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Vallis M, Berard L, Cosson E, Kristensen FB, Levrat-Guillen F, Naiditch N, Rabasa-Lhoret R, Polonsky W. Promoting Self-Management in Adults with Type 2 Diabetes: Development of the Impact of Glucose Monitoring on Self-Management Scale. Can J Diabetes 2024:S1499-2671(24)00141-2. [PMID: 39033927 DOI: 10.1016/j.jcjd.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 06/26/2024] [Accepted: 07/11/2024] [Indexed: 07/23/2024]
Abstract
OBJECTIVES Type 2 diabetes (T2D) management requires behavioural engagement to achieve optimal outcomes and continuous glucose monitoring (CGM) technologies may facilitate self-management. In this study we describe the development and validation of a self-report instrument, the Impact of Glucose Monitoring on Self-Management Scale (IGMSS), assessing the impact of device use (primarily CGM but also self-monitored blood glucose [SMBG]) on the capability, motivation, and opportunity to engage in self-management. METHODS Potential items were generated from 3 sources: themes and quotes from 13 adults with T2D motivated by CGM use who participated in a qualitative study; behaviour change theory identifying capability, opportunity, and motivation to self-manage; and expert committee review of items. An initial pool of 42 items were generated describing CGM as promoting personalized knowledge, improved health (Capability), improved relationships, having positive device characteristics (Opportunity), and improved engagement in self-management (Motivation). Based on expert committee consensus, items were written so as to be completed by those using any glucose-sensing device (SMBG and CGM). Psychometric evaluation was conducted with 514 English-speaking Canadians. Scale reduction (22 final items) was completed using item-response distribution, internal consistency, factor analysis, and expert opinion. Construct and convergent validity were evaluated using the Impact of Glucose Monitoring Satisfaction Scale, the Diabetes Self-Management Questionnaire, the Diabetes Distress Scale, the 5-item World Health Organization Well-Being Index, and the Centre for Epidemiology Depression Scale. Test-retest reliability was determined for 130 participants. RESULTS Internal consistency was high for all scales, ranging from 0.73 to 0.91. Test-retest reliability ranged from 0.58 to 0.79, except for Device Characteristics. Construct and convergent validity indices were acceptable. There was substantial overlap between the IGMSS and established measures of CGM satisfaction. IGMSS findings were also predictive of self-management behaviour and emotional functioning. CONCLUSIONS The IGMSS has positive psychometric characteristics and has the potential to screen people with T2D for engagement in diabetes self-management using CGM or any sensing device. Scores can be determined for various aspects of Capability (Personalized Knowledge, Improved Health), Opportunity (Relationships and Device Characteristics), and Motivation.
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Affiliation(s)
- Michael Vallis
- Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Lori Berard
- Pink Pearls, Inc, Winnipeg, Manitoba, Canada
| | - Emmanuel Cosson
- AP-HP Hôpitaux Universitaires Paris Seine-Saint-Denis, Avicenne Hospital, Bobigny, France; Equipe de Recherche en Epidémiologie Nutritionnelle, Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and Statistics, Bobigny, France
| | - Finn Boerlum Kristensen
- Department of Public Health Research Unit of User Perspectives, University of South Denmark, Odense, Denmark
| | | | - Nicolas Naiditch
- Fédération Française des Diabétiques, Paris, Île-de-France, France
| | - Remi Rabasa-Lhoret
- Institut de Recherches Cliniques de Montréal and Université de Montréal, Montréal, Quebéc, Canada
| | - William Polonsky
- Behavioral Diabetes Institute, San Diego, California, United States
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Sayed Ahmed HA, Abdallah EM, Mohamed MAE, Aboelfotoh TM, Nour-Eldein H, Fouad AM. Association between erectile dysfunction and subjective well-being in primary care patients with type 2 diabetes. Diabetol Int 2024; 15:421-432. [PMID: 39101170 PMCID: PMC11291785 DOI: 10.1007/s13340-024-00699-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/31/2024] [Indexed: 08/06/2024]
Abstract
Objectives To assess the association between erectile dysfunction and subjective well-being among primary care patients with type 2 diabetes mellitus. Methods This cross-sectional study included 340 men with type 2 diabetes treated in primary health care settings in the Ismailia governorate between April 2021 and April 2022. A multistage random cluster sampling technique was used. Sociodemographic data, disease characteristics, lifestyle, surgical and sexual history, and the Arabic translations of the abridged 5-item version of the International Index of Erectile Function (IIEF-5) Questionnaire, and the 5-item World Health Organization Well-Being Index (WHO-5) were gathered. Results Erectile dysfunction was identified in 72.94% of diabetic patients, with 55% mild or mild-to-moderate (ED I), and 17.9% moderate or severe (ED II). Twenty percent had Poor subjective well-being, with a mean WHO-5 index of 63.4 (± 15.4). Binary logistic regression analysis showed that education, diabetes duration, insufficient income, dyslipidemia, benign prostate hyperplasia, and IIEF-5 score were significantly associated with poor subjective well-being. Increasing IIEF-5 score was significantly associated with a 22% decrease in the odds of poor subjective well-being (OR: 0.78; 95% CI 0.66-0.93). Multinomial regression analysis showed that increasing score of the WHO-5 well-being index was associated with a 11% and 14% reduction in the odds of ED I and II, respectively (OR: 0.89 (95% CI 0.86-0.93), and 0.86 (95% CI 0.81-0.92), respectively). Conclusion Erectile dysfunction and subjective well-being were interrelated. Early detection of erectile dysfunction is essential for improving the positive mental health of men with type 2 diabetes in primary care.
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Affiliation(s)
- Hazem A. Sayed Ahmed
- Department of Family Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | | | | | | | - Hebatallah Nour-Eldein
- Department of Family Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Ahmed Mahmoud Fouad
- Department of Public Health, Occupational and Environmental Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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Fisher L, Polonsky W, Naranjo D, Strycker L, Hessler D. A novel approach to understanding and assessing the emotional side of type 1 diabetes: The Type 1-Diabetes Distress Assessment System. Diabet Med 2024; 41:e15282. [PMID: 38244209 DOI: 10.1111/dme.15282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 01/22/2024]
Abstract
AIMS To describe the development of a novel, conceptually sound instrument with contemporary content for assessing diabetes distress (DD) among adults with type 1 diabetes. METHODS Qualitative interviews with 15 adults and 7 clinicians were used to develop Core (intensity of DD emotional burden) and primary Source (key DD contributors) items. These were administered to a national sample recruited from the TCOYD Research Registry, T1D Exchange and our previous studies. Exploratory and confirmatory factor analyses were undertaken, along with reliability and construct validity studies, and cut-point analyses to determine elevated DD. RESULTS Analyses based on 650 respondents yielded an 8-item Core DD scale (α = 0.95) and 10 2- or 3-item DD Source Scales (α range = 0.53-0.88): Financial Worries, Interpersonal Challenges, Management Difficulties, Shame, Hypoglycemia Concerns, Healthcare Quality, Lack of Diabetes Resources, Technology Challenges, Burden to Others and Worries about Complications. Core and Source scores were significantly associated with criterion variables: Higher DD scores were significantly linked with higher HbA1C, more frequent episodes of severe hypoglycaemia, missed boluses, and poorer quality of life (p > 0.001). A ≥2.0 scale cut-point to define elevated DD is suggested. CONCLUSIONS The new T1-Diabetes Distress Assessment System demonstrated good reliability and validity, and with measures of both Core emotional burden and Sources of DD, it provides a contemporary, flexible and practical approach to assessing DD that can be used seamlessly to inform intervention for clinicians and researchers.
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Affiliation(s)
- Lawrence Fisher
- University of California, San Francisco, San Francisco, California, USA
| | | | | | | | - Danielle Hessler
- University of California, San Francisco, San Francisco, California, USA
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Kortegaard AS, Rokkjær RB, Harboe HMH, Lund S, Andersen A, Bohl M. A group-based intervention for diabetes-related emotional distress among emerging adults with type 1 diabetes: A pilot study. Eur J Intern Med 2024:S0953-6205(24)00241-3. [PMID: 38852025 DOI: 10.1016/j.ejim.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/30/2024] [Accepted: 06/03/2024] [Indexed: 06/10/2024]
Abstract
AIMS To assess diabetes-related emotional distress (DD) in emerging adults with type 1 diabetes (T1D) and assess a group-based intervention's impact. METHODS To investigate DD we used data from the Problem Areas in Diabetes Questionnaire comprising 20 items (PAID-20). Furthermore, changes in the WHO Well-Being Index comprising five items (WHO-5) and glycated haemoglobin (HbA1c) were analysed. The intervention was evaluated using follow-up data from the emerging adults who participated. RESULTS From 2021 to 2023, we screened 180 emerging adults using PAID-20. DD (PAID-20≥30) was prevalent in 25.0 % (95 % CI 18.9; 32.0 %), and associated with the female sex, higher HbA1c and WHO-5 < 50. Continuous subcutaneous insulin infusion at baseline was associated with PAID-20<30. 21 individuals attended a group-based intervention. At one-week follow up PAID-20 was reduced (29.1 ± 15.4 vs. 41.3 ± 12.1 at baseline, p = 0.003), and at nine-twelve months' follow-up HbA1c was reduced (59.3 ± 15.3 mmol/mol vs. 68.0 ± 17.4 mmol/mol at baseline, p = 0.012). CONCLUSIONS This pilot study demonstrated that 25 % of the investigated emerging adults with T1D experienced DD (PAID-20≥30) associated with four clinical factors. We found a reduction in HbA1c and a short-term reduction in PAID-20 following the group-based intervention.
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Affiliation(s)
- Anne-Sofie Kortegaard
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark.
| | - Rikke B Rokkjær
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.
| | - Hanne Marie H Harboe
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark.
| | - Sten Lund
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.
| | - Anette Andersen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark
| | - Mette Bohl
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark; Department of Clinical Medicine - Medical Diagnostic Centre, Regional Hospital Central Jutland, Heibergs Allé 4, 8800 Viborg, Denmark.
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Pouwer F, Deschênes S. Critical comments regarding the assessment of quality of life and the clinical impact of the POWER2DM intervention. Diabetologia 2024; 67:954-955. [PMID: 38427074 DOI: 10.1007/s00125-024-06117-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 12/18/2023] [Indexed: 03/02/2024]
Affiliation(s)
- Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark.
- Steno Diabetes Center Odense (SDCO), Odense, Denmark.
- Department of Medical Psychology, Amsterdam UMC, Amsterdam, the Netherlands.
| | - Sonya Deschênes
- School of Psychology, University College Dublin, Dublin, Ireland
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Embaye J, de Wit M, Snoek F. A Self-Guided Web-Based App (MyDiaMate) for Enhancing Mental Health in Adults With Type 1 Diabetes: Insights From a Real-World Study in the Netherlands. JMIR Diabetes 2024; 9:e52923. [PMID: 38568733 PMCID: PMC11024740 DOI: 10.2196/52923] [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: 09/19/2023] [Revised: 01/23/2024] [Accepted: 02/08/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND MyDiaMate is a web-based intervention specifically designed for adults with type 1 diabetes (T1D) that aims to help them improve and maintain their mental health. Prior pilot-testing of MyDiaMate verified its acceptability, feasibility, and usability. OBJECTIVE This study aimed to investigate the real-world uptake and usage of MyDiaMate in the Netherlands. METHODS Between March 2021 and December 2022, MyDiaMate was made freely available to Dutch adults with T1D. Usage (participation and completion rates of the modules) was tracked using log data. Users could volunteer to participate in the user profile study, which required filling out a set of baseline questionnaires. The usage of study participants was examined separately for participants scoring above and below the cutoffs of the "Problem Areas in Diabetes" (PAID-11) questionnaire (diabetes distress), the "World Health Organization Well-being Index" (WHO-5) questionnaire (emotional well-being), and the fatigue severity subscale of the "Checklist Individual Strength" (CIS) questionnaire (fatigue). Two months after creating an account, study participants received an evaluation questionnaire to provide us with feedback. RESULTS In total, 1008 adults created a MyDiaMate account, of whom 343 (34%) participated in the user profile study. The mean age was 43 (SD 14.9; 18-76) years. Most participants were female (n=217, 63.3%) and higher educated (n=198, 57.6%). The majority had been living with T1D for over 5 years (n=241, 73.5%). Of the study participants, 59.1% (n=199) of them reported low emotional well-being (WHO-5 score≤50), 70.9% (n=239) of them reported elevated diabetes distress (PAID-11 score≥18), and 52.4% (n=178) of them reported severe fatigue (CIS score≥35). Participation rates varied between 9.5% (n=19) for social environment to 100% (n=726) for diabetes in balance, which opened by default. Completion rates ranged from 4.3% (n=1) for energy, an extensive cognitive behavioral therapy module, to 68.6% (n=24) for the shorter module on hypos. There were no differences in terms of participation and completion rates of the modules between study participants with a more severe profile, that is, lower emotional well-being, greater diabetes distress, or more fatigue symptoms, and those with a less severe profile. Further, no technical problems were reported, and various suggestions were made by study participants to improve the application, suggesting a need for more personalization. CONCLUSIONS Data from this naturalistic study demonstrated the potential of MyDiaMate as a self-help tool for adults with T1D, supplementary to ongoing diabetes care, to improve healthy coping with diabetes and mental health. Future research is needed to explore engagement strategies and test the efficacy of MyDiaMate in a randomized controlled trial.
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Affiliation(s)
- Jiska Embaye
- Department of Medical Psychology, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Maartje de Wit
- Department of Medical Psychology, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Frank Snoek
- Department of Medical Psychology, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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van Bon AC, Blauw H, Jansen TJP, Laverman GD, Urgert T, Geessink-Mennink J, Mulder AH, Out M, Groote Veldman R, Onvlee AJ, Schouwenberg BJJW, Vermeulen MAR, Diekman MJM, Gerding MN, van Wijk JPH, Klaassen M, Witkop M, DeVries JH. Bihormonal fully closed-loop system for the treatment of type 1 diabetes: a real-world multicentre, prospective, single-arm trial in the Netherlands. Lancet Digit Health 2024; 6:e272-e280. [PMID: 38443309 DOI: 10.1016/s2589-7500(24)00002-5] [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: 05/17/2023] [Revised: 11/15/2023] [Accepted: 01/05/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Management of insulin administration for intake of carbohydrates and physical activity can be burdensome for people with type 1 diabetes on hybrid closed-loop systems. Bihormonal fully closed-loop (FCL) systems could help reduce this burden. In this trial, we assessed the long-term performance and safety of a bihormonal FCL system. METHODS The FCL system (Inreda AP; Inreda Diabetic, Goor, Netherlands) that uses two hormones (insulin and glucagon) was assessed in a 1 year, multicentre, prospective, single-arm intervention trial in adults with type 1 diabetes. Participants were recruited in eight outpatient clinics in the Netherlands. We included adults with type 1 diabetes aged 18-75 years who had been using flash glucose monitoring or continuous glucose monitors for at least 3 months. Study visits were integrated into standard care, usually every three months, to evaluate glycaemic control, adverse events, and person-reported outcomes. The primary endpoint was time in range (TIR; glucose concentration 3·9-10·0 mmol/L) after 1 year. The study is registered in the Dutch Trial Register, NL9578. FINDINGS Between June 1, 2021, and March 2, 2022, we screened 90 individuals and enrolled 82 participants; 78 were included in the analyses. 79 started the intervention and 71 were included in the 12 month analysis. Mean age was 47.7 (SD 12·4) years and 38 (49%) were female participants. The mean preintervention TIR of participants was 55·5% (SD 17·2). After 1 year of FCL treatment, mean TIR was 80·3% (SD 5·4) and median time below range was 1·36% (IQR 0·80-2·11). Questionnaire scores improved on Problem Areas in Diabetes (PAID) from 30·0 (IQR 18·8-41·3) preintervention to 10·0 (IQR 3·8-21·3; p<0·0001) at 12 months and on World Health Organization-Five Well-Being Index (WHO-5) from 60·0 (IQR 44·0-72·0) preintervention to 76·0 (IQR 60·0-80·0; p<0·0001) at 12 months. Five serious adverse events were reported (one cerebellar stroke, two severe hypoglycaemic, and two hyperglycaemic events). INTERPRETATION Real-world data obtained in this trial demonstrate that use of the bihormonal FCL system was associated with good glycaemic control in patients who completed 1 year of treatment, and could help relieve these individuals with type 1 diabetes from making treatment decisions and the burden of carbohydrate counting. FUNDING Inreda Diabetic.
