Barriers to and facilitators of self-management adherence in Korean older adults with type 2 diabetes

Barriers and enablers to maintaining self-management behaviours after attending a self-management support intervention for type 2 diabetes: a systematic review and qualitative evidence synthesis

Attendance at type 2 diabetes self-management interventions is associated with improved outcomes. However, difficulties maintaining self-management behaviours attenuate long-term impact. This review aimed to identify and synthesise qualitative research on barriers and enablers to maintaining type 2 diabetes self-management behaviours after attending a self-management intervention. Eight electronic databases were searched to identify relevant peer-reviewed and grey literature studies. Data were synthesised using the best-fit framework synthesis approach guided by the themes and constructs identified by Kwasnicka et al. (2016) on their review of theoretical explanations for behaviour change maintenance. Study methodological limitations and confidence in findings were assessed using an adapted version of the Critical Appraisal Skills Programme (CASP) tool and the GRADE-CERQual approach respectively. Eleven articles reporting on 10 studies were included. Twenty-eight barriers and enablers were coded to the a priori themes. Barriers were commonly coded to the themes self-regulation, resources, and environmental and social influences. Enablers were commonly coded to the themes habits and maintenance motives. Methodological limitations of included studies varied, leading to moderate or low confidence in most findings. Interventions may improve behavioural maintenance by providing post-intervention support, promoting positive behaviour change motives, self-regulation, habit formation, and facilitating access to resources and support.

Perspectives of Japanese elders and their healthcare providers on use of wearable technology to monitor their health at home: A qualitative exploration

BACKGROUND

With 24 million Japanese elderly aging at home, the challenges of managing chronic conditions are significant. As many Japanese elders manage multiple chronic conditions, investigating the usefulness of wearable health devices for this population is warranted.

AIM

The purpose of this qualitative study, using grounded theory, was to explore the perspectives of Japanese elders, their caretakers, and their healthcare providers on the use of technology and wearable devices to monitor health conditions and keep Japanese elders safe at home.

METHODS

In conducting this study, a community advisory board was first established to guide the research design; six focus groups and two one-on-one interviews were conducted, with a total of 21 participants.

RESULTS

Four major themes emerged from the analysis: 1) Current Status of Health Issues Experienced by Japanese Elders and Ways of Being Monitored; 2) Current Use of Monitoring Technology and Curiosity about Use of the Latest Digital Technology to Keep Elderly Healthy at Home; 3) Perceived Advantages of Wearing Sensor Technology; and 4) Perceived Disadvantages of Wearing Technology. Many of the elderly participants were interested in using monitoring devices at home, particularly if not complicated. Healthcare workers found monitoring technologies particularly useful during the isolation of the COVID-19 pandemic. Elderly participants felt cost and technical issues could be barriers to using monitoring devices.

CONCLUSION

While there are challenges to utilizing monitoring devices, the potential to aid the aging population of Japan justifies further investigation into the effectiveness of these devices. This study was not registered with a research trial registry.

Barriers and facilitators in dietary and physical activity management of type 2 diabetes: Perspective of healthcare providers and patients

BACKGROUND AND AIMS

Type 2 diabetes (T2DM) is a chronic disease that requires continuous management and daily self-care activities. The purpose of the study was to identify the barriers and facilitators in dietary and physical activity management of T2DM by patients.

METHOD

Two focus group discussions with patients with T2DM (n = 12) and interviews with healthcare providers (HCPs, n = 15) were done, to identify the barriers and facilitators experienced by patients towards lifestyle management in T2DM. Data were analyzed using qualitative data analysis software Atlas ti. version 8.

RESULT

Three major themes were identified as barriers and facilitators viz., Personal barriers and facilitators, social barriers and facilitators, and barriers and facilitators related to the healthcare provider. Major barriers were denial of illness, low level of knowledge of the disease, excess use of gadgets, poor infrastructure, gender issues, and lack of time. Major facilitators identified were patient education and motivation, continuous counseling and regular follow-up, family and peer support, and recreational and indoor activities.

CONCLUSION

Based on the findings of the study, a multifaceted approach is required to address these barriers and facilitators. These findings will help in developing novel intervention strategies and making policy-level changes, which are required to improve diabetes self-management practices in people with T2DM.

Barriers to Treatment Adherence Among Older Adults With Type 2 Diabetes: A Qualitative Study

The current qualitative study aimed to determine the barriers to treatment adherence among older adults with type 2 diabetes (T2D). This study was performed using a content analysis approach. Semi-structured interviews were conducted with 25 older adults with T2D between May and September 2021. Data were organized using MAXQDA-10 software and analyzed using the Elo and Kyngäs qualitative content analysis method. Three themes emerged from the analysis: Patient-Specific Barriers, Health Care Provider- and Heath Care System-Specific Barriers, and Social-Specific Barriers. Results of this study can be used to develop targeted interventions to promote and facilitate treatment adherence among older adults with T2D. [Journal of Gerontological Nursing, 49(1), 42-49.].

