met the inclusion criteria (with 17.786 participants), mostly carried out in USA. The methodological quality was good for all studies. Almost all studies reported the age, gender/sex and race distribution of study participants. The majority of trials additionally used at least one further PROGRESS-Plus factor at baseline, with education being the most commonly used, followed by income (55%). Large variation was observed between these studies for type of interventions, target populations, and outcomes evaluated. Few studies examined differential intervention effects by PROGRESS-plus factors. Existing evidence suggests that some QI intervention delivered in primary care can improve diabetes-related health outcomes in social disadvantaged population subgroups such as ethnic minorities. However, we found very few studies comparing health outcomes between population subgroups and reporting differential effect estimates of QI interventions. CONCLUSIONS This review provides evidence that QI interventions for people with diabetes is feasible to implement and highly acceptable. However, more research is needed to understand their effective components as well as the adoption of an equity-oriented approach in conducting primary studies. Moreover, a wider variety of socio-economic characteristics such as social capital, place of residence, occupation, education, and religion should be addressed.
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Affiliation(s)
| | - Simona Vecchi
- Department of Epidemiology, Lazio Region- ASL Rome1, Rome, Italy
| | | | - Nera Agabiti
- Department of Epidemiology, Lazio Region- ASL Rome1, Rome, Italy
| | - Zuzana Mitrova
- Department of Epidemiology, Lazio Region- ASL Rome1, Rome, Italy
| | - Laura Amato
- Department of Epidemiology, Lazio Region- ASL Rome1, Rome, Italy
| | - Marina Davoli
- Department of Epidemiology, Lazio Region- ASL Rome1, Rome, Italy
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Blanco-Cornejo M, Riva-Palacio-Chiang-Sam IL, Sánchez-Díaz I, Cerritos A, Tena-Tamayo C, López-Hernández D. New model for diabetes primary health care based on patient empowerment and the right to preventive health: the MIDE program. Rev Panam Salud Publica 2017; 41:e128. [PMID: 31384261 PMCID: PMC6645172 DOI: 10.26633/rpsp.2017.128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 02/02/2017] [Indexed: 12/29/2022] Open
Abstract
Objective. To evaluate Mexico’s national Integrated Management of Diabetes in Stages (Manejo Integral de la Diabetes por Etapas, MIDE) program using three types of indicators: process, structure, and impact. Methods. A cross-sectional study was conducted using data for 97 452 people with diabetes (PWD) who participated in the MIDE patient empowerment program (PEP) at “MIDE modules” (standardized diabetes health care units) at Mexico’s Institute for Social Security and Services for State Workers (Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, ISSSTE) hospital clinics and family medical clinics nationwide between 2007 and 2014. The program promotes diabetes patient empowerment and self-care through outpatient consultations with a multidisciplinary health care team supported by continuous training. Baseline data were compared with results post-program for the following indicators: process (metabolic control (MetC), based on glycated hemoglobin (HbA1c), triglyceride (TG), and total cholesterol (TC) levels); structure (number of MIDE modules installed at ISSSTE clinics and number of patients/health personnel accredited as diabetes experts/awarded diplomas); and impact (average number of patient illness days (IDs) and hospitalization episodes (HEs) per PWD over a 12-month period). Results. Over the seven-year study period, the proportion of patients with MetC (HbA1c < 7.0%, TG < 150 mg/dL, and TC < 200 mg/dL) increased significantly (from 35.4% to 60% (with a peak level of 62% in 2013); P < 0.001); average HbA1c, triglycerides, and total cholesterol per PWD dropped by 25%, 31%, and 11% respectively; average number of IDs and HEs per PWD over a 12-month period dropped by 38% and 41% respectively; a total of 140 MIDE modules were installed at ISSSTE clinics; and a total of 1 117 diplomas were awarded to 826 health professionals, and 2 613 PWD were accredited as “patient experts in diabetes.” Conclusions. The MIDE PEP is feasible, usable, and acceptable to PWD. The program improves MetC; reduces the frequency of IDs and HEs; and facilitates patient participation, the involvement of health personnel, and shared decision-making.