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Affiliation(s)
- A C van Bon
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, Netherlands.
| | - H Blauw
- Inreda Diabetic, Goor, Netherlands
| | | | - G D Laverman
- Department of Internal Medicine, ZGT Hospital, Hengelo, Netherlands
| | - T Urgert
- Department of Internal Medicine, ZGT Hospital, Hengelo, Netherlands
| | - J Geessink-Mennink
- Department of Internal Medicine, Slingeland Hospital, Doetinchem, Netherlands
| | - A H Mulder
- Department of Internal Medicine, Slingeland Hospital, Doetinchem, Netherlands
| | - M Out
- Department of Internal Medicine, MST, Enschede, Netherlands
| | | | - A J Onvlee
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - B J J W Schouwenberg
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - M J M Diekman
- Department of Internal Medicine, Deventer Hospital, Deventer, Netherlands
| | - M N Gerding
- Department of Internal Medicine, Deventer Hospital, Deventer, Netherlands
| | - J P H van Wijk
- Department of Internal Medicine, Hospital Gelderse Vallei, Ede, Netherlands
| | | | - M Witkop
- Inreda Diabetic, Goor, Netherlands
| | - J H DeVries
- Department of Internal Medicine, Amsterdam UMC, Amsterdam, Netherlands
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Hermanns N, Kulzer B, Ehrmann D. Person-reported outcomes in diabetes care: What are they and why are they so important? Diabetes Obes Metab 2024; 26 Suppl 1:30-45. [PMID: 38311448 DOI: 10.1111/dom.15471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 02/06/2024]
Abstract
In this review, we aim to show how person-reported outcomes (PROs) and person-reported experiences (PREs) can significantly contribute to the way diabetes care is delivered, the involvement of people with diabetes in diabetes care, and the collaboration between health care professionals and people with diabetes. This review focuses on the definition and measurement of PROs and PREs, the importance of PROs and PREs for person-centred diabetes care, and integrating the perspectives of people with diabetes in the evaluation of medical, psychological and technological interventions. PROs have been increasingly accepted by Health Technology Assessment bodies and are therefore valued in the context of reimbursement decisions and consequently by regulators and other health care stakeholders for the allocation of health care resources. Furthermore, the review identified current challenges to the assessment and use of PROs and PREs in clinical care and research. These challenges relate to the combination of questionnaires and ecological momentary assessment for measuring PROs and PREs, lack of consensus on a core outcome set, limited sensitivity to change within many measures and insufficient standardization of what can be considered a minimal clinically important difference. Another issue that has not been sufficiently addressed is the involvement of people with diabetes in the design and development of measures to assess PROs and PREs.
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Affiliation(s)
- Norbert Hermanns
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg, Bamberg, Germany
| | - Bernhard Kulzer
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg, Bamberg, Germany
| | - Dominic Ehrmann
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich-University of Bamberg, Bamberg, Germany
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Koper N, Boin Y, Creemers HE, van Dam L, Stams GJJM, Branje S. Effectiveness of a multidisciplinary treatment with youth-initiated mentoring for youths with mental health needs from multi-problem families: a quasi-experimental study. BMC Public Health 2024; 24:1. [PMID: 38166901 PMCID: PMC10759347 DOI: 10.1186/s12889-023-17506-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Children from multi-problem families have an increased risk for experiencing mental health problems. These families face problems in several domains that are often found to be chronic and intergenerational. Yet, the effects of mental health care for youths from multi-problem families are small at best, urging research on new treatment programs. The InConnection approach is an integrated care program to improve resilience of youths with mental health needs from multi-problem families by connecting professional expertise from multiple disciplines with the informal social network of the youth. Youths are asked to nominate a youth-initiated mentor (YIM) from the supportive adults in their network. METHODS This quasi-experimental study compared the effectiveness of the InConnection approach to treatment as usual in a sample of 107 families (n = 66 intervention group, n = 41 control group) with n = 115 youths receiving treatment (cases). Youths (n = 102 reports, Mage = 15.59 years), parents (n = 85 reports) and case managers (n = 107 reports) responded to questionnaires four times over 15 months. Using these data, we measured youth resilience as the primary outcome, seven secondary outcomes, and three intermediate outcomes. RESULTS Latent growth models showed only one significant change in outcomes over time across conditions, namely a decrease in case manager-reported child unsafety, and only two condition effects, which were both parent-reported. Parents in the InConnection group reported improvements over time in youth's emotional and behavioral problems and their own positive parenting, whereas control parents reported no changes (ps ≤ 0.013). DISCUSSION The treatment conditions were not effective in improving most of the youth and parental outcomes over time, except for child safety reported by the case manager. The InConnection approach only outperformed care as usual on two parent-reported outcomes. Future research should examine for whom and under what circumstances the InConnection approach works more convincingly. TRIAL REGISTRATION Netherlands Trial Register NL7565. Retrospectively registered on 05/03/2019.
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Affiliation(s)
- Natasha Koper
- Department of Youth and Family, Utrecht University, PO box 80140, Utrecht, 3508TC, the Netherlands.
- Department of Forensic Child and Youth Care Sciences, University of Amsterdam, Amsterdam, the Netherlands.
- YIM Foundation, Amersfoort, the Netherlands.
| | - Yukiko Boin
- Department of Youth and Family, Utrecht University, PO box 80140, Utrecht, 3508TC, the Netherlands
| | - Hanneke E Creemers
- Department of Forensic Child and Youth Care Sciences, University of Amsterdam, Amsterdam, the Netherlands
| | - Levi van Dam
- Department of Forensic Child and Youth Care Sciences, University of Amsterdam, Amsterdam, the Netherlands
- YIM Foundation, Amersfoort, the Netherlands
- Levvel youth and family care, Amsterdam, the Netherlands
| | - Geert Jan J M Stams
- Department of Forensic Child and Youth Care Sciences, University of Amsterdam, Amsterdam, the Netherlands
| | - Susan Branje
- Department of Youth and Family, Utrecht University, PO box 80140, Utrecht, 3508TC, the Netherlands
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Fisher L, Fortmann A, Knaebel J, Stuhr A. Can a Basic Management App Paired With A Glucose Meter Help Reduce Glucose Levels Among Adults With Type 2 Diabetes? The REALL Study. J Diabetes Sci Technol 2024; 18:99-105. [PMID: 35533145 PMCID: PMC10899840 DOI: 10.1177/19322968221096163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Evaluations of technology to help adults manage type 2 diabetes (T2D) have yielded mixed results. We analyzed the effectiveness of a free app linked to a glucose meter to study reductions in glucose levels over time among a self-selected sample of adults with T2D. RESEARCH DESIGN AND METHODS Adults with T2D >12 months, >21 years, ability to read English (insulin using-IU and non-insulin using-NIU) who independently elected to pair their CONTOUR NEXT ONE meter with the CONTOUR DIABETES App were invited to participate. Glucose data from baseline to 16 weeks were uploaded to the cloud (N = 461). Assessment of diabetes distress, medication taking, quality of life, and hypoglycemia concerns occurred at baseline, six, and 16 weeks. RESULTS Findings indicated a significant decrease in weekly glucose levels over time: baseline mean = 169 (62.0) (9.4 mmol/L; 3.44); 16-week mean = 146.5 (36.0) (8.1 mmol/L; 2.0) (P < .001), with no IU and NIU differences. Largest reductions occurred during the first six weeks, with no later rebound effects. Significant, though modest, improvements in global quality of life (P = .03), hypoglycemia concerns (P = .01), and diabetes distress (P < .001) occurred over 16 weeks. CONCLUSIONS Making an App for monitoring glucose easily available for download with a glucose meter can be helpful for self-selected adults with T2D. Effective utilization assumes that users are sufficiently motivated and engaged, are comfortable and trusting of the technology, and have sufficient knowledge of how to make use of the glucose data.
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Affiliation(s)
- Lawrence Fisher
- University of California San Francisco, San Francisco, CA, USA
| | - Addie Fortmann
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, CA, USA
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Stice E, Wisting L, Desjardins CD, Hood KK, Hanes S, Rubino L, Shaw H. Evaluation of a novel eating disorder prevention program for young women with type 1 diabetes: A preliminary randomized trial. Diabetes Res Clin Pract 2023; 206:110997. [PMID: 37951479 PMCID: PMC11326084 DOI: 10.1016/j.diabres.2023.110997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/23/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE Evaluate whether the Body Project prevention program adapted for young women with type 1 diabetes (Diabetes Body Project) reduces eating disorder (ED) risk factors and symptoms. METHODS Young women (aged 15-30) at high-risk for EDs due to having type 1 diabetes and body image concerns (N = 55) were randomized to virtually delivered Diabetes Body Project groups or an educational control condition, completing measures at pretest, posttest, and 3-month follow-up. RESULTS Diabetes Body Project versus the control participants showed significantly greater reductions in thin-ideal internalization, body dissatisfaction, diabetes distress, diabetes eating pathology, and ED symptoms by posttest, and greater reductions in diabetes eating pathology and ED symptoms, and greater improvements in quality of life by 3-month follow-up, which were medium to large effects (d's ranged from -0.43 to -0.90). Although control participants showed a worsening of glycemic control (time in range) verses Diabetes Body Project participants, this difference was non-significant (d = 0.26). CONCLUSIONS Virtually delivered Diabetes Body Project decreased ED risk factors and symptoms in young women with type 1 diabetes. A well powered randomized controlled trial is warranted to evaluate this intervention over longer follow-up.
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12
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Du J, Jiang Y, Lloyd C, Sartorius N, Ren J, Zhao W, Wei J, Hong X. Validation of Chinese version of the 5-item WHO well-being index in type 2 diabetes mellitus patients. BMC Psychiatry 2023; 23:890. [PMID: 38031007 PMCID: PMC10685601 DOI: 10.1186/s12888-023-05381-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 11/15/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND For better disease management and improved prognosis, early identification of co-morbid depression in diabetic patients is warranted. the WHO-5 well-being index (WHO-5) has been used to screen for depression in diabetic patients, and its Chinese version (WHO-5-C) has been validated. However, its psychometric properties remain to be further validated in the type 2 diabetes patient population. The aim of our study was to examine the reliability and validity of the WHO-5-C in patients with type 2 diabetes mellitus. METHODS The cross-sectional study was conducted on 200 patients from July 2014 to March 2015. All patients should complete the WHO-5-C, the Patient Health Questionnaire-9 (PHQ-9), the 20-item Problem Areas in Diabetes Scale (PAID-20), the Mini International Neuropsychiatric Interview (M.I.N.I), and Hamilton Rating Scale for Depression (HAM-D). Internal consistency of WHO-5 was revealed by Cronbach's alpha, and constructive validity by confirmatory factor analysis (CFA). Relationship with PHQ-9, HAM-D, and PAID-20 was examined for concurrent validity, and ROC analysis was performed for criterion validity. RESULTS The WHO-5-C presented satisfactory reliability (Cronbach's alpha = 0.88). CFA confirmed the unidimensional factor structure of WHO-5-C. The WHO-5-C had significant negative correlation with HAM-D (r = -0.610), PHQ-9 (r = -0.694) and PAID-20 (r = -0.466), confirming good concurrent validity. Using M.I.N.I as the gold standard, the cut-off value of WHO-5-C was 42, with a sensitivity of 0.83 and specificity of 0.75. CONCLUSION The WHO-5-C holds satisfactory reliability and validity that is suitable for depression screening in type 2 diabetes patients as a short and convenient instrument.
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Affiliation(s)
- Jianhua Du
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Yinan Jiang
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Cathy Lloyd
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, UK
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes (AMH), Geneva, Switzerland
| | - Jie Ren
- Department of Psychiatry, Beijing Xicheng District Pingan Hospital, Beijing, People's Republic of China
| | - Weigang Zhao
- Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Jing Wei
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China.
| | - Xia Hong
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China.
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13
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Graue M, Igland J, Haugstvedt A, Hernar I, Birkeland KI, Zoffmann V, Richards DA, Kolltveit BCH. Evaluation of an interprofessional follow-up intervention among people with type 2 diabetes in primary care-A randomized controlled trial with embedded qualitative interviews. PLoS One 2023; 18:e0291255. [PMID: 37967084 PMCID: PMC10650997 DOI: 10.1371/journal.pone.0291255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 08/21/2023] [Indexed: 11/17/2023] Open
Abstract
With an ageing population and improved treatments people live longer with their chronic diseases, and primary care clinics face more costly and difficult-to-treat multimorbid patients. To meet these challenges, current guidelines for the management of type 2 diabetes suggest that an interprofessional team should collaborate to enhance the delivery of worthwhile self-management support interventions. In this study, we aimed to evaluate the effects of an empowerment-based interprofessional follow-up intervention in people with type 2 diabetes in primary care on patient-reported outcomes, biomarkers and weight, and to explore the experiences of patients attending the intervention. We invited patients during regular visits to their general practitioners. The 12-month intervention included 1) empowerment-based counselling; 2) a standardized medical report. The control group received consultations with physicians only. The primary outcome was the Patient Activation Measure, a patient-reported measure assessing individual knowledge, skills, and confidence integral to managing one's health and healthcare. After the trial we conducted qualitative interviews. We observed no difference in the primary outcome scores. On secondary outcomes we found a significant between-group intervention effect in favor of the intervention group, with mean differences in glycemic control after 12 months (B [95% CI] = -8.6 [-17.1, -0.1] mmol/l; p = 0.045), and significant within-group changes of weight (B [95% CI] = -1.8 kg [-3.3, -0.3]; p = 0.02) and waist circumference (B [95% CI] = -3.9 cm [-7.3, -0.6]; p = 0.02). The qualitative data showed that the intervention opened patients' eyes for reflections and greater awareness, but they needed time to take on actions. The patients emphasized that the intervention gave rise to other insights and a greater understanding of their health challenges. We suggest testing the intervention among patients with larger disease burden and a more expressed motivation for change.