Barriers and enablers to sustaining self-management behaviours after attending a self-management support intervention for type 2 diabetes: a protocol for a systematic review and qualitative evidence synthesis

Background: Attendance at self-management support interventions is associated with improved outcomes for people with type 2 diabetes. However, initial improvements are often not sustained beyond one year, which may be a result of difficulties in sustaining positive changes made to self-management behaviours. The aim of this systematic review is to synthesise qualitative research on the barriers and enablers to sustaining self-management behaviours following attendance at a self-management support intervention for type 2 diabetes.

Methods: The review will use the “best fit” framework synthesis method to develop a new conceptual model of sustained behaviour change in type 2 diabetes. MEDLINE (Ovid), EMBASE (Elsevier), CINAHL (EBSCO), PsycINFO (Ovid), SCOPUS, ProQuest Dissertations and Theses, WorldCat and Open Grey will be searched to identify primary qualitative studies. A parallel search will be conducted in Google Scholar to identify relevant theories for the development of an a priori framework to synthesise findings across studies. Methodological limitations of included studies will be assessed using an adapted version of the Critical Appraisal Skills Programme tool for Qualitative Studies. A sensitivity analysis will be conducted to examine the impact of studies with methodological limitations on synthesis findings. Confidence in the synthesis findings will be assessed using the GRADE-CERQual tool. Screening, data extraction, methodological limitation assessment, synthesis and GRADE-CERQual assessment will be conducted by one author with a second author independently verifying a randomly selected 20% sample.

Discussion: This review will develop a new model of sustained behaviour change in type 2 diabetes self-management. The findings can be used to inform the development of new interventions or revision of existing interventions to better support sustained engagement in type 2 diabetes self-management behaviours.

Preferences Regarding Self-Management Intervention Outcomes of Dutch Chronically Ill Patients With Limited Health Literacy

Background:

For many chronically ill patients self-management of their disease is difficult. This may be especially true for people with limited health literacy as they are faced with additional challenges in the day-to-day management of their disease. Research has shown that self-management support is most effective when tailored to the needs and preferences of patients. Therefore, this study explores the preferences regarding self-management outcomes of chronically ill patients with limited health literacy.

Methods

A total of 35 patients with limited health literacy were invited to a concept-mapping procedure consisting of two card sorting tasks. Patients ranked 60 outcomes, which are often found in literature in relation to self-management, to the level that was important for themselves. Means were calculated for each outcome and domain, and differences within the group were analyzed.

Results

For patients with limited health literacy, satisfaction with care is the most important outcome domain. This domain includes overall satisfaction, the communication with health care providers, the provision of information and trust. At an outcome level, outcomes related to symptom management and improving competences to self-management scored very high. No differences between patient groups for age and sex were found.

Conclusion

Chronically ill patients with limited health literacy prefer a wide variety of outcomes for their self-management. Next to health related outcomes, patients mostly prefer to work on their competences for self-management. For health care professionals, acting on these patient preferences and building a solid relationship will enhance successful self-management.

The Relationships Among Health Literacy, Illness Perception, and Diabetes Self-Care in Korean-Speaking Immigrants With Diabetes

Diabetes self-care is explained as an illness-related coping behavior. Health literacy is an important predictor in self-care behaviors. However, little is known about their association with illness perception in Korean immigrants with diabetes. This study aimed to examine the relationships among health literacy, illness perception, and diabetes self-care in Korean-speaking immigrants with diabetes. This cross-sectional study was conducted in 2020. A convenience sample of 52 Korean adults with diabetes in Dallas-Fort Worth areas completed a survey. Data were analyzed using SPSS (version 25) with statistical significance at α < .05. The mean of health literacy was high (11.1, SD = 1.1, ranges 0-12) although risk of type II error with the small sample size. There were no statistically significant associations between health literacy, illness perception, and diabetes self-care. Language barriers are considered a literacy issue, but health literacy and limited English proficiency must be approached differently by health care providers.

What are the self-management experiences of the elderly with diabetes? A systematic review of qualitative research

BACKGROUND

The number of elderly individuals with diabetes is dramatically increasing. Diabetes is a long-term condition and a noncommunicable disease and requires intensive daily self-management. Understanding of self-management from the patients’ perspectives is important to nurses, healthcare providers, and researchers and benefits people by improving their self-management skills.

AIM

To examine and synthesize qualitative studies that explore the experiences of elderly people in self-managing diabetes.

METHODS

Electronic databases were searched, including MEDLINE, CINAH, PsycINFO, PubMed, CNKI, and WANFADATA. Relevant research was identified by manually searching reference lists and gray literature. Only English and Chinese publications were included. The Critical Appraisal Skills Program was used to assess the quality of the research. The Confidence in the Evidence from Reviews of Qualitative research approach was used to assess the confidence of the findings.