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Affiliation(s)
- Margarita Blanco-Cornejo
- Health Protection and Prevention Sub-Directorate Medical Directorate, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado Mexico City Mexico Health Protection and Prevention Sub-Directorate, Medical Directorate, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico
| | - Irma Luz Riva-Palacio-Chiang-Sam
- Health Protection and Prevention Sub-Directorate Medical Directorate, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado Mexico City Mexico Health Protection and Prevention Sub-Directorate, Medical Directorate, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico
| | - Iyari Sánchez-Díaz
- Health Protection and Prevention Sub-Directorate Medical Directorate, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado Mexico City Mexico Health Protection and Prevention Sub-Directorate, Medical Directorate, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico
| | - Antonio Cerritos
- Health Protection and Prevention Sub-Directorate Medical Directorate, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado Mexico City Mexico Health Protection and Prevention Sub-Directorate, Medical Directorate, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico
| | - Carlos Tena-Tamayo
- Hospital Regional de Alta Especialidad del Bajío Ministry of Health León, GJ Mexico Hospital Regional de Alta Especialidad del Bajío, Ministry of Health, León, GJ, Mexico
| | - Daniel López-Hernández
- Health Protection and Prevention Sub-Directorate Medical Directorate, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado Mexico City Mexico Health Protection and Prevention Sub-Directorate, Medical Directorate, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico
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Pamungkas RA, Chamroonsawasdi K, Vatanasomboon P. A Systematic Review: Family Support Integrated with Diabetes Self-Management among Uncontrolled Type II Diabetes Mellitus Patients. Behav Sci (Basel) 2017; 7:E62. [PMID: 28914815 PMCID: PMC5618070 DOI: 10.3390/bs7030062] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/05/2017] [Accepted: 09/06/2017] [Indexed: 01/03/2023] Open
Abstract
The rate of type-2 diabetes mellitus (T2D) is dramatically increasing worldwide. Continuing diabetes mellitus (DM) care needs effective self-management education and support for both patients and family members. This study aimed to review and describe the impacts of diabetes mellitus self-management education (DSME) that involve family members on patient outcomes related to patient health behaviors and perceived self-efficacy on self-management such as medication adherence, blood glucose monitoring, diet and exercise changes, health outcomes including psychological well-being and self-efficacy, and physiological markers including body mass index, level of blood pressure, cholesterol level and glycemic control. Three databases, PubMed, CINAHL, and Scopus were reviewed for relevant articles. The search terms were "type 2 diabetes," "self-management," "diabetes self-management education (DSME)," "family support," "social support," and "uncontrolled glycaemia." Joanna Briggs Institute (JBI) guidelines were used to determine which studies to include in the review. Details of the family support components of DSME intervention and the impacts of these interventions had on improving the health outcomes patients with uncontrolled glycaemia patients. A total of 22 intervention studies were identified. These studies involved different DSME strategies, different components of family support provided, and different health outcomes to be measured among T2D patients. Overall, family support had a positive impact on healthy diet, increased perceived support, higher self-efficacy, improved psychological well-being and better glycemic control. This systematic review found evidence that DSME with family support improved self-management behaviors and health outcomes among uncontrolled glycaemia T2D patients. The findings suggest DSME models that include family engagement can be a useful direction for improving diabetes care.
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Affiliation(s)
- Rian Adi Pamungkas
- Department of Family Health, Mahidol University, Bangkok 10400, Thailand.
- Department of Nursing, College of Health, Mega Rezky Makassar, Makassar 90245, Indonesia.
| | | | - Paranee Vatanasomboon
- Department of Health Education and Behavioral Science, Mahidol University, Bangkok 10400, Thailand.
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Cuevas HE, Brown SA. Self-Management Decision Making of Cuban Americans With Type 2 Diabetes. J Transcult Nurs 2017; 29:222-228. [PMID: 28826301 DOI: 10.1177/1043659617696977] [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: 11/16/2022] Open
Abstract
PURPOSE Although researchers have studied how individuals manage type 2 diabetes, none have examined how Cuban Americans do so. This article explores how Cuban Americans make self-management choices and examines whether an empowerment framework is viable for informing interventions. DESIGN A qualitative descriptive study was conducted ( n = 20) with Cuban Americans with type 2 diabetes. Individual interviews were analyzed with content analysis. RESULTS Motivation and temporal factors, such as knowledge of symptoms and the ability to plan ahead, positively affect self-management. Cultural factors, such as access to cultural foods, negatively affect self-management. Empowerment formed a comprehensive lens through which self-management decisions were acted on. CONCLUSION Given the cultural context, empowerment and unique barriers and facilitators can affect diabetes self-management in this population. Strategies to promote healthy decisions must take into account the strengths of this community as well as its challenges.
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García AA, Zuñiga JA, Lagon C. A Personal Touch: The Most Important Strategy for Recruiting Latino Research Participants. J Transcult Nurs 2016; 28:342-347. [PMID: 27114390 DOI: 10.1177/1043659616644958] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
People from non-White racial groups and other underserved populations, including Latinos, are frequently reluctant to participate in research. Yet their participation into research is foundational to producing information that researchers and health care providers need to address health disparities. The purpose of this article is to describe challenges we have encountered along with culturally relevant strategies we used in five research studies to recruit Mexican American participants from community settings, some of whom were also of low socioeconomic status. We found that the most effective recruitment strategies reflect the common cultural values of personalismo, simpátia, confianza, respeto, and familismo.
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