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Affiliation(s)
- Marit Graue
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Jannicke Igland
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Anne Haugstvedt
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Ingvild Hernar
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Internal Medicine, Haukeland University Hospital, Bergen, Norway
| | | | - Vibeke Zoffmann
- Interdisciplinary Research Unit of Women’s, Children’s and Families’ Health, Julie Marie Centre, Rigshospitalet, Copenhagen, Denmark
- Institute of Public Health Copenhagen University, Copenhagen, Denmark
| | - David A. Richards
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Beate-Christin Hope Kolltveit
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Vossevangen Medical Center, Voss, Norway
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14
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de Wit M, van Raalte DH, van den Berg K, Racca C, Muijs LT, Lutgers HL, Siegelaar SE, Serné E, Snoek FJ. Glucose variability and mood in people with type 1 diabetes using ecological momentary assessment. J Psychosom Res 2023; 173:111477. [PMID: 37643560 DOI: 10.1016/j.jpsychores.2023.111477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE Mood fluctuations related to blood glucose excursions are a commonly reported source of diabetes-distress, but research is scarce. We aimed to assess the relationship between real-time glucose variability and mood in adults with type 1 diabetes (T1D) using ecological momentary assessments. METHODS In this prospective observational study, participants wore a masked continuous glucose monitor and received prompts on their smartphone 6 times a day to answer questions about their current mood (Profile Of Mood States (POMS)-SF (dimensions: Anxiety, Depressive symptoms, Anger, Fatigue, Vigor)) for 14 days. Mixed model analyses examined associations over time between daily Coefficient of Variation (CV) of blood glucose and mean and variability (CV) of POMS scores. Further, within-person differences in sleep and nocturnal hypoglycemia were explored. RESULTS 18 people with T1D (10 female, mean age 44.3 years) participated. A total of 264 out of 367 days (70.2%) could be included in the analyses. No overall significant associations were found between CV of blood glucose and mean and CV of POMS scores, however, nocturnal hypoglycemia moderated the associations between CV of blood glucose and POMS scales (mean Fatigue Estimate 1.998, p < .006, mean Vigor Estimate -3.308, p < .001; CV Anger Estimate 0.731p = 0.02, CV Vigor Estimate -0.525, p = .006). CONCLUSION We found no overall relationship between real-time glycemic variability and mood per day. Further research into within-person differences such as sleep and nocturnal hypoglycemia is warranted.
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Affiliation(s)
- Maartje de Wit
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Medical Psychology, de Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Public Health, Mental Health, Amsterdam, the Netherlands.
| | - Daniël H van Raalte
- Amsterdam Public Health, Mental Health, Amsterdam, the Netherlands; Amsterdam UMC, location Vrije Universiteit Amsterdam, Endocrinology and Metabolism, de Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC, location Vrije Universiteit Amsterdam, Vasculair Medicine, de Boelelaan 1117, Amsterdam, the Netherlands; Diabetes Center Amsterdam UMC, location Vrije Universiteit Amsterdam, Vasculair Medicine, de Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Cardiovasculair Science, Amsterdam, the Netherlands
| | - Kirsten van den Berg
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Medical Psychology, de Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Public Health, Mental Health, Amsterdam, the Netherlands
| | - Catherina Racca
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Endocrinology and Metabolism, de Boelelaan 1117, Amsterdam, the Netherlands
| | - Linda T Muijs
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Medical Psychology, de Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Public Health, Mental Health, Amsterdam, the Netherlands
| | - Helen L Lutgers
- Medical Center Leeuwarden, Department of Internal Medicine, Leeuwarden, the Netherlands
| | - Sarah E Siegelaar
- Amsterdam UMC, location University of Amsterdam, Department of Endocrinology and Metabolism, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology and Metabolism, Amsterdam, the Netherlands
| | - Erik Serné
- Amsterdam Public Health, Mental Health, Amsterdam, the Netherlands; Amsterdam UMC, location Vrije Universiteit Amsterdam, Endocrinology and Metabolism, de Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC, location Vrije Universiteit Amsterdam, Vasculair Medicine, de Boelelaan 1117, Amsterdam, the Netherlands; Diabetes Center Amsterdam UMC, location Vrije Universiteit Amsterdam, Vasculair Medicine, de Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Cardiovasculair Science, Amsterdam, the Netherlands
| | - Frank J Snoek
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Medical Psychology, de Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Public Health, Mental Health, Amsterdam, the Netherlands
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15
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Polonsky WH, Soriano EC. Psychosocial and Glycemic Benefits for Insulin-Using Adults With Type 2 Diabetes After Six Months of Pump Therapy: A Quasi-Experimental Approach. J Diabetes Sci Technol 2023:19322968231198533. [PMID: 37667482 DOI: 10.1177/19322968231198533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
BACKGROUND Continuous subcutaneous insulin infusion (CSII) use in adults with type 1 diabetes offers psychosocial and clinical benefits, but little is known about its impact on such outcomes in the type 2 diabetes (T2D) population. To address this gap, we conducted a quasi-experimental prospective study to assess psychosocial, glycemic, and behavioral changes over six months in T2D adults on multiple daily injections (MDI) who were interested in starting Omnipod DASH, comparing those who did versus did not start on it. METHODS In total, 458 adults with T2D completed baseline questionnaires assessing psychosocial dimensions (eg, diabetes distress), clinical metrics (eg, HbA1c [glycosylated hemoglobin]), and behavioral measures (eg, missed mealtime boluses). Six months later, 220 (48.0%) completed the same questionnaire again. To examine differences in outcomes over time between those who began CSII (n = 176) versus those who remained on MDI (n = 44), a latent change score approach was used. RESULTS The CSII users reported greater gains than MDI users on all major psychosocial metrics, including overall well-being (P < .001) diabetes distress (P < .001), perceived T2D impact on quality of life (P = .003), and hypoglycemic worries and concerns (P < .001). The CSII users similarly reported a larger decline in HbA1c than MDI users (P < .05) and greater declines in two critical self-care behaviors: number of missed mealtime boluses (P < .001) and number of days of perceived overeating (P = .001). CONCLUSIONS The introduction of CSII (Omnipod DASH) in T2D adults can contribute to significant psychosocial, glycemic, and behavioral benefits, indicating that broader use of CSII in the T2D population may be of value.
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Affiliation(s)
- William H Polonsky
- Behavioral Diabetes Institute, San Diego, CA, USA
- University of California, San Diego, San Diego, CA, USA
| | - Emily C Soriano
- Scripps Whittier Diabetes Institute, Scripps Health, La Jolla, CA, USA
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16
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Nielsen BK, Nielsen PB, Mejdahl CT, Nielsen LA, Nielsen CP, Maindal HT, Wolf M. Mental well-being and patient activation during the first eight months of the COVID-19 pandemic in Denmark - a cohort study among 710 Danish adults with chronic conditions. BMC Public Health 2023; 23:1472. [PMID: 37532983 PMCID: PMC10394778 DOI: 10.1186/s12889-023-16316-0] [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: 09/16/2022] [Accepted: 07/14/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND COVID-19 has highlighted the importance of patient activation in managing chronic conditions and promoting resilience during times of crisis. Patient activation refers to an individual's knowledge, skills, and confidence in managing their own health and healthcare. Previous research has shown that people with higher levels of patient activation are better prepared to navigate the challenges of chronic illness and are more likely to engage in healthy behaviors. However, the impact of patient activation on COVID-19-related concerns and mental well-being among people with chronic conditions during the pandemic remains unclear. This study aims to investigate the possible role of patient activation in shaping COVID-19-related concerns and to describe changes in mental well-being among Danish adults with one or more chronic conditions during the early months of the pandemic. METHODS Danish adults with chronic conditions (e.g. diabetes, coronary heart disease, obstructive pulmonary lung disease, cancer) who had participated in a municipal health education program prior to the COVID-19 outbreak were asked to participate in this prospective questionnaire study in May 2020 and November 2020. Sociodemographic (sex, age, living status, educational attainment, employment status) and disease-related information (diagnosis, one or more chronic conditions) along with the Patient Activation Measure were collected before the outbreak and were obtained from a clinical database used for monitoring and evaluation of municipal health education programs. In contrast, the two questionnaires collected six months apart consisted of single items related to concerns about COVID-19 and the WHO-5 well-being index. RESULTS A total of 710 people with chronic conditions (mean age 60.9 years; 55.8% female) participated at both time points. In bivariate analyses, patient activation was associated with COVID-19-related concern and well-being. At follow-up, participants experienced a significant decrease in well-being. The decrease was associated with poorer well-being measured six months earlier, a greater perception that it had become more challenging to take care of one's health due to the pandemic, and finally, feeling lonely. The association between patient activation and well-being ceased to be significant in the multivariate regression model. CONCLUSIONS A considerable proportion of people with chronic conditions participating in this study have been mentally burdened during COVID-19. Although lower levels of patient activation were associated with greater COVID-19-related concerns, it did not have a significant impact on mental well-being over time.
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Affiliation(s)
- Berit Kjærside Nielsen
- DEFACTUM - Public Health Research, Central Denmark Region, Olof Palmes Allé 15, Aarhus N, DK-8200, Denmark.
| | - Pernille Bjørnholt Nielsen
- DEFACTUM - Public Health Research, Central Denmark Region, Olof Palmes Allé 15, Aarhus N, DK-8200, Denmark
| | | | - Lise Arnth Nielsen
- DEFACTUM - Public Health Research, Central Denmark Region, Olof Palmes Allé 15, Aarhus N, DK-8200, Denmark
| | - Camilla Palmhøj Nielsen
- DEFACTUM - Public Health Research, Central Denmark Region, Olof Palmes Allé 15, Aarhus N, DK-8200, Denmark
- Department of Public Health - Department of Health Services Research, Aarhus University, Aarhus C, Denmark
| | - Helle Terkildsen Maindal
- Department of Public Health - Department of Health Services Research, Aarhus University, Aarhus C, Denmark
| | - Michael Wolf
- Institute for Public Health and Medicine (IPHAM) - Center for Applied Health Research on Aging, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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17
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Pylov D, Polonsky W, Imberg H, Holmer H, Hellman J, Wijkman M, Bolinder J, Heisse T, Dahlqvist S, Nyström T, Schwarz E, Hirsch I, Lind M. Treatment Satisfaction and Well-Being With CGM in People With T1D: An Analysis Based on the GOLD Randomized Trial. J Diabetes Sci Technol 2023:19322968231183974. [PMID: 37501366 DOI: 10.1177/19322968231183974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
BACKGROUND The GOLD trial demonstrated that continuous glucose monitoring (CGM) in people with type 1 diabetes (T1D) managed with multiple daily insulin injections (MDI) improved not only glucose control but also overall well-being and treatment satisfaction. This analysis investigated which factors contributed to improved well-being and treatment satisfaction with CGM. METHODS The GOLD trial was a randomized crossover trial comparing CGM versus self-monitored blood glucose (SMBG) over 16 months. Endpoints included well-being measured by the World Health Organization-Five Well-Being Index (WHO-5) and treatment satisfaction by the Diabetes Treatment Satisfaction Questionnaire (DTSQ) as well as glucose metrics. Multivariable R2-decomposition was used to understand which variables contributed most to treatment satisfaction. RESULTS A total of 139 participants were included. Multivariable analyses revealed that increased convenience and flexibility contributed to 60% (95% confidence interval [CI] = 50%-69%) of the improvement in treatment satisfaction (Diabetes Treatment Satisfaction Questionnaire change version [DTSQc]) observed with CGM, whereas perceived effects on hypoglycemia and hyperglycemia only contributed to 6% (95% CI = 2%-11%) of improvements. Significant improvements in well-being (WHO-5) by CGM were observed for the following: feeling cheerful (P = .025), calm and relaxed (P = .024), being active (P = .046), and waking up fresh and rested (P = .044). HbA1c reductions and increased time in range (TIR) were associated with increased treatment satisfaction, whereas glycemic variability was not. HbA1c reduction showed also an association with increased well-being and increased TIR with less diabetes-related distress. CONCLUSIONS While CGM improves glucose control in people with T1D on MDI, increased convenience and flexibility through CGM is of even greater importance for treatment satisfaction and patient well-being. These CGM-mediated effects should be taken into account when considering CGM initiation.
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Affiliation(s)
- Daniel Pylov
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - William Polonsky
- Behavioral Diabetes Institute, San Diego, CA, USA
- University of California, San Diego, CA, USA
| | - Henrik Imberg
- Chalmers University of Technology, Gothenburg, Sweden
- University of Gothenburg, Gothenburg, Sweden
- Statistiska Konsultgruppen, Gothenburg, Sweden
| | - Helen Holmer
- Department of Internal Medicine, Centralsjukhuset, Kristianstad, Sweden
| | - Jarl Hellman
- Department of Medical Sciences, Clinical Diabetes and Metabolism, Uppsala University, Uppsala, Sweden
| | - Magnus Wijkman
- Department of Internal Medicine and Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Jan Bolinder
- Department of Medicine, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden
| | | | - Sofia Dahlqvist
- Department of Medicine, NU Hospital Group, Uddevalla, Sweden
| | - Thomas Nyström
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Erik Schwarz
- Department of Internal Medicine, Faculty of Medicine & Health, Örebro University, Örebro Sweden
| | - Irl Hirsch
- School of Medicine, University of Washington, Seattle, WA, USA
| | - Marcus Lind
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Medicine, NU Hospital Group, Uddevalla, Sweden
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18
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Mejdahl CT, Nielsen PB, Nielsen LA, Christensen AF, Nielsen BK. Experiences of being at high-risk during the COVID-19 pandemic and its impact on emotional well-being and daily life in people with chronic conditions: a qualitative study. J Patient Rep Outcomes 2023; 7:62. [PMID: 37405541 DOI: 10.1186/s41687-023-00607-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/24/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND With its health risks and extensive disruption to everyday life, the SARS-CoV-2 (COVID-19) pandemic has affected the lives of billions of people. People with chronic conditions are particularly susceptible to severe illness if infected by COVID-19, and they have repeatedly been urged to take stringent steps to 'shield' themselves from the virus. It is argued that the negative impact of isolation and other lockdown-related restrictions on emotional well-being and daily life may be most prominent among people at increased risk for severe illness from COVID-19. This qualitative thematic analysis aimed to explore how individuals with chronic conditions perceived the risk posed by COVID-19 and to understand how being at high risk affected their emotional well-being and everyday life. METHODS The study is a thematic analysis of qualitative data consisting of semi-structured interviews with adults affected by at least one chronic condition supplemented with free text comments from a PRO-based survey. RESULTS Based on 17 semi-structured interviews and 144 free text comments from a PRO-based survey three thematic patterns representing diverse COVID-19-related risk experiences were extracted: (1) Feeling vulnerable and at risk, (2) Uncertainty about being at risk, and (3) Distancing from the high-risk label. CONCLUSIONS The risk of COVID-19 impacted the participants' everyday lives and emotional well-being in various ways. Some participants felt vulnerable and at risk causing them and their families to take on far-reaching precautions with significant consequences for their everyday life and emotional well-being. Some participants expressed uncertainty associated with whether they were at increased risk. Such uncertainty gave rise to dilemmas about how to navigate their everyday life. Other participants did not identify themselves as at higher risk and took no special precautions. Such a lack of perceived risk may undermine their motivation for taking preventive measures, which calls for public attention regarding current or future pandemics.