RESULTS

A total of 10 qualitative studies were included, and content analysis was performed. Five themes were identified: The need for knowledge about diabetes care, support systems, functional decline, attitudes toward diabetes, and healthy lifestyle challenges.

CONCLUSION

This present review provides a deep and broad understanding of the experiences in the self-management of diabetes and can be valuable to nursing practice and provide recommendations for future research.

Systematic review of perception of barriers and facilitators to chronic disease self-management among older adults: Implications for evidence-based practice

BACKGROUND

An aging population has contributed to an increased prevalence in chronic disease. To empower patients, healthcare systems are shifting toward chronic disease self-management. However, no review on how older adults self-manage chronic disease and the barriers and facilitators they experience has been published.

AIMS

To explore barriers and facilitators perceived by older adults during the process of self-managing chronic disease.

METHODS

A systematic review of qualitative literature was performed using the Joanna Briggs Institute methodology. The literature search was conducted using Ovid databases (MEDLINE, CINAHL with full text, and PsycINFO) for the period of 1988-2020. All records were screened using predetermined eligibility criteria. The critical appraisal instrument QARI (Qualitative Assessment and Review Instrument) was employed to assess the quality of the included studies. Data from the included papers were extracted using the QARI data extraction tool. Extracted data were then synthesized to produce final sets of themes and sub-themes relating to the review question.

RESULTS

A total of 267 abstracts were screened, and 13 studies reporting barriers and facilitators perceived by older adults during the process of managing chronic diseases were included in the review. Physical and cognitive decline, low-health literacy, culture, and relationships with healthcare professionals were described as barriers. Facilitators were described as resources that supported disease self-management and included family, social networks, healthcare professionals, and religious beliefs.

LINKING EVIDENCE TO ACTION

This study highlights the importance of understanding the patients' perspectives of the barriers and enablers of self-management of chronic illness for health professionals across settings. Understanding barriers and facilitators to chronic disease self-management will support health professionals to identify strength-based approaches to self-management that meet the needs of individual older adults.

Barriers and enablers to sustaining self-management behaviours after completing a self-management support intervention for type 2 diabetes: a protocol for a systematic review and qualitative evidence synthesis

Background: Attendance at self-management support interventions is associated with improved outcomes for people with type 2 diabetes. However, initial improvements are often not sustained beyond one year, which may be a result of difficulties in sustaining positive changes made to self-management behaviours. The aim of this systematic review is to synthesise qualitative research on the barriers and enablers to sustaining self-management behaviours following completion of a self-management support intervention for type 2 diabetes. Methods: The review will use the “best fit” framework synthesis method to develop a new conceptual model of sustained behaviour change in type 2 diabetes. MEDLINE (Ovid), EMBASE (Elsevier), CINAHL (EBSCO), PsycINFO (Ovid), SCOPUS, ProQuest Dissertations and Theses, WorldCat and Open Grey will be searched to identify primary qualitative studies. A parallel search will be conducted in Google Scholar to identify relevant theories for the development of an a priori framework to synthesise findings across studies. Methodological limitations of included studies will be assessed using an adapted version of the Critical Appraisal Skills Programme tool for Qualitative Studies. A sensitivity analysis will be conducted to examine the impact of studies with methodological limitations on synthesis findings. Confidence in the synthesis findings will be assessed using the GRADE-CERQual tool. Screening, data extraction, methodological limitation assessment, synthesis and GRADE-CERQual assessment will be conducted by one author with a second author independently verifying a randomly selected 20% sample. Discussion: This review will develop a new model of sustained behaviour change in type 2 diabetes self-management. The findings can be used to inform the development of new interventions or revision of existing interventions to better support sustained engagement in type 2 diabetes self-management behaviours.

[Diabetes Self-Management Experience of Patients with Diabetes: Focused on the Visually Impaired]

PURPOSE

This study aimed to understand and describe the diabetes self-management experience of visually impaired people with diabetes.

METHODS

Ten participants were recruited through a website used by the visually impaired from February to March 2020. Data were collected through two focus group interviews conducted in June 2020; each group consisted of five participants. All interviews were recorded with the consent of the participants and transcribed verbatim. The transcribed data were analyzed using qualitative content analysis.

RESULTS

Seven categories were as follows; a two-faced, lifelong companion, an unprepared encounter, struggle to live, love-hate relationship with family, strategies to adapt, lessening attention to self-management, the desire to learn properly.

CONCLUSION

It can be concluded that the visually impaired have fewer opportunities for receiving diabetes self-management education than general diabetic patients. Consequently, plans to improve the education available to such patients are required. Additionally, psychological counseling and diabetes education for patients' families are necessary, and improving the perception of medical workers regarding the visually impaired will be prove useful.