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Affiliation(s)
| | - Pernille Bjørnholt Nielsen
- DEFACTUM - Public Health Research, Central Denmark Region, Olof Palmes Allé 15, Aarhus N, DK-8200, Denmark
| | - Lise Arnth Nielsen
- DEFACTUM - Public Health Research, Central Denmark Region, Olof Palmes Allé 15, Aarhus N, DK-8200, Denmark
| | | | - Berit Kjærside Nielsen
- DEFACTUM - Public Health Research, Central Denmark Region, Olof Palmes Allé 15, Aarhus N, DK-8200, Denmark
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19
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Alzahrani O, Fletcher JP, Hitos K. Quality of life and mental health measurements among patients with type 2 diabetes mellitus: a systematic review. Health Qual Life Outcomes 2023; 21:27. [PMID: 36949507 PMCID: PMC10031182 DOI: 10.1186/s12955-023-02111-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 03/14/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Over the past few decades the benefits of assessing Quality of Life (QoL) and mental health in patients with Type 2 Diabetes Mellitus (T2DM) have steadily increased with limited studies relating to the most useful method to assess these patients. This study aims to identify, review, summarise, and evaluate the methodological quality for the most validated commonly used health-related QoL and mental health assessment measurements in diabetic patients. METHODS All original articles published on PubMed, MedLine, OVID, The Cochrane Register, Web of Science Conference Proceedings and Scopus databases were systematically reviewed between 2011 and 2022. A search strategy was developed for each database using all possible combinations of the following keywords: "type 2 diabetes mellitus", "quality of life", mental health", and "questionnaires". Studies conducted on patients with T2DM of ≥ 18 years with or without other clinical illnesses were included. Articles designed as a literature or systematic review conducted on either children or adolescents, healthy adults and/or with a small sample size were excluded. RESULTS A total of 489 articles were identified in all of the electronic medical databases. Of these articles, 40 were shown to meet our eligibility criteria to be included in this systematic review. Approximately, 60% of these studies were cross-sectional, 22.5% were clinical trials, and 17.5% of cohort studies. The top commonly used QoL measurements are the SF-12 identified in 19 studies, the SF-36, included in 16 studies, and the EuroQoL EQ-5D, found in 8 studies. Fifteen (37.5%) studies used only one questionnaire, while the remaining reviewed (62.5%) used more than one questionnaire. Finally, the majority (90%) of studies reported using self-administered questionnaires and only 4 used interviewer mode of administration. CONCLUSION Our evidence highlights that the commonly used questionnaire to evaluate the QoL and mental health is the SF-12 followed by SF-36. Both of these questionnaires are validated, reliable and supported in different languages. Moreover, using single or combined questionnaires as well as the mode of administration depends on the clinical research question and aim of the study.
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Affiliation(s)
- Owiss Alzahrani
- Westmead Research Centre for Evaluation of Surgical Outcomes, Department of Surgery, Westmead Hospital, Sydney, Australia.
- The University of Sydney, Faculty of Medicine and Health, Westmead Clinical School, Sydney, Australia.
- Department of Community Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - John P Fletcher
- Westmead Research Centre for Evaluation of Surgical Outcomes, Department of Surgery, Westmead Hospital, Sydney, Australia
- The University of Sydney, Faculty of Medicine and Health, Westmead Clinical School, Sydney, Australia
| | - Kerry Hitos
- Westmead Research Centre for Evaluation of Surgical Outcomes, Department of Surgery, Westmead Hospital, Sydney, Australia
- The University of Sydney, Faculty of Medicine and Health, Westmead Clinical School, Sydney, Australia
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20
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Polonsky WH, Fortmann AL, Soriano EC, Guzman SJ, Funnell MM. The AH-HA! Project: Transforming Group Diabetes Self-Management Education Through the Addition of Flash Glucose Monitoring. Diabetes Technol Ther 2023; 25:194-200. [PMID: 36409486 DOI: 10.1089/dia.2022.0419] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: The majority of individuals referred to diabetes self-management education and support (DSMES) programs do not access this resource. Of those who do, attrition is high, with anecdotal reports pointing to the didactic and impersonal nature of these programs contributing to low utilization and completion rates. In an effort to develop a more engaging form of DSMES for adults with type 2 diabetes (T2D), we constructed a nondidactic "discovery learning"-based DSMES program centered on real-time flash glucose monitoring (FGM). Methods: In this single-arm pilot study, 35 adults with T2D duration 1-5 years, ages 21-75 years, not using insulin and HbA1c ≥8.0% were introduced to FGM and participated in five weekly group sessions. DSMES content was personalized, emerging from the concerns and questions arising from participants' FGM discoveries. The primary outcome was glycemic change as assessed by blinded FGM at baseline and month 3. Secondary outcomes included psychosocial and behavioral measures. Results: There was a significant gain in percentage time in range (% TIR) 70-180 mg/dL from baseline (55%) to month 3 (74%), and a parallel drop-in percentage time above range (TAR) >180 mg/dL from 44% to 25% (Ps = 0.01). Overall well-being rose significantly (P = 0.04), whereas diabetes distress showed a nonsignificant drop. Participants reported improvements in healthy eating (P < 0.001) and physical activity, although the latter did not reach statistical significance. Conclusions: These findings support a new approach to DSMES, a method that integrates FGM with a highly interactive and engaging patient-driven "discovery learning" approach to education.
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Affiliation(s)
- William H Polonsky
- Behavioral Diabetes Institute, San Diego, California, USA
- University of California, San Diego, California, USA
| | - Addie L Fortmann
- Scripps Whittier Diabetes Institute, Scripps Health, La Jolla, California, USA
| | - Emily C Soriano
- Scripps Whittier Diabetes Institute, Scripps Health, La Jolla, California, USA
| | - Susan J Guzman
- Behavioral Diabetes Institute, San Diego, California, USA
| | - Martha M Funnell
- Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
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21
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Serné EH, van den Berg IK, Racca C, van Raalte DH, Kramer MHH, de Wit M, Snoek FJ. Improved Effectiveness of Immediate Continuous Glucose Monitoring in Hypoglycemia-Prone People with Type 1 Diabetes Compared with Hypoglycemia-Focused Psychoeducation Following a Previous Structured Education: A Randomized Controlled Trial. Diabetes Technol Ther 2023; 25:50-61. [PMID: 36326825 DOI: 10.1089/dia.2022.0232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objective: Stepped-care has been suggested in the management of patients with problematic hypoglycemia and impaired awareness of hypoglycemia (IAH), initially with psychoeducational programs based on blood glucose awareness training, progressing to diabetes technology in those with persisting need. We examined the clinical effectiveness of stepped-care starting with HypoAware and adding continuous glucose monitoring (CGM) as needed, versus immediate CGM in type 1 diabetes patients with problematic hypoglycemia despite previous structured education in insulin adjustment. Research Design and Methods: A randomized controlled trial (N = 52, mean age 53, 56% females). The stepped-care group attended HypoAware. If a severe hypoglycemic event (SHE) had occurred or IAH was still present after 6 months, CGM was initiated. The control group started immediate CGM. Primary endpoint was the number of participants with self-reported SHE. Secondary outcomes, evaluated at 6 and 12 months, were glycated hemoglobin (HbA1c), the number of participants with IAH time below range (TBR; <54 mg/dL), and patient-reported outcomes (PROs). Results: At 6 months, the number of patients reporting SHE had decreased significantly more in the CGM group: -39% (P < 0.05). HbA1c decreased more in the CGM group (-0.47 percentage-points, P < 0.05). IAH was restored in 31% of patients in both groups. TBR (<54 mg/dL) was lower in the CGM group (-2.4 percentage-points, P < 0.05). In the stepped-care group, 93% started CGM/intermittently scanned CGM. At 12 months, the number of patients reporting SHE was still higher in the stepped-care group. No differences were found in PROs. Conclusions: Immediate start of CGM is more effective than a hypoglycemia-focused reeducation program in reducing SHE risk and attaining glycemic targets in individuals with problematic hypoglycemia and IAH despite previous education in insulin dose adjustment. Trial registration: Netherlands Trial Register, NL64474.029.18.
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Affiliation(s)
- Erik H Serné
- Department of Internal Medicine, Diabetes Center, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ingrid Kirsten van den Berg
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Caterina Racca
- Department of Internal Medicine, Diabetes Center, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Daniël H van Raalte
- Department of Internal Medicine, Diabetes Center, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mark H H Kramer
- Department of Internal Medicine, Diabetes Center, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Maartje de Wit
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Frank J Snoek
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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22
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Roche D, Rafferty A, Holden S, Killeen SL, Kennelly M, McAuliffe FM. Maternal Well-Being and Stage of Behaviour Change during Pregnancy: A Secondary Analysis of the PEARS Randomised Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:34. [PMID: 36612357 PMCID: PMC9819687 DOI: 10.3390/ijerph20010034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
We aimed to determine whether early pregnancy well-being was associated with the stage of behaviour change during an antenatal lifestyle intervention using a secondary analysis of data from the Pregnancy Exercise and Nutrition Research Study (PEARS). Pregnant women (n = 277) with well-being data in early pregnancy were included. Maternal well-being was measured using the World Health Organisation Five-Item Well-Being Index. The intervention consisted of a mobile health (mHealth) phone application, supported by antenatal education and exercise, to prevent gestational diabetes in a population with overweight. Stage of behaviour change was measured in late pregnancy using a five-stage classification. Ordinal logistic regression was used to examine if well-being, the study group, or their interaction, were related to behaviour change. Maternal well-being (OR 1.03, 95% CI 1.01, 1.04, p < 0.01) and the study group (OR 2.25, 95% CI 1.44, 3.51, p < 0.01) both significantly influenced the positive stage of behaviour change. The probability of being at stage 5 increased from 43 to 92% as well-being increased from 0 to 100% and was higher in the intervention (53%) compared to the control (34%) group (p ≤ 0.01 (8.65, 29.27). This study demonstrates the potential importance of well-being in enabling women to engage with a healthy lifestyle, and the role that mHealth technology has in facilitating beneficial behaviour change.
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Affiliation(s)
- Doireann Roche
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, D02 YH21 Dublin, Ireland
| | - Anthony Rafferty
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, D02 YH21 Dublin, Ireland
| | - Sinead Holden
- UCD School of Mathematics and Statistics, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Sarah Louise Killeen
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, D02 YH21 Dublin, Ireland
| | - Maria Kennelly
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, D02 YH21 Dublin, Ireland
| | - Fionnuala M. McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, D02 YH21 Dublin, Ireland
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23
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Koper N, Creemers HE, van Dam L, Stams GJJM, Branje S. Resilience, well-being and informal and formal support in multi-problem families during the Covid-19 pandemic. Child Adolesc Psychiatry Ment Health 2022; 16:103. [PMID: 36536396 PMCID: PMC9762621 DOI: 10.1186/s13034-022-00542-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The Covid-19 pandemic may have had negative effects on youth and parental mental health, especially in high-risk populations such as multi-problem families (i.e., families that experience problems in multiple domains, such as mental health and social network problems). Using one to four assessments during all phases of the Covid-19 pandemic up until January 2022, we examined the associations between pandemic-related stress and mental health (resilience and well-being) of youth and parents from multi-problem families. We also investigated whether experienced informal (i.e., youth informal mentoring) and formal support (i.e., therapist support) served as protective factors in this association. METHODS A total of 92 youth aged 10-19 years (46.7% girls; mean age 16.00 years) and 78 parents (79.5% female; mean age 47.17 years) filled in one to four questionnaires between March 2020 and January 2022. Multi-level analyses were conducted to account for the nested structure of the data. RESULTS For youth, pandemic-related stress was associated with lower well-being, but not with resilience. Perceived support from both mentors and therapists was positively associated with youth mental health. Furthermore, high perceived therapist support protected youth from the negative effect of pandemic-related stress on resilience. For parents, pandemic-related stress was not related to mental health, irrespective of therapist support. Yet, therapist support was directly and positively associated with parental mental health. CONCLUSIONS Youth from multi-problem families who experience pandemic-related stress are at risk of (elevated) mental health problems during the pandemic, specifically if they have no or weak therapist support. The mental health of parents, however, was minimally affected by pandemic-related stress, indicating strength and flexibility. Youth and parents who experienced support during the pandemic reported higher levels of resilience and well-being, demonstrating the importance of support for individuals' mental health during stressful times such as a pandemic.
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Affiliation(s)
- Natasha Koper
- Department of Youth and Family, Utrecht University, PO box 80140, 3508TC, Utrecht, The Netherlands. .,Department of Forensic Child and Youth Care Sciences, University of Amsterdam, Amsterdam, The Netherlands. .,YIM Foundation, Amersfoort, The Netherlands.
| | - Hanneke E. Creemers
- grid.7177.60000000084992262Department of Forensic Child and Youth Care Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Levi van Dam
- grid.7177.60000000084992262Department of Forensic Child and Youth Care Sciences, University of Amsterdam, Amsterdam, The Netherlands ,YIM Foundation, Amersfoort, The Netherlands ,grid.491096.3Levvel Youth and Family Care, Amsterdam, The Netherlands
| | - Geert Jan J. M. Stams
- grid.7177.60000000084992262Department of Forensic Child and Youth Care Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Susan Branje
- grid.5477.10000000120346234Department of Youth and Family, Utrecht University, PO box 80140, 3508TC Utrecht, The Netherlands
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24
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Sayed Ahmed HA, Mohamed SF, Mostafa M, Elotla SF, Shah A, Shah J, Fouad AM. Psychometric evaluation of the Arabic version of the 5-item Problem Areas in Diabetes (AR-PAID-5) scale. BMC PRIMARY CARE 2022; 23:148. [PMID: 35681150 PMCID: PMC9185861 DOI: 10.1186/s12875-022-01758-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 05/30/2022] [Indexed: 11/29/2022]
Abstract
Background Screening for diabetes distress is recommended when caring for patients with type 2 diabetes mellitus (T2DM) in primary healthcare (PHC). The 5-item Problem Areas in Diabetes (PAID-5) scale is widely used to measure diabetes distress, but its Arabic validation studies are scarce, so this study was carried to assess the psychometric properties of the Arabic version of the PAID-5 (AR-PAID-5) in Egyptian PHC patients with T2DM. Methods We conducted a cross-sectional study including 260 participants from six rural PHC settings in Ismailia governorate, Egypt. Internal consistency using Cronbach’s α and one-month test-retest reliability using intraclass correlation coefficient (ICC) were investigated. Confirmatory factor analysis (CFA) was used to evaluate the one-factor structure of the AR-PAID-5. Correlations of the AR-PAID-5 with the Arabic versions of the 20-item Problem Areas in Diabetes (PAID), Patient Health Questionnaire 9 (PHQ-9), Generalized Anxiety Disorder 7 (GAD-7), 5-item World Health Organization Well-Being Index (WHO-5) scales and glycated hemoglobin (HbA1c) were investigated for supporting the convergent validity. Associations of the PAID-5 with sociodemographic, and clinical characteristics were assessed for demonstrating the discriminant validity. Criterion validity was also evaluated. Results There was a good internal consistency (α = 0.88) and a stable test-retest reliability (ICC = 0.74). The CFA confirmed the one-factor structure of the AR-PAID-5. Significant positive correlations existed between the AR-PAID-5 with diabetes distress evaluated by the Arabic version of the PAID (rho = 0.93, p < 0.001), depressive symptoms (PHQ-9) (rho = 0.56, p < 0.001), anxiety symptoms (GAD-7) (rho = 0.47, p < 0.001), emotional well-being (WHO-5) (rho = − 0.38, p < 0.001), and HbA1c (rho = 0.16, p = 0.003). A satisfactory discriminant validity, and an acceptable criterion validity were demonstrated. Conclusions The AR-PAID-5 scale is a reliable and valid tool that can be used for diabetes distress screening and in research in Arabic speaking PHC patients with T2DM.
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25
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Mitchell AM, Heitz HK, Leach SM, Berghuis KJ. Material circumstances, health care access, and self-reported health: A latent class analysis. J Health Psychol 2022; 28:675-689. [DOI: 10.1177/13591053221132899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Latent class analysis was used to explore intersections of material circumstances and health care access among 308 adults, and associations between classes with health outcomes. Good fit was found for a four-class model: Resource Stable (Class 1, 62.43%), Unbalanced Meals with Health Care (Class 2, 16.91%), Resource Insecurity with Delayed Health Care (Class 3, 14.75%), and Resource Stability without Access to Health Care (Class 4, 5.91%). Class 1 reported greater well-being and self-rated health than Class 2 and 3. Class 1 reported lower BMI than Class 2. Findings document intersections among economic marginalization indicators with varying health outcomes among classes.
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26
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Snoek FJ. Mental health in diabetes care. Time to step up. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:1039192. [PMID: 36992782 PMCID: PMC10012141 DOI: 10.3389/fcdhc.2022.1039192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022]
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27
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Langendoen-Gort M, Groeneveld L, Prinsen CAC, Beulens JW, Elders PJM, Halperin I, Mukerji G, Terwee CB, Rutters F. Patient-reported outcome measures for assessing health-related quality of life in people with type 2 diabetes: A systematic review. Rev Endocr Metab Disord 2022; 23:931-977. [PMID: 35779199 PMCID: PMC9515038 DOI: 10.1007/s11154-022-09734-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2022] [Indexed: 11/26/2022]
Abstract
Patient-Reported Outcome Measures (PROMs) are important tools to assess outcomes relevant to patients, with Health-Related Quality Of Life (HRQOL) as an important construct to be measured. Many different HRQOL PROMs are used in the type 2 diabetes field, however a complete overview of these PROMs is currently lacking. We therefore aimed to systematically describe and classify the content of all PROMs that have specifically been developed or validated to measure (aspects of) HRQOL in people with type 2 diabetes. A literature search was performed in PubMed and EMBASE until 31 December 2021. Studies on the development or validation of a PROM measuring HRQOL, or aspects of HRQOL, in people with type 2 diabetes were included. Title and abstract and full-text screening were conducted by two independent researchers and data extraction was performed independently by one of the researchers. Data were extracted on language in which the PROM was developed, target population, construct(s) being measured, names of (sub)scales and number of items per (sub)scale. In addition, all PROMs and subscales were classified according to specific aspects of HRQOL based on the Wilson & Cleary model (symptom status, functional status, general health perceptions) to aid researchers in PROM selection. In total 220 studies were identified that developed or validated PROMs that measure (aspects of) HRQOL in people with type 2 diabetes. Of the 116 unique HRQOL PROMs, 91 (of the subscales) measured symptom status, 60 measured functional status and 26 measured general health perceptions. In addition, 16 of the PROMs (subscales) measured global quality of life. 61 of the 116 PROMs (subscales) also include characteristics of the individual (e.g. aspects of personality, coping) or environment (e.g. social or financial support) and patient-reported experience measures (PREMs, e.g. measure of a patient's perception of their personal experience of the healthcare they have received, e.g. treatment satisfaction), which are not part of the HRQOL construct. Only 9 of the 116 PROMs measure all aspects of HRQOL based on the Wilson & Cleary model. Finally, 8 of the 116 PROMs stating to measure HRQOL, measured no HRQOL construct. In conclusion, a large number of PROMs are available for people with type 2 diabetes, which intend to measure (aspects of) HRQOL. These PROMs measure a large variety of (sub)constructs, which are not all HRQOL constructs, with a small amount of PROMs not measuring HRQOL at all. There is a need for consensus on which aspects of HRQOL should be measured in people with type 2 diabetes and which PROMs to use in research and daily practice. PROSPERO: CRD42017071012. COMET database: http://www.comet-initiative.org/studies/details/956 .
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Affiliation(s)
- Marlous Langendoen-Gort
- General Practice, Amsterdam UMC, Location Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
- Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands
| | - Lenka Groeneveld
- Epidemiology and Data Science, Amsterdam UMC, Location Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
- Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands
| | - Cecilia A C Prinsen
- Epidemiology and Data Science, Amsterdam UMC, Location Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
- Amsterdam Public Health, Methodology, Amsterdam, The Netherlands
| | - Joline W Beulens
- Epidemiology and Data Science, Amsterdam UMC, Location Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
- Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Diabetes & Metabolism, Amsterdam, The Netherlands
| | - Petra J M Elders
- General Practice, Amsterdam UMC, Location Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
- Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Diabetes & Metabolism, Amsterdam, The Netherlands
| | - Ilana Halperin
- Department of Medicine, Temerty Faculty of Medicine, Sunnybrook Health Sciences Center, King's College Circle, University of Toronto, Toronto, ON, Canada
| | - Geetha Mukerji
- Department of Medicine, Temerty Faculty of Medicine, Sunnybrook Health Sciences Center, King's College Circle, University of Toronto, Toronto, ON, Canada
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, Canada
| | - Caroline B Terwee
- Epidemiology and Data Science, Amsterdam UMC, Location Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
- Amsterdam Public Health, Methodology, Amsterdam, The Netherlands
| | - Femke Rutters
- Epidemiology and Data Science, Amsterdam UMC, Location Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands.
- Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands.
- Amsterdam Cardiovascular Sciences, Diabetes & Metabolism, Amsterdam, The Netherlands.
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28
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Continuous subcutaneous insulin infusion is associated with a better glycemic control than multiple daily insulin injections without difference in diabetic ketoacidosis and hypoglycemia admissions among Emiratis with Type 1 diabetes. PLoS One 2022; 17:e0264545. [PMID: 36136973 PMCID: PMC9498969 DOI: 10.1371/journal.pone.0264545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 02/12/2022] [Indexed: 11/19/2022] Open
Abstract
Aims
To characterizes Emiratis patients with Type 1 diabetes (T1D) and compares outcomes between continuous subcutaneous insulin infusion (CSII) versus multiple daily insulin injections (MDI) users. The WHO-Five Well-Being Index (WHO-5) score was used to screen for depression.
Methods
In this cross-sectional study; sociodemographic, clinical characteristics and insulin replacement regimens were collected on patients with T1D between 2015–2018.
Results
134 patients with mean age of 20.9±7.5 years were included. Females constitute 56.7% and 50.7% had diabetes duration of >10 years. Diabetic ketoacidosis (DKA) at presentation was reported in 46.3%. Average glycemic control over preceding 12months was satisfactory (less than 7.5%), suboptimal (7.5–9%), and poor (more than 9%) in 26.6%, 42.7% & 30.6% of the patients, respectively. Higher proportion of patients using CSII achieved satisfactory or suboptimal glycemic control compared to patients with MDI (P = 0.003). The latest median /IQR HbA1c was significantly lower (P = 0.041) in patients using CSII (8.2 /1.93%) compared to MDI (8.5/2.45%). There was no significant difference between two groups in DKA, severe hypoglycemia or total WHO-5 score.
Conclusions
CSII usage was associated with better glycemic control than MDI, although no difference in DKA and severe hypoglycemia. The overall glycemic control among Emiratis subjects with T1D is unsatisfactory and needs more rigorous patient counseling and education.
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Langendoen-Gort M, Al-Jabr H, Hugtenburg JG, Rutters F, de Wit M, Bhattacharya D, Abu-Hanna A, Farmer A, Elders PJM. A personalised intervention programme aimed at improving adherence to oral antidiabetic and/or antihypertensive medication in people with type 2 diabetes mellitus, the INTENSE study: study protocol for a randomised controlled trial. Trials 2022; 23:731. [PMID: 36056388 PMCID: PMC9438235 DOI: 10.1186/s13063-022-06491-7] [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: 12/24/2021] [Accepted: 06/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medication non-adherence is a prevalent health problem in people with type 2 diabetes mellitus (T2DM). Interventions have previously been developed to improve medication adherence, but inconsistent outcomes have been reported. A potential explanation for this inconsistency is a 'one size fits all' approach, with interventions not tailored to the needs and preferences of individuals. Therefore, the aim of this study is to evaluate the effectiveness of a personalised intervention programme aimed at improving adherence to oral antidiabetic and/or antihypertensive medication in people with T2DM. METHODS A parallel-group randomised controlled trial will be conducted in 40-50 community pharmacies in the Netherlands and the United Kingdom (UK). A total of 300 participants will be included and followed up for a period of 6 months. Participants will be people with T2DM identified as non-adherent to oral antidiabetic and/or antihypertensive medication, aged 35-75 years and mobile phone users. The intervention group will receive a personalised intervention programme that is based on one or more of the participants' pre-defined non-adherence profile(s), namely (I) Knowledge and perceptions, (II) Practical problems, (III) Side effects and (IV) Negative mood and beliefs. The intervention comprises of one or more supporting modules, namely (I) Brief messaging, (II) Clinical medication review, (III) Medication schedule, (IV) Reminding messaging, (V) Medication dispensing systems, (VI) Smart messaging, (VII) Referral to general practitioner and (VIII) Unguided web-based Self Help Application for low mood. The control group will receive usual care including access to a publicly available informative diabetes website. The primary study outcome is medication adherence measured with a telephone pill count. Secondary outcomes are systolic blood pressure, HbA1c level, self-reported medication adherence, attitude and beliefs toward medication, satisfaction with diabetes treatment, health status and medical consumption and productivity cost. In addition, a process evaluation will be undertaken to establish the fidelity, reach and the extent to which intervention delivery is normalised in the daily practice of community pharmacy teams. DISCUSSION The study can lead to a personalised intervention programme that improves medication adherence in people with T2DM that are non-adherent to oral antidiabetic and/or antihypertensive medication. TRIAL REGISTRATION Dutch Trial Register, Trial NL8747 , registered 02 July, 2020; ISRCTN Registry, ISRCTN36009809 , registered 05 February, 2020.
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Affiliation(s)
- Marlous Langendoen-Gort
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of General Practice, Boelelaan 1117, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Hiyam Al-Jabr
- Integrated Care Academy, University of Suffolk, Ipswich, UK
| | - Jacqueline G Hugtenburg
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Clinical Pharmacology and Pharmacy, Boelelaan 1117, Amsterdam, The Netherlands
| | - Femke Rutters
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Boelelaan 1117, Amsterdam, The Netherlands
| | - Maartje de Wit
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Medical Psychology, Boelelaan 1117, Amsterdam, The Netherlands
| | - Debi Bhattacharya
- School of Allied Health Professions, University of Leicester, United Kingdom School of Pharmacy, University of East Anglia, Norwich, UK
| | - Ameen Abu-Hanna
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Meibergdreef 9, Amsterdam, The Netherlands
| | - Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Petra J M Elders
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of General Practice, Boelelaan 1117, Amsterdam, The Netherlands. .,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
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30
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Lara-Cabrera ML, Betancort M, Muñoz-Rubilar A, Rodríguez-Novo N, Bjerkeset O, Cuevas CDL. Psychometric Properties of the WHO-5 Well-Being Index among Nurses during the COVID-19 Pandemic: A Cross-Sectional Study in Three Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10106. [PMID: 36011741 PMCID: PMC9407690 DOI: 10.3390/ijerph191610106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/04/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
Nurses' well-being has been increasingly recognised due to the ongoing pandemic. However, no validation scales measuring nurses' well-being currently exist. Thus, we aimed to validate the WHO-5 Well-Being Index (WHO-5) in a sample of nurses. A cross-sectional multinational study was conducted, and a total of 678 nurses who worked during the COVID-19 pandemic in Spain (36.9%), Chile (40.0%) and Norway (23.1%) participated in this study. The nurses completed the WHO-5, the Patient Health Questionnaire-2 (PHQ-2), the Generalized Anxiety Disorder-2 (GAD-2) and three questions about the quality of life (QoL). The WHO-5 demonstrated good reliability and validity in the three countries. Cronbach's alphas ranged from 0.81 to 0.90. High correlations were found between the WHO-5 and the psychological well-being dimension of QoL, and negative correlations between the WHO-5 and PHQ-2. The unidimensional scale structure was confirmed in all the countries, explaining more than 68% of the variance. The item response theory likelihood ratio model did not show discernible differences in the WHO-5 across the countries. To conclude, the WHO-5 is a psychometrically sound scale for measuring nurses' well-being during a pandemic. The scale showed strong construct validity for cross-cultural comparisons; however, more research is required with larger sample sizes.
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Affiliation(s)
- Mariela Loreto Lara-Cabrera
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7091 Trondheim, Norway
- Nidelv Community Mental Health Centre, Division of Psychiatry, St Olavs Hospital Trondheim University Hospital, 7006 Trondheim, Norway
| | - Moisés Betancort
- Department of Clinical Psychology, Psychobiology and Methodology, Universidad de La Laguna, 38200 San Cristóbal de La Laguna, Spain;
| | - Amparo Muñoz-Rubilar
- Faculty of Health Sciences, Universidad Central de Chile, Santiago 8370178, Chile;
| | - Natalia Rodríguez-Novo
- Departament of Nursing, Universidad de La Laguna, 38200 San Cristóbal de La Laguna, Spain;
| | - Ottar Bjerkeset
- Faculty of Nursing and Health Sciences, Nord University, Levanger Campus, 8026 Levanger, Norway;
| | - Carlos De las Cuevas
- Department of Internal Medicine, Dermatology and Psychiatry, Universidad de La Laguna, 38200 San Cristóbal de La Laguna, Spain;
- Instituto Universitario de Neurociencia (IUNE), Universidad de La Laguna, 38200 San Cristóbal de La Laguna, Spain
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Joensen LE, Schultz AA, Madsen KP, Persson F, Nørgaard K, Kristensen PL, Pedersen J, Willaing I. Flexible inclusion of dialogue about psychosocial aspects of life with type 1 diabetes in routine consultations: A study of a questionnaire-based dialogue tool to promote person-centred support. Diabet Med 2022; 39:e14881. [PMID: 35560258 DOI: 10.1111/dme.14881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 05/11/2022] [Indexed: 11/30/2022]
Abstract
AIMS To explore (1) experiences among people with type 1 diabetes and diabetologists of using a questionnaire-based dialogue tool in routine consultations to identify and address psychosocial challenges and (2) experiences of person-centredness in this group compared with a group who did not use the tool. METHODS In all, 42 people with type 1 diabetes (mean age 54 years, mean diabetes duration 31 years and 60% women) were interviewed and completed an evaluation questionnaire following a routine consultation with the use of a dialogue tool including PAID-5, WHO-5 and open-ended questions. A comparison group of 42 people with type 1 diabetes attending routine consultations without the use of dialogue tools completed evaluation questionnaires. All consultations were audio recorded. Diabetologists were interviewed after completing all test consultations. Interviews were analysed using thematic text condensation. Evaluation questionnaires were analysed using descriptive statistics, chi square tests and Student's two-sided t-tests. RESULTS Most participants found questions in the dialogue tool relevant to discuss with the diabetologist, and two-thirds were satisfied with the time spent on that. Experiences of people with type 1 diabetes and diabetologists were related to three pathways: (1) the tool supported valuable conversations with the diabetologist, (2) conversations with the diabetologist were unchanged and (3) the tool derailed conversations. All participants reported high levels of person centredness; however, significantly more in the comparison group reported that the diabetologist made them feel at ease (80 vs. 55%) and discussed and planned specific changes with them (93 vs. 67%). CONCLUSION A questionnaire-based dialogue tool in consultations can support the discussion of psychosocial issues of people with type 1 diabetes. However, flexible and tailored use of the dialogue tool is crucial as consultations may otherwise be derailed.