The Complexity of Living with Diabetes and Urinary Incontinence for Older Adults with Multiple Chronic Conditions Receiving Home Care Services: An Interpretive Description Study

Over 40% of older adults with diabetes receiving home-care services experience urinary incontinence. However, experiential knowledge is lacking on how these older adults live with diabetes and incontinence. Interpretive description methodology was used to explore the experiences of 18 older adults with diabetes and urinary incontinence receiving home-care services in Ontario, Canada. Five themes emerged from the findings: (a) enduring urinary incontinence: "patch it in pads"; (b) struggling to manage diabetes, incontinence, and multiple chronic conditions: "a balancing act"; (c) covering the costs of care: "I can't afford it"; (d) counting on a caregiver: "he does everything"; and (e) home-care services not meeting my needs: "it's not individual." These findings suggest that living with urinary incontinence and diabetes is a complex and challenging experience. This evidence could inform the provision of comprehensive home care to support self-care for this population.

Iranian Study on Social Determinants of Self-management in Patients with Hypertension Referring to Tabriz Health Care Centers in 2017-2018

Aim

The present study aims to evaluate self-management status in Iranian patients with hypertension and its relationship with social determinants.

Setting and Design

This study was carried out in 2017-2018 in health care centers affiliated with Tabriz University of Medical Sciences in Iran.

Methods

A total of 240 patients with hypertension, who referred to health care centers of Tabriz, were invited to fill out the self-management (researcher made) and social determinants of health questionnaires.

Statistical Analysis

Spearman correlation was used to determine the relationship between self-management score and its items with items of social determinants of health questionnaire. Also, Pearson correlation Student t-test was used.

Results

In this research 197 patients were studied. Mean age of the participants was 56.6 ± 10.1 years. The mean ± SD (standard deviation) of self-management score was 81.51 ± 13.16. The correlation coefficient of self -management with financial ability of securing the education expenses, nutrition and fruits, and health care expenses were 0.228 (P = 0.001), 0.149 (P value <0.05), and 0.28 (P < 0.001) respectively. Also, the correlation coefficient of age with self-management was - 0.206 (P value = 0.004). Item level analysis showed strong significant associations between social determinants and three items related to lifestyle and two items related to monitoring of blood pressure (BP) at home.

Conclusion

Overall self -management status of the patients was very good. Health centers that plan self -management support programs for patients should consider the social determinants of life style modification and monitoring of BP at home by hypertensive patients.

Type 2 Diabetes Self-Management Barriers in Older Adults: An Integrative Review of the Qualitative Literature

Type 2 diabetes is a prevalent chronic health condition more frequently affecting adults ages 65 and older. Furthermore, these individuals tend to have more type 2 diabetes-associated complications, compared with younger individuals with diabetes, and face unique challenges throughout the self-management process. Despite many studies and reviews about diabetes self-management, few researchers focus specifically on older adults. Of particular importance is the need to understand self-management challenges through the patient's lens. Therefore, the purpose of the current review is to examine and summarize the qualitative literature concerning type 2 diabetes self-management barriers in older adults. Following critical appraisal of literature published from 2007-2018, 10 articles were reviewed and content analysis performed. Four themes emerged: Lack of Knowledge and Understanding, Self-Management Implementation Challenges, Culture and Language Barriers, and Health Care Providers as a Perceived Barrier. The state of the qualitative science, implications for nursing practice, and recommendations for future research are discussed. [Journal of Gerontological Nursing, 45(3), 43-54.].

Novel psychosocial factor involved in diabetes self-care in the Japanese cultural context

AIMS/INTRODUCTION

Recent evidence shows that cultural context can influence the management of diabetes mellitus. The aim of the present study was to examine the relationship between interdependence, which is valued in the Eastern cultural context, and diabetes self-care behavior in Japanese patients with type 2 diabetes mellitus.

MATERIAL AND METHODS

We carried out a cross-sectional survey of 161 Japanese adults with type 2 diabetes mellitus using well-established questionnaires. The association of an interdependent tendency with diabetes self-care activities was analyzed using multiple regression analysis.

RESULTS

Diabetes self-care activities had a negative correlation with interdependent tendency (r = -0.16, P = 0.047), and they had positive correlations with age (r = 0.42, P < 0.001), emotional support (r = 0.25, P = 0.001) and diabetes self-care support (r = 0.36, P < 0.001). When patients were divided into two groups at the median age (68 years), multiple regressions showed that interdependent tendency (β = -0.20, P = 0.048), male sex (β = -0.24, P = 0.023), emotional support (β = 0.22, P = 0.028) and diabetes self-care support (β = 0.39, P < 0.001) were significant determinants of diabetes self-care activities only in the younger group.

CONCLUSIONS

Interdependence might influence diabetes self-care behavior, and intervention focusing on support from close others might lead patients to more successful care among Japanese adults with type 2 diabetes mellitus, especially those aged <68 years.

Factors influencing patients' hypertension self-management and sustainable self-care practices: a qualitative study

OBJECTIVE

The objective of this study was to explore factors influencing patients with hypertension to participating in a hypertension self-management education (HSME) programme and challenges of sustaining the learnt self-care practices.

STUDY DESIGN

This was a qualitative study with focus group discussions.