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Affiliation(s)
| | | | | | | | - Kirsten Nørgaard
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Peter Lommer Kristensen
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
- Department of Endocrinology and Nephrology, Nordsjaellands Hospital, Hillerød, Denmark
| | - Jens Pedersen
- Department of Endocrinology and Nephrology, Nordsjaellands Hospital, Hillerød, Denmark
| | - Ingrid Willaing
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Public Health, Copenhagen University, Copenhagen, Denmark
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Quansah F, Hagan JE, Ankomah F, Agormedah EK, Nugba RM, Srem-Sai M, Schack T. Validation of the WHO-5 Well-Being Scale among Adolescents in Ghana: Evidence-Based Assessment of the Internal and External Structure of the Measure. CHILDREN 2022; 9:children9070991. [PMID: 35883975 PMCID: PMC9323714 DOI: 10.3390/children9070991] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 06/24/2022] [Accepted: 06/29/2022] [Indexed: 11/16/2022]
Abstract
The WHO-5 well-being measure happens to be one of the most renowned measures of subjective well-being across the globe. Although the instrument has been calibrated in different countries, its psychometric properties and applicability in Africa, especially in Ghana, are not known. In this study, the WHO-5 well-being scale was validated among adolescents in Ghana by assessing the validity evidence of the measure based on the internal and external structure. In particular, the study examined the (1) dimensionality of the WHO-5 well-being scale, (2) quality of the items (including the scale functioning) for the measure, and (3) criterion validity of the well-being measure. Using a survey approach, 997 adolescents were recruited in secondary schools across the northern belt of Ghana. The study found a one-factor structure of the scale, which supports the factor solution of the original measure. The items were found to be of high quality, except for one item. The WHO-5 well-being measure was found to have sufficient evidence regarding convergent and divergent validity. The outcome of this validation study provides support for the validity and reliability of the WHO-5 well-being scale’s utility and use among adolescents in Ghana. The study encourages further validation studies to be conducted in Ghana to widen the reproducibility of the WHO-5 well-being measure.
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Affiliation(s)
- Frank Quansah
- Department of Educational Foundations, University of Education, Winneba P.O. Box 25, Ghana;
| | - John Elvis Hagan
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast 03321, Ghana
- Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sports Science, Bielefeld University, Postfach 10 01 31, 33501 Bielefeld, Germany;
- Correspondence:
| | - Francis Ankomah
- Department of Education and Psychology, University of Cape Coast, Cape Coast 03321, Ghana; (F.A.); (R.M.N.)
- Department of Education, SDA College of Education, Asokore-Koforidua P.O. Box AS 18, Ghana
| | - Edmond Kwesi Agormedah
- Department of Business & Social Sciences Education, University of Cape Coast, Cape Coast 03321, Ghana;
| | - Regina Mawusi Nugba
- Department of Education and Psychology, University of Cape Coast, Cape Coast 03321, Ghana; (F.A.); (R.M.N.)
| | - Medina Srem-Sai
- Department of Health, Physical Education, Recreation and Sports, University of Education, Winneba P.O. Box 25, Ghana;
| | - Thomas Schack
- Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sports Science, Bielefeld University, Postfach 10 01 31, 33501 Bielefeld, Germany;
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Polonsky WH, Soriano EC, Fortmann AL. The Role of Retrospective Data Review in the Personal Use of Real-Time Continuous Glucose Monitoring: Perceived Impact on Quality of Life and Health Outcomes. Diabetes Technol Ther 2022; 24:492-501. [PMID: 35255224 DOI: 10.1089/dia.2021.0526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: To explore whether regularly reviewing one's own retrospective continuous glucose monitoring (CGM) data might be linked with perceived quality of life (QoL) and glycemic benefits. Methods: Adults with type 1 diabetes (N = 300) or insulin-using type 2 diabetes (N = 198) using the Dexcom G5 Mobile or G6 Real-Time CGM (RT-CGM) system and receiving the weekly CLARITY summary report of their glucose data completed a survey exploring their use of the report and its perceived value and impact on QoL and glycemic outcomes. Regression analyses examined whether personal use of the report was associated with QoL, perceived glycemic outcomes, and RT-CGM metrics. Results: The majority reported that receiving and viewing the report contributed to improved hypoglycemic confidence (75.9%) and overall well-being (50.0%), reduced diabetes distress (59.3%-74.1%), and helped to improve A1C (73.1%) and reduce problems with hypoglycemia (61.8%) and chronic hyperglycemia (73.1%). Regularly reviewing the report with family or friends (positive predictor) and doing nothing with the report's information (negative predictor) were independently associated with QoL and perceived glycemic outcomes. Surprisingly, both predictors were also associated with poorer glycemic control (e.g., greater % time above range >180). Conclusions: These findings suggest that receiving a weekly RT-CGM summary report may contribute to QoL and health benefits, especially if the individual chooses to actively review and make use of the report's findings and openly reviews the findings with family or friends. Prospective studies are needed to more precisely determine how retrospective RT-CGM data summaries can best be presented and utilized effectively by adults with diabetes to enhance health outcomes.
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Affiliation(s)
- William H Polonsky
- Behavioral Diabetes Institute, San Diego, California
- Department of Medicine, University of California, San Diego, California
| | - Emily C Soriano
- Scripps Whittier Diabetes Institute, Scripps Health, La Jolla, California, USA
| | - Addie L Fortmann
- Scripps Whittier Diabetes Institute, Scripps Health, La Jolla, California, USA
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Informal Employment and Poor Mental Health in a Sample of 180,260 Workers from 13 Iberoamerican Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137883. [PMID: 35805540 PMCID: PMC9265366 DOI: 10.3390/ijerph19137883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 02/05/2023]
Abstract
The aim of this study is to estimate the association between employment conditions and mental health status in the working population of Iberoamerica. In this cross-sectional study, we pooled individual-level data from nationally representative surveys across 13 countries. A sample of 180,260 workers was analyzed. Informality was assessed by social security, health affiliation, or contract holding. Mental health was assessed using several instruments. We used Poisson regression models to estimate the contribution of informality to poor mental health by sex and country, adjusted by sociodemographic and work-related characteristics. Then, we performed a meta-analysis pooling of aggregate data using a random-effects inverse-variance model. Workers in informal employments showed a higher adjusted prevalence ratio (aPR) of poor mental health than those in formal employment in Peru (aPR men 1.5 [95% confidence intervals 1.16; 1.93]), Spain (aPR men 2.2 [1.01; 4.78]) and Mexico (aPR men 1.24 [1.04; 1.47]; women 1.39 [1.18; 1.64]). Overall estimates showed that workers in informal employment have a higher prevalence of poor mental health than formal workers, with it being 1.19 times higher (aPR 1.19 [1.02; 1.39]) among men, and 1.11 times higher prevalence among women (aPR 1.11 [1.00; 1.23]). Addressing informal employment could contribute to improving workers’ mental health.
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Habtamu K, Birhane R, Medhin G, Hanlon C, Fekadu A. Psychometric properties of screening questionnaires to detect depression in primary healthcare setting in rural Ethiopia. BMC PRIMARY CARE 2022; 23:138. [PMID: 35655164 PMCID: PMC9161478 DOI: 10.1186/s12875-022-01755-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 05/23/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Much of the research about the validity of depression screening questionnaires is on criterion validity. Evidence is scarce on the concurrent, convergent and construct validity of these measures, particularly from low-income countries. This study aimed to evaluate the psychometric properties of depression screening questionnaires in primary healthcare (PHC) in rural Ethiopia. METHODS A facility-based cross-sectional study was conducted with 587 participants recruited from patients attending three PHC facilities and two 'Holy water sites' (places where religious treatment is being provided). The psychometric properties of five mental health screening questionnaires were evaluated: the nine item Patient Health Questionnaire (PHQ-9), the two item version of PHQ-9 (PHQ-2), a version of PHQ-9 with two added items of irritability and noise intolerance (PHQ-11), the Patient Health Questionnaire-15 (PHQ-15), and the World Health Organization-Five Well-being Index (WHO-5). Clinical diagnosis of depression was ascertained by psychiatrists. We analyzed data using exploratory factor analysis, Spearman's rank order correlation coefficient (Rho), the Mann Whitney test of the equality of medians, univariate logistic regression and Cronbach's alpha. RESULTS PHQ-9, PHQ-11 and WHO-5 were found to be unidimensional, with items in each scale highly loading onto one factor (factor loadings ranging from 0.64 to 0.87). The items of each instrument were internally consistent, with Cronbach's alpha ranging from 0.72 (PHQ-2) to 0.89 (PHQ-11). Scores for all screening scales were moderately or highly correlated with each other (Rho = 0.58 to 0.98) and moderately correlated with anxiety and disability scores. Median scores of all screening scales were significantly higher in those diagnosed with depression. The association of items measuring emotional and cognitive symptoms with the diagnosis of depression was stronger than the association with items measuring somatic symptoms. Irritability and noise intolerance had higher association with depression diagnosis than PHQ-9 items. CONCLUSION Emotional and cognitive symptoms are more useful than somatic symptoms to predict the diagnosis of depression in the PHC context in Ethiopia. Future research should focus on testing the unidimensionality of PHQ-9, PHQ-11 and WHO-5 using confirmatory factor analysis; establishing the criterion validity of PHQ-11 and WHO-5; and on assessing test-retest reliability of all the measures.
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Affiliation(s)
- Kassahun Habtamu
- grid.7123.70000 0001 1250 5688School of Psychology, College of Education and Behavioral Studies, Addis Ababa University, P.O.BOX: 1176, Addis Ababa, Ethiopia
| | - Rahel Birhane
- grid.7123.70000 0001 1250 5688Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Girmay Medhin
- grid.7123.70000 0001 1250 5688Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- grid.7123.70000 0001 1250 5688Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- grid.13097.3c0000 0001 2322 6764Centre for Global Mental Health, Health Service and Population Research Department, and WHO Collaborating Centre for Mental Health Research and Training, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Abebaw Fekadu
- grid.7123.70000 0001 1250 5688Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- grid.7123.70000 0001 1250 5688Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
- grid.414601.60000 0000 8853 076XGlobal Health & Infection Department, Brighton and Sussex Medical School, Brighton, UK
- grid.13097.3c0000 0001 2322 6764Center for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Validation of the mental health continuum-short form: The bifactor model of emotional, social, and psychological well-being. PLoS One 2022; 17:e0268232. [PMID: 35584145 PMCID: PMC9116639 DOI: 10.1371/journal.pone.0268232] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 04/25/2022] [Indexed: 11/19/2022] Open
Abstract
The Mental Health Continuum-Short Form (MHC-SF) is aimed at measuring the three dimensions of mental health; emotional, social, and psychological well-being. The purpose of the current study was to evaluate the psychometric properties of the MHC-SF within the context of Singapore and Australia. A total of 299 Singaporeans or permanent residents (59.2% female; mean age = 24.26, SD = 6.13) and 258 Australians or permanent residents (69% female; mean age = 23.95, SD = 8.66) completed the study. Confirmatory factor analyses were used to assess the structural validity of the MHC-SF. Internal consistency reliability was assessed via the Cronbach’s α and MacDonald’s ω reliability coefficients. Concurrent validity was examined against the World Health Organisation-Five Well-Being Index, discriminant validity using the Hospital Anxiety and Depression Scale, and criterion validity using a self-rated question of “Please rate your averaged level of mental health over the past month”, all via Pearson’s correlations. A bifactor model of the MHC-SF, where each item loaded on a general factor and simultaneously on their respective uncorrelated group factors, yielded the best fit to the data across both samples. Further investigations demonstrated that the general well-being factor accounted for majority of variances of the MHC-SF. Internal consistency reliability, concurrent validity, discriminant validity, and criterion validity were all demonstrated. In conclusion, the current study provided support for the bifactor model of MHC-SF and demonstrated evidence of good psychometrics across both samples. The results highlighted the unidimensionality of the measure, suggesting that it is more informative to interpret the aggregated score than scores of independent factors standalone.
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Vallis M, Holt RIG. User-driven open-source artificial pancreas systems and patient-reported outcomes: A missed opportunity? Diabet Med 2022; 39:e14797. [PMID: 35092089 DOI: 10.1111/dme.14797] [Citation(s) in RCA: 2] [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] [Received: 07/20/2021] [Accepted: 01/25/2022] [Indexed: 11/27/2022]
Abstract
AIM This paper aims to highlight the attributes of engagement and urgency to act to control diabetes demonstrated by open-source artificial pancreas system users with the view that increased user involvement in research and practice can capitalize on these self-management traits; and to outline the challenges of researching outcomes in the context of unlicensed therapies. METHODS A group of technically minded people with type 1 diabetes have reverse-engineered commercially available diabetes devices to help them achieve the diabetes outcomes they desire. Although studies have reported improved biomedical outcomes with these artificial pancreas systems, there are only a few studies examining patient-reported outcomes. RESULTS The investigation of patient-reported outcomes for open-source artificial pancreas system users has been hampered by the rapid advances in the technology, the lack of randomized controlled trials and the ethical challenges of researching unregulated technologies. There is an on-going debate about the most appropriate types of measures to evaluate patient-related outcomes. CONCLUSIONS The early adopters of open-source artificial pancreas systems exhibit many of the characteristics that predict optimal diabetes outcomes through engagement and urgency regarding self-management. These qualities should be harnessed to improve research in this and other areas of diabetes management.
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Affiliation(s)
| | - Richard I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
- Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Suhaimi AF, Makki SM, Tan KA, Silim UA, Ibrahim N. Translation and Validation of the Malay Version of the WHO-5 Well-Being Index: Reliability and Validity Evidence from a Sample of Type 2 Diabetes Mellitus Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074415. [PMID: 35410094 PMCID: PMC8998902 DOI: 10.3390/ijerph19074415] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 03/10/2022] [Accepted: 03/23/2022] [Indexed: 02/01/2023]
Abstract
The translation and validation process of the WHO-5 Well-Being Index (WHO-5) into Malay is still not yet available. This study is the first psychometric evaluation of the Malay version of the WHO-5 in a sample of 127 primary care patients with type 2 diabetes mellitus. We evaluated the internal consistency and 5-week test–retest reliability of the WHO-5 Malay, and three aspects of its validity—first, the factorial validity in relation to the factor structure of the WHO-5 Malay; second, the concurrent validity in relation to depression and diabetes-related distress; and third, the convergent validity in relation to diabetes management self-efficacy and diabetes self-care behaviors. This study had two phases. Phase 1 involved the translation of the WHO-5 into Malay language following established procedures, whereas Phase 2 involved the validation of the WHO-5 Malay. Excellent internal consistency and 5-week test–retest reliability estimates were obtained. The factorial validity of the WHO-5 was found to be unidimensional. As for concurrent validity, the WHO-5 Malay was found to be negatively correlated with depression and diabetes-related distress. The WHO-5 was found to be correlated with diabetes management self-efficacy and diabetes self-care behaviors, thereby establishing convergent validity. The WHO-5 Malay has reliable and valid psychometric properties and represents a promising tool that informs healthcare providers in making effective and holistic diabetes management.