METHODS

Focus group discussions using a semistructured moderator guide were conducted among participants who had attended the HSME programme. Data were audio recorded, transcribed verbatim and analysed using a thematic analysis approach.

RESULTS

Three focus groups involving 19 participants were conducted. Four major themes emerged from the data collected. Most participants enjoyed the group-based HSME sessions because sharing experiences with those having similar health problems can reduce their sense of isolation. However, the participants highlighted the difficulty in sustaining self-care practices in the presence of friends and family influences.

CONCLUSION

A number of patient-, family- and community-level motivators and barriers to patients' hypertension self-management have been identified. Efforts to tailor behavioural interventions to sustain daily self-care activities during social and cultural events are imperative.

Experiences of Patients With a Diabetes Self-Care App Developed Based on the Information-Motivation-Behavioral Skills Model: Before-and-After Study

BACKGROUND

Mobile phones have been actively used in various ways for diabetes self-care. Mobile phone apps can manage lifestyle factors such as diet, exercise, and medication without time or place restrictions. A systematic review has found these apps to be effective in reducing blood glucose. However, the existing apps were developed and evaluated without a theoretical framework to explain the process of changes in diabetes self-care behaviors.

OBJECTIVE

This study aimed to evaluate the diabetes self-care app that we developed by measuring differences in diabetes self-care factors between before and after using the app with the Information-Motivation-Behavioral skills model of Diabetes Self-Care (IMB-DSC).

METHODS

We conducted a single-group pre- and postintervention study with a convenience sample of diabetes patients. A total of 38 adult patients with diabetes who had an Android smartphone were recruited. After conducting a preliminary survey of those who agreed to participate in the study, we provided them with a manual and a tutorial video about the diabetes self-care app. The app has functions for education, recommendations, writing a diary, recording, goal setting, sharing, communication, feedback, and interfacing with a glucometer, and it was applied for 4 weeks. We measured the general characteristics of participants, their history of diabetes self-care app usage, IMB-DSC factors, and blood glucose levels. The IMB-DSC factors of information, personal motivation, social motivation, behavioral skills, and behaviors were measured using an assessment tool consisting of 87 items extracted from the Diabetes Knowledge Test, third version of the Diabetes Attitude Scale, Diabetes Family Behavior Checklist, and Diabetes Self-Management Assessment Report Tool.

RESULTS

The mean age of the participants was 43.87 years. A total 30 participants out of 38 (79%) had type 2 diabetes and 8 participants (21%) had type 1 diabetes. The most frequently used app function was recording, which was used by 34 participants out of 38 (89%). Diabetes self-care behaviors (P=.02) and diabetes self-care social motivation (P=.05) differed significantly between pre- and postintervention, but there was no significant difference in diabetes self-care information (P=.85), diabetes self-care personal motivation (P=.57), or diabetes self-care behavioral skills (P=.89) between before and after using the diabetes self-care app.

CONCLUSIONS

Diabetes self-care social motivation was significantly improved with our diabetes self-care app by sharing experiences and sympathizing with other diabetes patients. Diabetes self-care behavior was also significantly improved with the diabetes self-care app by providing an interface with a glucometer that removes the effort of manual input. Diabetes self-care information, diabetes self-care personal motivation, and diabetes self-care behavioral skills were not significantly improved. However, they will be improved with additional offline interventions such as reflective listening and simulation.

Health-Related Quality-of-Life and Diabetes Self-Care Activity in Elderly Patients with Diabetes in Korea

A critical goal in the management of elderly patients with diabetes is to improve their health-related quality of life (HRQOL). This study aimed to identify the factors affecting HRQOL in elderly Korean patients with diabetes. Participants were 365 elderly patients with diabetes who were treated in a general hospital in Korea. The data were analysed using independent t-tests, Pearson correlations, and stepwise multiple regression. The mean total HRQOL score was 74.77, and HRQOL showed positive correlations with activities of daily living (ADL), instrumental activities of daily living (IADL), and the Summary of Diabetes Self-care Activities (SDSA). There was a negative correlation between HRQOL and Short Geriatric Depression Scale (SGDS). Lower SGDS scores, higher SDSA scores, and being male were associated with higher HRQOL, with these variables explaining 57.5% of the variance in participants' HRQOL. Improvement in the HRQOL of elderly patients with diabetes requires the development of interventions for depression, and improvements in methods of diabetes self-care and gender-dependent managerial measures.

Barriers and facilitators to physical activity among urban residents with diabetes in Nepal

INTRODUCTION

Physical activity is an important component of type 2 diabetes management. Physical activity level among general population in Nepal is reported to vary considerably. However, knowledge on physical activity in Nepali diabetics is very limited. Engagement in physical activity could be influenced by perception of barriers against adopting the behavior and benefits of adopting it. This study explores the prevalence of physical activity and factors that promote and hinder the behavior among urban residing diabetic patients from Nepal.