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Affiliation(s)
- Aida Farhana Suhaimi
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Malaysia;
- Department of Psychiatry and Mental Health, Hospital Putrajaya, Ministry of Health, Putrajaya 62250, Malaysia
- Correspondence: (A.F.S.); (K.-A.T.)
| | | | - Kit-Aun Tan
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Malaysia;
- Correspondence: (A.F.S.); (K.-A.T.)
| | - Umi Adzlin Silim
- Department of Psychiatry and Mental Health, Hospital Serdang, Ministry of Health, Kajang 43000, Malaysia;
| | - Normala Ibrahim
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Malaysia;
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Regeer H, van Empelen P, Bilo HJG, de Koning EJP, Huisman SD. Change is possible: How increased patient activation is associated with favorable changes in well-being, self-management and health outcomes among people with type 2 diabetes mellitus: A prospective longitudinal study. PATIENT EDUCATION AND COUNSELING 2022; 105:821-827. [PMID: 34274165 DOI: 10.1016/j.pec.2021.07.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 06/21/2021] [Accepted: 07/08/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To examine the relationship between risk factors for low patient activation and change in patient activation, well-being, and health outcomes in people with type 2 diabetes mellitus (T2DM). METHOD A longitudinal prospective study was conducted with measurements at baseline and 20-week follow-up among 603 people with T2DM participating in a group-based walking intervention. Patient activation and risk factors were assessed using online questionnaires. Health outcomes were assessed in participants' general practices. RESULTS No association was found between risk factors for activation and change in patient activation. Patient activation significantly increased (t(602) = 2.53, p = 0.012) and was associated with an increase in emotional well-being (β = 0.22), exercise behavior (β = 0.17), general diet behavior (β = 0.20), and a reduction in BMI (β = -0.28), weight (β = -0.29), and HbA1c (β = -0.27). CONCLUSION Favorable changes in patient activation, self-management, well-being, and health outcomes occurred during a walking intervention, despite highly prevalent risk factors for low activation and less engagement in self-management. PRACTICE IMPLICATIONS Group-based walking interventions might empower people with T2DM to begin taking a larger role in their self-care and improve (mental) health outcomes. Vulnerable groups of patients (with multiple risk factors for low activation) can change and presumably need this kind of interventions to be able to change.
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Affiliation(s)
- Hannah Regeer
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands; Bas Van De Goor Foundation, Arnhem, The Netherlands.
| | | | - Henk J G Bilo
- Diabetes Knowledge Centre, Isala, Zwolle, The Netherlands.
| | - Eelco J P de Koning
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands.
| | - Sasja D Huisman
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands.
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Stahl-Pehe A, Selinski S, Bächle C, Castillo K, Lange K, Holl RW, Rosenbauer J. Overestimation and underestimation of youths' health-related quality of life are associated with youth and caregiver positive screens for depression: results of a population-based study among youths with longstanding type 1 diabetes. Diabetol Metab Syndr 2022; 14:40. [PMID: 35264222 PMCID: PMC8905804 DOI: 10.1186/s13098-022-00809-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/23/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND This study aimed to analyze the extent and direction of disagreement between self- and proxy-reported quality of life (QoL) and the factors associated with QoL overestimation and underestimation by caregivers compared with self-reports. METHODS This study used data from population-based questionnaire surveys conducted in 2012-2013 and 2015-2016 with 11- to 17-year-olds with a duration of type 1 diabetes of 10 years or longer and their caregivers (n = 1058). QoL in youth was assessed via 10-item KIDSCREEN (KIDSCREEN-10) self- and proxy-reported questionnaires. The scores ranged from 0 to 100, with higher scores indicating better QoL. Depression screening was performed via the Center for Epidemiological Studies Depression Scale for Children for youths (CES-DC screen positive: score > 15) and WHO-5 Well-being Index for parents/caregivers (WHO-5 screen positive: score ≤ 50). RESULTS The mean self- and proxy-reported normalized KIDSCREEN-10 scores were 64.2 (standard deviation [SD] 11.4) and 66.1 (11.5), respectively. More caregivers overestimated (self-reported minus proxy-reported score < - 0.5*SD self-reported score) than underestimated (self-reported minus proxy-reported score > 0.5*SD self-reported score) youths' QoL (37% versus 23%, p < 0.001). Youths who screened positive for depression (18%) were at higher risk of their QoL being overestimated and lower risk of their QoL being underestimated by caregivers than youths who screened negative for depression (RROverestimation 1.30 [95% CI 1.10-1.52], RRUnderestimation 0.27 [0.15-0.50]). Caregivers who screened positive for depression (28%) overestimated the QoL of their children less often and underestimated the QoL of their children more often than caregivers who screened negative for depression (RROverestimation 0.73 [0.60-0.89], RRUnderestimation 1.41 [1.14-1.75]). CONCLUSIONS Caregivers often over- or underestimated their children's QoL. Positive screens for depression among both youths and caregivers contributed to the observed differences between self- and caregiver-reported QoL.
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Affiliation(s)
- Anna Stahl-Pehe
- Institute for Biometrics and Epidemiology, German Diabetes Centre, Leibniz Centre for Diabetes Research, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany.
- German Centre for Diabetes Research (DZD), Munich-Neuherberg, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany.
| | - Silvia Selinski
- Institute for Biometrics and Epidemiology, German Diabetes Centre, Leibniz Centre for Diabetes Research, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
- German Centre for Diabetes Research (DZD), Munich-Neuherberg, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
| | - Christina Bächle
- Institute for Biometrics and Epidemiology, German Diabetes Centre, Leibniz Centre for Diabetes Research, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
- German Centre for Diabetes Research (DZD), Munich-Neuherberg, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
| | - Katty Castillo
- Institute for Biometrics and Epidemiology, German Diabetes Centre, Leibniz Centre for Diabetes Research, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
- German Centre for Diabetes Research (DZD), Munich-Neuherberg, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
| | - Karin Lange
- Medical Psychology Unit, Hannover Medical School, Hannover, Germany
| | - Reinhard W Holl
- German Centre for Diabetes Research (DZD), Munich-Neuherberg, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
| | - Joachim Rosenbauer
- Institute for Biometrics and Epidemiology, German Diabetes Centre, Leibniz Centre for Diabetes Research, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
- German Centre for Diabetes Research (DZD), Munich-Neuherberg, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
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Sayed Ahmed HA, Mohamed SF, Elotla SF, Mostafa M, Shah J, Fouad AM. Psychrometric Properties of the Arabic Version of the Problem Areas in Diabetes Scale in Primary Care. Front Public Health 2022; 10:843164. [PMID: 35284366 PMCID: PMC8913881 DOI: 10.3389/fpubh.2022.843164] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 01/27/2022] [Indexed: 11/22/2022] Open
Abstract
Background The Problem Areas in Diabetes (PAID) scale is a reliable and valid tool that is widely used for diabetes-distress screening, but the Arabic version of the scale lacks validity and reliability analysis in primary healthcare (PHC) patients. Our study aimed to evaluate the psychometric properties of the Arabic version of the PAID (AR-PAID) scale among Egyptian patients with type 2 diabetes mellitus (T2DM) in PHC settings. Methods We conducted a cross-sectional study on a convenience sample of 200 patients from six rural PHC settings in the Ismailia governorate. The confirmatory factor analysis (CFA) was performed to test the goodness-of-fit to the predefined models of the PAID. Convergent construct was evaluated through correlations with the Arabic versions of the Patient Health Questionnaire 9 (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), and 5-item World Health Organization Well-Being Index (WHO-5), additionally glycated hemoglobin (HbA1c) levels. Discriminant validity was evaluated through associations with patients' sociodemographic and clinical characteristics. Reliability was evaluated through internal consistency (Cronbach's α) and test-retest reliability analysis (intraclass correlation coefficient, ICC). Results The CFA demonstrated the best fit for a four-factor model. The AR-PAID was significantly correlated with the following measures: PHQ-9 (rho = 0.71, p < 0.001), GAD-7 (rho = 0.50, p < 0.001), WHO-5 (rho = −0.69, p < 0.001), and HbA1c (rho = 0.36, p < 0.001), supporting sound convergent validity. Discriminant validity was satisfactory demonstrated. Internal consistency was excellent (α = 0.96) and test-retest reliability was stable (ICC = 0.97). Conclusions The AR-PAID scale is a valid and reliable instrument for diabetes-distress screening in primary care patients with T2DM that can be used in clinical settings and research. Further research is needed to validate short forms of the AR-PAID scale.
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Affiliation(s)
- Hazem A. Sayed Ahmed
- Department of Family Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Samar Farag Mohamed
- Department of Family Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Sally Fawzy Elotla
- Department of Public Health, Occupational and Environmental Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Mona Mostafa
- Department of Internal Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Jaffer Shah
- Medical Research Center, Kateb University, Kabul, Afghanistan
- *Correspondence: Jaffer Shah
| | - Ahmed Mahmoud Fouad
- Department of Public Health, Occupational and Environmental Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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Allen NA, Bristol A, Grigorian EG, Iacob E, Berg CA, Litchman ML. SHARE plus: Delivering a Telehealth CGM Data-Sharing Intervention to Older Adults and Their Care Partners. Diabetes Spectr 2022; 35:16-25. [PMID: 35308160 PMCID: PMC8914598 DOI: 10.2337/dsi21-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Care partners of older adults with type 1 diabetes often become part of the diabetes care team but lack knowledge of how to become involved with glucose management. This article describes a study confirming the feasibility of SHARE plus, a telehealth intervention involving continuous glucose monitoring and data-sharing to assist these individuals in working together on diabetes management. The intervention provides a strategy for increasing remote patient monitoring and facilitating care partner involvement in diabetes management.
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Affiliation(s)
- Nancy A. Allen
- University of Utah College of Nursing, Salt Lake City, UT
- Corresponding author: Nancy A. Allen,
| | - Alycia Bristol
- University of Utah College of Nursing, Salt Lake City, UT
| | | | - Eli Iacob
- University of Utah College of Nursing, Salt Lake City, UT
| | - Cynthia A. Berg
- University of Utah College of Social and Behavioral Science, Salt Lake City, UT
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Kokoszka A, Pacura A, Kostecka B, Lloyd CE, Sartorius N. Body self-esteem is related to subjective well-being, severity of depressive symptoms, BMI, glycated hemoglobin levels, and diabetes-related distress in type 2 diabetes. PLoS One 2022; 17:e0263766. [PMID: 35167598 PMCID: PMC8846537 DOI: 10.1371/journal.pone.0263766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 01/26/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There are limited data on the role of body image in patients with type 2 diabetes. The purpose of this study was to compare body self-esteem in this group with norms for the general Polish population and to investigate the relationship between body self-esteem and the psychological and clinical characteristics of the course of diabetes. METHODS A group of 100 consecutive adult patients with type 2 diabetes (49 women and 51 men) aged 35 to 66 years were assessed using the Body Esteem Scale (BES), World Health Organization-Five Well-Being Index (WHO-5), Problem Areas in Diabetes Scale (PAID), and Hamilton Rating Scale for Depression (HAM-D). RESULTS In comparison to norms for the general population, women with type 2 diabetes had lower body self-esteem only in the dimension of Physical Condition (M = 30.71; SD = 7.11 versus M = 32.96; SD = 5.69; P = 0.003), whereas men in the dimensions of Physical Condition (M = 42.43; SD = 9.43 versus M = 48.30; SD = 8.42; P <0.001) and Upper Body Strength (M = 32.16; SD = 6.60 versus M = 33.97; SD = 5.86; P = 0.015). There were moderate or weak positive correlations between the overall BES score and/or its dimensions and subjective well-being, and negative correlations between the overall BES score and/or its dimension and the severity of depression symptoms, level of glycated hemoglobin (HbA1c), body mass index (BMI), and diabetes-related distress among women. Among men, BES scores were positively correlated with well-being, and negatively, with BMI and diabetes-related distress. A correlation of r = 0.39 between BES scores and HbA1c levels was relatively high compared with values for other psychosocial factors. Both in women and men, a high Physical Condition score was a significant predictor of better well-being, less severe depression, and milder diabetes-related distress. Among men, it was also a significant predictor of lower BMI, whereas among women, BMI was predicted by Weight Concern. CONCLUSIONS Persons with diabetes seem to have lower body self-esteem than the general population, which is significantly associated with clinical and psychological characteristics of the diabetes course. The observed differences and relationships are gender-specific.
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Affiliation(s)
- Andrzej Kokoszka
- II Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Agata Pacura
- SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - Barbara Kostecka
- II Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Cathy E. Lloyd
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, United Kingdom
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes (AMH), Geneva, Switzerland
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Knudsen L, Hansen DL, Joensen LE, Wibaek R, Benros ME, Jørgensen ME, Andersen GS. Need for improved diabetes support among people with psychiatric disorders and diabetes treated in psychiatric outpatient clinics: results from a Danish cross-sectional study. BMJ Open Diabetes Res Care 2022; 10:10/1/e002366. [PMID: 35078855 PMCID: PMC8796247 DOI: 10.1136/bmjdrc-2021-002366] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 01/04/2022] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION People with psychiatric disorders have increased risk of premature death partly due to diabetes. This study aims to explore the quality of diabetes care, diabetes management, diabetes support and well-being of people with psychiatric disorders and diabetes. RESEARCH DESIGN AND METHODS A total of 107 participants aged ≥18 years with diabetes and psychiatric disorders treated at psychiatric outpatient clinics in Denmark were recruited from August 2018 to June 2019. This descriptive cross-sectional study includes data from medical records on quality of diabetes care (eg, level and annual examination of hemoglobin A1c (HbA1c)) and questionnaires on diabetes management (measured on items from the Summary of Diabetes Self-Care Activities Scale and diabetes distress based on Problem Areas in Diabetes Scale (PAID-5)), diabetes support (no, some or high support from eight potential support persons and experience of care actions measured on items from Patient Assessment of Chronic Illness Care) and well-being (WHO 5-Item Scale and self-rated general health). RESULTS The mean age was 52 years, 56% were men, the mean body mass index was 31.9 kg/m2, the median HbA1c was 53 mmol/mol (7.0%) and the mean blood pressure was 131/83 mm Hg. The proportion with annual measurements of HbA1c was 93%, blood pressure 80%, cholesterol 93%, foot examination 77% and eye examination 75%. Fifty-one per cent had high diabetes distress (PAID-5 score ≥8). Diabetologists and general practitioners (39% and 37%) were the health professionals most frequently reported to provide high diabetes support. CONCLUSIONS This study highlights a need for improved diabetes support in people with psychiatric disorders and diabetes. Although a high proportion received appropriate diabetes care, we found high levels of diabetes distress, moderate levels of optimal self-management behaviors, low well-being and low diabetes support from psychiatric health professionals, while one-third of the population found it relevant to receive diabetes support from psychiatric health professionals.