METHODS

A descriptive cross-sectional design was adopted using a simple random sampling of type 2 diabetic patients from two diabetes clinics at Lalitpur and Kaski districts of Nepal. Two hundred and seventy participants were surveyed to obtain information on physical activity using Global Physical Activity Questionnaire. Metabolic equivalent values were calculated and categorized into high, moderate and low levels of physical activity. The information on perceived facilitators and barriers was collected by Exercise Barriers and Benefits Survey scale. Odds ratios and 95% confidence intervals of the measures were estimated using multinomial logistic regression.

RESULTS

The study showed relatively high prevalence of physical activity among the urban Nepali diabetic patients; 52% were moderately active and 28% highly active. Travel and work-related activities were the major contributors. Male participants, educated and those living in extended families were more motivated for physical activity than their counterparts. Physical fitness, strength and flexibility, better sleep at night, social interaction and longevity, were identified as the major facilitators. Family responsibilities, busy schedule and family discouragement were identified as barriers against being physically active.

CONCLUSION

The diabetic patients were mostly moderately physically active. Future research could explore different context-specific ways of remaining physically active, apart from walking and doing household chores. More focus should also be placed on leisure time physical activity as it was found to be low. Interventions could be designed by promoting the facilitators and addressing the barriers of physical activity, which is likely to reduce the healthcare costs of management of diabetic complications.

Effect of a Health Literacy-Considered Diabetes Self-Management Program for Older Adults in South Korea

The current randomized controlled study evaluated the effects of a health literacy-considered diabetes self-management program on diabetes-related parameters: diabetes self-management knowledge (DSK), diabetes health beliefs (DHB), diabetes self-efficacy (DSE), diabetes self-management behavior (DSMB), and diabetes biomarkers. Fifty-one Korean older adults with diabetes completed 12 weekly sessions that were developed based on their health literacy and health-related characteristics. The results indicate significant posttest differences between groups in DSK (p = 0.046), DSE (p = 0.046), DSMB (p = 0.012), and the DSMB self-monitored blood glucose subscale (p = 0.002). Significant pre-post changes between groups were observed in the DHB benefit subscale (p = 0.043), DSE (p = 0.006), DSMB (p = 0.008), DSMB diet (p = 0.029), and the self-monitored blood glucose subscale (p < 0.001). A significant pre-post difference was observed in the intervention group's HbA1c levels (p = 0.008). The program effectively improved participants' DSK, DHB, DSE, and DSMB values, which may be helpful for improving HbA1c levels. [Res Gerontol Nurs. 2017; 10(5):215-225.].

Development of a scale to measure diabetes self-management behaviors among older Koreans with type 2 diabetes, based on the seven domains identified by the American Association of Diabetes Educators

AIM

The purpose of this study was to develop the Diabetes Self-Management Behavior for Older Koreans (DSMB-O). This scale is based on the seven relevant domains that have been identified by the American Association of Diabetes Educators (AADE) and is adjusted for sociocultural and age-related characteristics.

METHODS

Four phases were used to develop of the DSMB-O as a criterion-referenced measure. In phases 1 and 2, the DSMB-O adopted the AADE's seven domains and established a self-report questionnaire using a small number of items that are applicable to older Koreans. In phase 3, the DSMB-O was formulated with 16 preliminary items, including seven subitems. By assessing the content validity, 14 items (including five subitems) were selected. The final phase involved evaluating the DSMB-O's psychometric properties, including test-retest reliability, content validity, and criterion-related validity, using data from 150 older Koreans with type 2 diabetes.

RESULTS

The coefficients of agreement and Cohen's Kappa for the test-retest reliability test ranged from 0.32 to 1.0 and -0.07 to 1.0, respectively. For the content validity, the values of both the item- and scale-level content validity indices were 1.0. The scores from the DSMB-O were positively correlated with the scores from the Korean version of the Summary of Diabetes Self-Care Activities Questionnaire.

CONCLUSION

The DSMB-O is short and easy for older Koreans to use, as well as having acceptable levels of reliability and validity. Hence, the DSMB-O can be a useful tool to evaluate diabetes self-management behaviors in older Koreans with type 2 diabetes.

A metasynthesis of factors affecting self-management of chronic illness

AIM

To identify factors that may serve as facilitators and barriers to self-management described by adults living with chronic illness by conducting a qualitative metasynthesis.

BACKGROUND

Self-management is an individuals' active management of a chronic illness in collaboration with their family members and clinicians.

DESIGN

Qualitative metasynthesis.

DATA SOURCES

We analysed studies (N = 53) published between January 2000-May 2013 that described factors affecting self-management in chronic illness as reported by adults aged over 18 years with chronic illness.

REVIEW METHODS

Sandelowsi and Barroso approach to qualitative metasynthesis: literature search; quality appraisal; analysis and synthesis of findings.