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Affiliation(s)
- Lenette Knudsen
- Education, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | | | - Lene Eide Joensen
- Diabetes Management Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Rasmus Wibaek
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Michael Eriksen Benros
- Biological and Precision Psychiatry, Copenhagen Research Centre for Mental Health, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marit Eika Jørgensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Center for Health Research in Greenland, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
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Polonsky WH, Fisher L, Hessler D, Desai U, King SB, Perez-Nieves M. Toward a more comprehensive understanding of the emotional side of type 2 diabetes: A re-envisioning of the assessment of diabetes distress. J Diabetes Complications 2022; 36:108103. [PMID: 34916146 DOI: 10.1016/j.jdiacomp.2021.108103] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/10/2021] [Accepted: 12/04/2021] [Indexed: 10/25/2022]
Abstract
AIMS To develop an updated, more theoretically sound system for describing and assessing diabetes-related emotional distress (DD) in adults with type 2 diabetes (T2D). METHODS Items were developed from qualitative interviews with 11 adults with T2D and 6 clinicians, then categorized as reflecting a core emotional experience of DD or a primary source of DD. Items were then administered to a national sample of TCOYD Registry participants. Data were analyzed using both exploratory (EFA) and confirmatory (CFA) factor analyses. Reliability (alpha) and construct validity also were assessed. RESULTS EFAs with 599 adults (258 insulin users, 341 non-insulin users) yielded a coherent DD Core scale and 7 DD Source scales (management demands, healthcare provider, hypoglycemia, long-term health, interpersonal issues, shame/stigma, healthcare access), which were confirmed by CFA. All alphas were >0.65. DD Core and DD Source scales were associated with criterion variables (all p < .001). Higher DD Core scores were linked to higher HbA1c, BMI, more frequent severe hypoglycemia, and poorer self-management (all p < .001). CONCLUSIONS Good reliability and validity were found for this two-part T2DD Assessment System. It reflects a more contemporary and actionable approach to DD assessment that distinguishes between its key emotional dimension and its underlying contributors.
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Affiliation(s)
- William H Polonsky
- Behavioral Diabetes Institute, San Diego, CA, USA; University of California, San Diego, CA, USA.
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Polonsky WH, Fortmann AL. Impact of Real-Time CGM Data Sharing on Quality of Life in the Caregivers of Adults and Children With Type 1 Diabetes. J Diabetes Sci Technol 2022; 16:97-105. [PMID: 33322931 PMCID: PMC8875067 DOI: 10.1177/1932296820978423] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND To examine caregivers' experiences with real-time continuous glucose monitoring (RT-CGM) data sharing and its impact on quality of life (QoL) and health outcomes. METHODS Parents of children with type 1 diabetes (T1D) (N = 303) and spouses/partners of T1D adults (N = 212) using the Dexcom G5 Mobile or G6 RT-CGM system and who were actively following their T1Ds' RT-CGM data completed a survey examining their perceived value of data sharing, the impact of sharing on their own QoL and their child/partner's health, and how they used RT-CGM data to support their T1Ds' diabetes management. Regression analyses examined whether their actions were linked to reported changes in QoL and health outcomes. RESULTS Respondents were predominantly non-Hispanic White (91.1% parents; 88.7% partners), female (78.2% parents; 54.7% partners), and college-educated (65.3% parents; 61.8% partners). The majority reported that data sharing had enhanced hypoglycemic confidence (97.7% parents; 98.1% partners), overall well-being (60.4% parents; 63.2% partners), and sleep quality (78.0% parents; 61.3% partners). Of note, three positive caregiver actions were broadly consistent and significant predictors of QoL and health benefits for both parents and partners: celebrating success related to glycemic control, providing encouragement when glycemic control is challenging, and teamwork discussions about how the caregiver should respond to out-of-range values. CONCLUSIONS RT-CGM data sharing was associated with a range of QoL and health benefits for caregivers. Degree of benefits was influenced by the collaborative actions taken by caregivers to support their child's or partner's diabetes management. To determine the most effective strategies for collaborative data sharing, longitudinal trials are needed.
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Affiliation(s)
- William H. Polonsky
- Behavioral Diabetes Institute, San Diego, CA, USA
- Department of Medicine, University of California, San Diego, CA, USA
- William H. Polonsky, Behavioral Diabetes Institute, 5230 Carroll Canyon Road, Suite 208, San Diego, CA 92121, USA.
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Skovlund SE, Troelsen LH, Noergaard LM, Pietraszek A, Jakobsen PE, Ejskjaer N. Feasibility and Acceptability of a Digital Patient-Reported Outcome Tool in Routine Outpatient Diabetes Care: Mixed Methods Formative Pilot Study. JMIR Form Res 2021; 5:e28329. [PMID: 34730545 PMCID: PMC8600435 DOI: 10.2196/28329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/19/2021] [Accepted: 08/24/2021] [Indexed: 01/17/2023] Open
Abstract
Background Improvements in the digital capabilities of health systems provide new opportunities for the integration of patient-reported outcome (PRO) solutions in routine care, which can facilitate the delivery of person-centered diabetes care. We undertook this study as part of our development of a new digital PRO diabetes questionnaire and clinical dialog support tool for use by people with diabetes and their health care professionals (HCPs) to improve person-centered diabetes care quality and outcomes. Objective This study evaluates the feasibility, acceptability, and perceived benefits and impacts of using a digital PRO diabetes tool, DiaProfil, in routine outpatient diabetes care. Methods Overall, 12 people with diabetes scheduled for routine medical diabetes visits at the outpatient clinic were recruited. Purposive sampling was used to optimize heterogeneity regarding age, gender, duration, type of diabetes, treatment modality, and disease severity. Participants filled out a PRO diabetes questionnaire 2 to 5 days before their visit. During the visit, HCPs used a digital PRO tool to review PRO data with the person with diabetes for collaborative care planning. Participants completed evaluation forms before and after the visit and were interviewed for 30 to 45 minutes after the visit. HCPs completed the evaluation questionnaires after each visit. All visits were audio-recorded and transcribed for analysis. Data were analyzed using quantitative, qualitative, and mixed methods analyses. Results People with diabetes found the PRO diabetes questionnaire to be relevant, acceptable, and feasible to complete from home. People with diabetes and HCPs found the digital PRO tool to be feasible and acceptable for use during the diabetes visit and would like to continue using it. HCPs were able to use the tool in a person-centered manner, as intended. For several people with diabetes, completion of the questionnaire facilitated positive reflection and better preparation for the visit. The use of the PRO tool primarily improved the quality of the dialog by improving the identification and focus on the issues most important to the person with diabetes. People with diabetes did not report any negative aspects of the PRO tool, whereas HCPs highlighted that it was demanding when the person with diabetes had many PRO issues that required attention within the predefined time allocated for a visit. Conclusions The Danish PRO diabetes questionnaire and the digital tool, DiaProfil, are feasible and acceptable solutions for routine diabetes visits, and this tool may generate important benefits related to advancement of person-centered care. Further research is now required to corroborate and expand these formative insights on a larger scale and in diverse health care settings. The results of this study are therefore being used to define research hypotheses and finalize real-world PRO evaluation tools for a forthcoming large-scale multisector implementation study in Denmark.
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Affiliation(s)
- Soren E Skovlund
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark.,Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
| | - Lise Havbæk Troelsen
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
| | | | - Anna Pietraszek
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
| | - Poul Erik Jakobsen
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
| | - Niels Ejskjaer
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
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Latenstein AEJ, Blonk L, Tjahjadi NS, de Jong N, Busch OR, de Hingh IHJT, van Hooft JE, Liem MSL, Molenaar IQ, van Santvoort HC, de van der Schueren MAE, DeVries JH, Kazemier G, Besselink MG. Long-term quality of life and exocrine and endocrine insufficiency after pancreatic surgery: a multicenter, cross-sectional study. HPB (Oxford) 2021; 23:1722-1731. [PMID: 34001452 DOI: 10.1016/j.hpb.2021.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 04/05/2021] [Accepted: 04/08/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Data regarding long-term quality of life and exocrine and endocrine insufficiency after pancreatic surgery for premalignant and benign (non-pancreatitis) disease are lacking. METHODS This cross-sectional study included patients ≥3 years after pancreatoduodenectomy or left pancreatectomy in six Dutch centers (2006-2016). Outcomes were measured with the EQ-5D-5L, the EORTC QLQ-C30, an exocrine and endocrine pancreatic insufficiency questionnaire, and PAID20. RESULTS Questionnaires were completed by 153/183 patients (response rate 84%, median follow-up 6.3 years). Surgery related complaints were reported by 72/153 patients (47%) and 13 patients (8.4%) would not undergo this procedure again. The VAS (EQ-5D-5L) was 76 ± 17 versus 82 ± 0.4 in the general population (p < 0.001). The mean global health status (QLQ-C30) was 78 ± 17 versus 78 ± 17, p = 1.000. Fatigue, insomnia, and diarrhea were clinically relevantly worse in patients. Exocrine pancreatic insufficiency was reported by 62 patients (41%) with relieve of symptoms by enzyme supplementation in 48%. New-onset diabetes mellitus was present in 22 patients (14%). The median PAID20 score was 6.9/20 (IQR 2.5-17.8). CONCLUSION Although generic quality of life after pancreatic resection for pre-malignant and benign disease was similar to the general population and diabetes-related distress was low, almost half suffered from a range of symptoms highlighting the need for long-term counseling.
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Affiliation(s)
- Anouk E J Latenstein
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Lotte Blonk
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Department of Nutrition and Dietetics, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Nic S Tjahjadi
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Nenke de Jong
- Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Olivier R Busch
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | | | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Mike S L Liem
- Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Isaaq Q Molenaar
- Department of Surgery, Regional Academic Cancer Center Utrecht, St Antonius Hospital Nieuwegein and University Medical Center Utrecht Cancer Center, Utrecht, the Netherlands
| | - Hjalmar C van Santvoort
- Department of Surgery, Regional Academic Cancer Center Utrecht, St Antonius Hospital Nieuwegein and University Medical Center Utrecht Cancer Center, Utrecht, the Netherlands
| | - Marian A E de van der Schueren
- Department of Nutrition and Health, HAN University of Applied Sciences, Nijmegen, the Netherlands; Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
| | - J Hans DeVries
- Department of Endocrinology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Geert Kazemier
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands.
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Skovlund SE, Troelsen LH, Klim L, Jakobsen PE, Ejskjaer N. The participatory development of a national core set of person-centred diabetes outcome constructs for use in routine diabetes care across healthcare sectors. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:62. [PMID: 34507618 PMCID: PMC8434700 DOI: 10.1186/s40900-021-00309-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 08/31/2021] [Indexed: 05/17/2023]
Abstract
BACKGROUND This study sought to utilise participatory research methods to identify the perspectives of people with diabetes regarding which diabetes outcomes were most important to them. These findings were then used to support an expert working group representing multiple health sectors and healthcare disciplines and people with diabetes to establish a core set of patient-important outcome constructs for use in routine diabetes care. METHODS 26 people with diabetes and family members were recruited through purposive sampling to participate in interviews, focus groups, voting and plenary activities in order to be part of identifying outcome constructs. Content and qualitative analysis methods were used with literature reviews to inform a national multi-stakeholder consensus process for a core set of person-centred diabetes outcome constructs to be used in routine diabetes care across health care settings. RESULTS 21 people with diabetes and 5 family members representing type 1 and 2 diabetes and a range of age groups, treatment regimens and disease burden identified the following patient-reported outcome constructs as an important supplement to clinical indicators for outcome assessment in routine diabetes care: self-rated health, psychological well-being, diabetes related emotional distress and quality of life, symptom distress, treatment burden, blood sugar regulation and hypoglycemia burden, confidence in self-management and confidence in access to person-centred care and support. Consensus was reached by a national multi-stakeholder expert group to adopt measures of these constructs as a national core diabetes outcome set for use in routine value-based diabetes care. CONCLUSIONS We found that patient-reported outcome (PRO) constructs and clinical indicators are needed in core diabetes outcome sets to evaluate outcomes of diabetes care which reflect key needs and priorities of people with diabetes. The incorporation of patient-reported outcome constructs should be considered complementary to clinical indicators in multi-stakeholder value-based health care strategies. We found participatory research methods were useful in facilitating the identification of a core prioritised set of diabetes outcome constructs for routine value-based diabetes care. The use of our method for involving patients may be useful for similar efforts in other disease areas aimed at defining suitable outcomes of person-centred value-based care. Future research should focus on developing acceptable and psychometrically valid measurement instruments to evaluate these outcome constructs as part of routine diabetes care.
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Affiliation(s)
- Soren Eik Skovlund
- Department of Clinical Medicine, Aalborg University, Sønderskovvej 15, 9000, Aalborg, Denmark.
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark.
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark.
| | - Lise H Troelsen
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
| | - Lotte Klim
- Danish Group for European Patients' Academy on Therapeutic Innovation (EUPATI), Copenhagen, Denmark
| | - Poul Erik Jakobsen
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
| | - Niels Ejskjaer
- Department of Clinical Medicine, Aalborg University, Sønderskovvej 15, 9000, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
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Muijs LT, de Wit M, Knoop H, Snoek FJ. Feasibility and user experience of the unguided web-based self-help app 'MyDiaMate' aimed to prevent and reduce psychological distress and fatigue in adults with diabetes. Internet Interv 2021; 25:100414. [PMID: 34401373 PMCID: PMC8350600 DOI: 10.1016/j.invent.2021.100414] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 03/19/2021] [Accepted: 06/07/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Psychological distress and fatigue are common in persons with diabetes, adversely affecting quality of life and complicating diabetes self-management. Offering diabetes-specific self-guided cognitive behavioral therapy (CBT) may be helpful for persons with diabetes and mild symptoms of psychological distress and fatigue. We are the first to test the feasibility and user experiences of a web-based self-help app called 'MyDiaMate' in adults with type 1 and type 2 diabetes. METHODS AND MATERIALS MyDiaMate was developed in close collaboration with persons with diabetes and professionals, building on elements from existing (guided) diabetes-specific CBT interventions. The study was advertised, offering free access to the app for adults with diabetes for a period of three months. Feasibility and user experiences were tested in a non-randomized study with pre- and post- measurements and interviews in a small sample.. In addition usage of the app was studied using log-data.. RESULTS In total N = 55 adults with diabetes signed up for the study. Mean age was M = 42.7 (SD = 15.6), mostly women (n = 39, 70.9%), higher educated (n = 36, 65.5%), and diagnosed with type 1 diabetes (n = 37, 67.3%). About half reported current or a history of psychological complaints. All the participants completed baseline assessments, and n = 32 participants (58%) completed the follow-up questionnaire. Main reasons for participating in the study were: to preserve or improve mental fitness (40.6%), curiosity (25.0%) and wanting to contribute to research (34.4%). No major technical issues were encountered in accessing or using the app. The app was opened at least once by n = 51 participants, median use of the modules was 28 min (1-80) within a period of 1 to 92 days (median = 10). Almost all participants (n = 50, 98.0%) opened the basic module 'Diabetes in balance', of whom 32 (62.7%) completed this module. 'My mood' and 'My energy' were opened by n = 40 (78.4%) and n = 32 (62.7%) participants, respectively, and completed by n = 21 (52.5%) and n = 9 (28.1%) of the participants. Of all participants, 40.6% would recommend the app to others living with diabetes. CONCLUSIONS This study confirmed the feasibility of MyDiaMate as a diabetes-specific self-guided app for adults wishing to preserve or improve their psychological health. While user experiences were overall positive, further tailoring the content to individual needs and preferences could enhance uptake, usage and appreciation. Future research should explore its effectiveness in a randomized controlled trial.
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Affiliation(s)
- Linda T. Muijs
- Department of Medical Psychology, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - Maartje de Wit
- Department of Medical Psychology, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Frank J. Snoek
- Department of Medical Psychology, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, the Netherlands
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