RESULTS

Collectively, article authors reported on sixteen chronic illnesses, most commonly diabetes (N = 28) and cardiovascular disease (N = 20). Participants included men and women (mean age = 57, range 18-94) from 20 countries representing diverse races and ethnicities. We identified five categories of factors affecting self-management: Personal/Lifestyle Characteristics; Health Status; Resources; Environmental Characteristics; and Health Care System. Factors may interact to affect self-management and may exist on a continuum of positive (facilitator) to negative (barrier).

CONCLUSION

Understanding factors that influence self-management may improve assessment of self-management among adults with chronic illness and may inform interventions tailored to meet individuals' needs and improve health outcomes.

Classification of Support Needs for Elderly Outpatients with Diabetes Who Live Alone

OBJECTIVES

To investigate the support needs of elderly patients with diabetes and to classify elderly patients with diabetes living alone on the basis of support needs.

METHODS

Support needs were derived from a literature review of relevant journals and interviews of outpatients as well as expert nurses in the field of diabetes to prepare a 45-item questionnaire. Each item was analyzed on a 4-point Likert scale. The study included 634 elderly patients with diabetes who were recruited from 3 hospitals in Japan. Exploratory factor analysis was performed to determine the underlying structure of support needs, followed by hierarchical cluster analysis to clarify the characteristics of patients living alone (n=104) who had common support needs.

RESULTS

Exploratory factor analysis suggested a 5-factor solution with 23 items: (1) hope for class and gatherings, (2) hope for personal advice including emergency response, (3) supportlessness and hopelessness, (4) barriers to food preparation, (5) hope of safe medical therapy. The hierarchical cluster analysis of subjects yielded 7 clusters, including a no special-support needs group, a collective support group, a self-care support group, a personal-support focus group, a life-support group, a food-preparation support group and a healthcare-environment support group.

CONCLUSIONS

The support needs of elderly patients with diabetes who live alone can be divided into 2 categories: life and self-care support. Implementation of these categories in outpatient-management programs in which contact time with patients is limited is important in the overall management of elderly patients with diabetes who are living alone.

A qualitative study of older adults seeking appropriate treatment to self-manage their chronic pain in rural North-East Thailand

BACKGROUND

Many older adults suffer from chronic pain which decreases their functional capacity and reduces quality of life. Health behaviours and self-care during chronic illness and chronic pain can exert an important influence on health outcomes. The aims of this study were to (a) understand how older adult Thai individuals seek appropriate treatment to self-manage their chronic pain, and (b) to identify factors that contribute to effective pain self-management.

METHODS

Qualitative interviews were conducted with 32 older adults living in villages in north-east Thailand. Observations were also conducted with consenting individuals. Most interviews were audio-recorded and transcripts were coded and analysed using a grounded theory approach.

RESULTS

Six contextual determinants affected the way participants choose to self-manage their chronic pain, including: priority accorded to pain management; information and resource seeking skills; critical appraisal skills; access to pain-related information; access to treatment; and satisfaction and preferences for practitioners. Participants used several strategies to inform and develop their self-management plans: accessing and responding to information, sourcing resources, trial and error, evaluating treatment and evaluating practitioners.

CONCLUSIONS

Attempts to increase accessibility, affordability and acceptability of pain treatment can promote pain self-management in older Thais. These findings have important implications for health professionals and government organisations seeking to enhance the self-management of pain and quality of life in this population.

Facilitators and barriers to self-management of nursing home residents: perspectives of health-care professionals in Korean nursing homes

Purpose

To explore facilitators and barriers to self-management from the viewpoint of staff taking care of nursing home (NH) residents with chronic diseases in South Korea.

Patients and methods

A qualitative content analysis was done using the focus group interview method. A total of 23 health-care professionals (16 registered nurses and 7 social workers) were interviewed from three urban NHs, each with more than 100 beds.

Results

Five facilitators were identified: grouping the residents; the resident’s awareness of his/her current health status; the willingness of residents to engage in self-management; residence in the facility; and support from the staff. Additionally, seven barriers were identified: deterioration of the resident’s health; the dependency expectations of the resident; hesitation in asking for help; difference in expectations between the staff and the resident’s family; insufficient staffing and time; lack of standardized guidelines; and conservative tendencies of the staff due to rigid policies.

Conclusion

The findings of this study can help health-care professionals recognize the factors that influence self-management and provide direction for registered nurses and other health professionals involved in supporting self-management programs for NH residents.

Intervention Mapping Protocol for Developing a Theory-Based Diabetes Self-Management Education Program

Development of behavior theory–based health promotion programs is encouraged with the paradigm shift from contents to behavior outcomes. This article describes the development process of the diabetes self-management program for older Koreans (DSME-OK) using intervention mapping (IM) protocol. The IM protocol includes needs assessment, defining goals and objectives, identifying theory and determinants, developing a matrix to form change objectives, selecting strategies and methods, structuring the program, and planning for evaluation and pilot testing. The DSME-OK adopted seven behavior objectives developed by the American Association of Diabetes Educators as behavioral outcomes. The program applied an information-motivation-behavioral skills model, and interventions were targeted to 3 determinants to change health behaviors. Specific methods were selected to achieve each objective guided by IM protocol. As the final step, program evaluation was planned including a pilot test. The DSME-OK was structured as the 3 determinants of the IMB model were intervened to achieve behavior objectives in each session. The program has 12 weekly 90-min sessions tailored for older adults. Using the IM protocol in developing a theory-based self-management program was beneficial in terms of providing a systematic guide to developing theory-based and behavior outcome–focused health education programs.

Spousal support in diabetes self-management among Korean immigrant older adults

The authors of the current article investigated domains of spousal support among diabetic Korean older adults and their spouses. Two focus groups were conducted with diabetic participants from the greater Los Angeles Korean community, and three were conducted with their spouses. In the focus groups, participants were asked to describe the spousal support given or received for diabetes self-management. Each group comprised four to nine participants. Focus groups were audiotaped, transcribed, and translated; two independent coders identified domains of spousal support. Content analysis identified six domains: diet, exercise, emotional support, medical regimen, communication with clinicians, and information. Diet was the most frequently described domain across all groups. Gender differences were noted in domains of information, communication, and medical regimen among diabetic participants. Both diabetic and spouse participants identified individualizing spousal support and recognizing diabetes management as teamwork as important elements of successful spousal support. Spousal support education for Korean older adults may have the greatest impact by incorporating these six domains, addressing gender differences, providing tips on individualizing support, and cultivating teamwork.

Development of a situation-specific theory for explaining health-related quality of life among older South Korean adults with type 2 diabetes

The purpose of the study was to develop a situation-specific theory for explaining health-related quality of life (QOL) among older South Korean adults with type 2 diabetes. To develop a situation-specific theory, three sources were considered: (a) the conceptual model of health promotion and QOL for people with chronic and disabling conditions (an existing theory related to the QOL in patients with chronic diseases); (b) a literature review using multiple databases including Cumulative Index for Nursing and Allied Health Literature (CINAHL), PubMed, PsycINFO, and two Korean databases; and (c) findings from our structural equation modeling study on health-related QOL in older South Korean adults with type 2 diabetes. The proposed situation-specific theory is constructed with six major concepts including barriers, resources, perceptual factors, psychosocial factors, health-promoting behaviors, and health-related QOL. The theory also provides the interrelationships among concepts. Health care providers and nurses could incorporate the proposed situation-specific theory into development of diabetes education programs for improving health-related QOL in older South Korean adults with type 2 diabetes.

Strategies for enhancing information, motivation, and skills for self-management behavior changes: a qualitative study of diabetes care for older adults in Korea

PURPOSE

To describe strategies for enhancing information, motivation, and skills related to changes in diabetes self-management behavior among community-dwelling older adults in Korea.

PATIENTS AND METHODS

A total of five focus group interviews (three separate focus groups) were conducted with 12 older adults with type 2 diabetes and five diabetes educators. Qualitative content analysis was used.

RESULTS

"One's own willingness and ability" emerged as a fundamental belief about the strategies for diabetes self-management. Six major themes under three categories were identified. Under the information category, the recurrent themes were: 1) repeatedly offering detailed knowledge regarding self-management, 2) providing information about current health status, and 3) identifying experiential knowledge of blood glucose control. The recurrent themes in the motivation category were: 1) ensuring a positive attitude regarding self-management, and 2) encouragement or feedback from significant others. Furthermore, in the skills category, we found that the following theme emerged: hands-on skills training with numerical standards.

CONCLUSION

This study identified six tailored strategies for enhancing information, motivation, and skills for diabetes self-management behavior changes. These strategies can be used in the development of a culturally sensitive diabetes self-management program for older adults.

Challenges of diabetes management in immigrant Korean Americans

PURPOSE

To examine challenges in diabetes self-management among Korean Americans to guide clinicians in providing culturally appropriate and population-targeted diabetes care.

METHODS

Five focus groups with 23 Korean Americans with type 2 diabetes, 30 to 75 years of age, were conducted. Open-ended questions were presented focusing on previous experiences in living with diabetes; digital recordings were transcribed verbatim; transcripts were coded and themes were identified.

RESULTS

Most participants were reluctant to disclose diabetes because of social stigma and said that they did not know much about diabetes and its complications. Diabetes self-management is not always a top priority for Korean Americans over other family obligations or financial stability in their busy immigration lives. Many Korean Americans experience conflicts with family members in managing diabetes or would not request support from family members for their diabetes care. Traditional women's roles and demanding immigration life seem to leave women particularly vulnerable to a lack of self-care. Lack of English proficiency limits access to mainstream health care.

CONCLUSIONS

Providing diabetes education at the community level is important to raise public awareness of diabetes and to eliminate social stigma. To facilitate family support for individuals with type 2 diabetes, it is appropriate to include the entire family in diabetes educational programs and to promote individual family members' health in the context of maintaining their role within the family. Future efforts should be made with full implementation of language services in various clinical encounters and diabetes education.