Illness representations, emotional distress, coping strategies, and coping efficacy as predictors of patient outcomes in type 2 diabetes

The Positive and Negative Affect Schedule - Food Allergy (PANAS-FA): Adaptation and psychometric properties

BACKGROUND

Food allergy (FA) is a worldwide concern, increasing up to 50% in the past decade, with a 700% rise in hospitalizations because of anaphylaxis. Individuals diagnosed with FA must have the emotional resources to cope with the many challenges that arise from self-management tasks and the social limitations that FA presents. Therefore, it is clear that close consideration of heightened emotions due to FA is needed.

METHOD

The present research aimed to adapt the Positive and Negative Affect Schedule (PANAS), one of the most used questionnaires available to measure mood or emotion worldwide, for a population of individuals with FA. We performed one study (N = 205; M age = 37.37; Age range = 18-72). To adapt the measure, we asked participants to what extent they "generally" felt about having a FA, through 20 items (eg, strong, alert - positive affect; upset, scared - negative affect). We used Item Response Theory, Confirmatory Factor Analysis (CFA), and reliability estimates to assess the data. We also propose a shorter version of the PANAS-FA, using its "best items". Finally, we also used the General Anxiety Disorder-7 measure and Need for Affect Questionnaire to assess convergent validity.

RESULTS

The PANAS-FA presented a good model fit and strong item parameters. We removed 4 items from each factor for the shorter version, which presented difficulty levels slightly higher than recommended. The short PANAS-FA presented comparable results to the longer version. The measure also showed significant associations with general anxiety and need for affect, which assesses to what extent an individual likes to engage in emotion-inducing situations. Through a mediational model, negative affect significantly influenced general anxiety, partially influenced by the extent individuals avoid emotional situations.

CONCLUSION

We are confident that the adaptation of the Positive and Negative Affect Schedule focused on food allergy (PANAS-FA) provides a novel opportunity to understand the intrinsic associations between emotions and living with FA. Identifying which FA emotions are related to these factors may be vital for future interventions, providing an environment that focuses or promotes these emotions to enhance individual well-being.

An Intervention to Change Illness Representations and Self-Care of Individuals With Type 2 Diabetes: A Randomized Controlled Trial

OBJECTIVE

Suboptimal self-care by individuals with diabetes mellitus (DM) is a significant public health concern. The common-sense model (CSM) proposes that illness representations are associated with coping and health outcomes across various conditions. The present study examined the efficacy of a CSM-based intervention in improving illness representations, self-care, self-care self-efficacy, use of adaptive coping strategies, and glycated hemoglobin among individuals with type 2 DM (T2DM).

METHODS

A two-arm randomized controlled trial was used. A total of 455 T2DM patients were recruited from an outpatient DM clinic and randomized to an intervention group that consisted of five weekly group-based education sessions or a control group that received five weekly educational booklets. Evaluation was conducted at baseline and at 1- and 6-month follow-up.

RESULTS

The 2 × 3 linear mixed-model analysis using a modified intention to treat revealed a significant time by condition interaction effect on level of self-care (F(2,840) = 7.78, p < .001), self-care self-efficacy (F(1.89,794.57) = 14.40, p < .001), and use of adaptive coping strategies (F(1.94,812.93) = 4.75, p = .010) in which participants in the intervention group reported greater improvement in such aspects compared with those in the control group. A significant time effect was observed in some dimensions of illness representations. No significant effect was found in glycated hemoglobin. Participants reported positive feedback to the intervention and perceived improvement in various domains.

CONCLUSIONS

The CSM-based intervention was effective in improving self-care and coping among DM patients. The intervention also demonstrated high feasibility and acceptability. Findings provided important insights in improving health-related outcomes for patients with T2DM using the CSM framework.

Illness perceptions of Libyans with T2DM and their influence on medication adherence: a study in a diabetes center in Tripoli

BACKGROUND

The surrounding environment influences the constitution of illness perceptions. Therefore, local research is needed to examine how Libyan diabetes patients perceive diabetes and how their perceptions influence their medication adherence.

METHODS

A cross-sectional study was conducted at the National Centre for Diabetes and Endocrinology in Tripoli, Libya, between October and December 2013. A total of 523 patients with type 2 diabetes participated in this study. A self-administered questionnaire was used for data collection; this included the Revised Illness Perception Questionnaire and the eight-item Morisky Medication Adherence Scale.

RESULTS

The respondents showed moderately high personal control and treatment control perceptions and a moderate consequences perception. They reported a high perception of diabetes timeline as chronic and a moderate perception of the diabetes course as unstable. The most commonly perceived cause of diabetes was Allah's will. The prevalence of low medication adherence was 36.1%. The identified significant predictors of low medication adherence were the low treatment control perception (p=0.044), high diabetes identity perception (p=0.008), being male (p=0.026), and employed (p=0.008).

CONCLUSION

Diabetes illness perceptions of type 2 diabetic Libyans play a role in guiding the medication adherence and could be considered in the development of medication adherence promotion plans.

Life-long battle: Perceptions of type 2 diabetes in Thailand

BACKGROUND

The number of people in Thailand who have Type 2 diabetes has increased dramatically making it one of the country's major health problems. The rising prevalence of diabetes in Thailand is associated with dietary changes, reduced physical activity and health education. Although there is much research about health education programmes, the most effective methods for promoting sustainability and adherence to self-management among diabetics remains unclear.

OBJECTIVES

To examine the perceptions of participants in Thailand regarding Type 2 diabetes and to utilize the findings to formulate a model for patient education.

METHODS

A grounded theory approach was selected and semi-structured face to face interviews and focus group were used to gather data from 33 adults with Type 2 diabetes.

RESULTS

Five explanatory categories emerged from the data: causing lifelong stress and worry, finding their own ways, after a while, still cannot and wanting a normal life.

CONCLUSION

A new approach to patient education about Type 2 diabetes in Thailand is needed to give patients a better understanding, provide recommendations that they can apply to their daily lives, and include information about alternative medication. The Buddhist way of thinking and effective strategies enhancing self-efficacy should be applied to patient education to promote sustainability and adherence to self-management.

Illness perceptions among adults at risk for diabetes

PURPOSE

The purpose of this study is to examine diabetes illness perceptions among a sample of at-risk adults according to specific characteristics that make them vulnerable to diabetes.

METHODS

At-risk adults (N = 372) participated in a study investigating the potential to screen them for diabetes at a large urban dental college. Sociodemographic and individual-level diabetes risk-related characteristics, A1C measures, diabetes-related symptoms, diabetes knowledge, diabetes illness perceptions, and perceived causes of diabetes were collected and reported for the study sample; t tests were then used to determine whether there were statistically significant differences in each of 8 dimensions of diabetes illness perceptions according to the presence or absence of 6 diabetes risk factors.

RESULTS

Average A1C values were 5.6% (38 mmol/mol), and 46% of the study sample had A1C values in the prediabetes or diabetes range. Participants had various diabetes knowledge gaps and misperceptions, and there were differences in dimensions of diabetes illness perceptions depending on specific diabetes-related risk factors.

CONCLUSIONS

In view of differences in the diabetes-related illness perceptions of persons at risk for diabetes, it is important for diabetes educators and other health care providers to personalize their diabetes-related education, management, and support to the specific needs and vulnerabilities of at-risk patients.

Coeliac disease--women's experiences in everyday life

AIMS AND OBJECTIVES

To describe what life is like as a woman living with coeliac disease.

BACKGROUND

The therapy for coeliac disease is a gluten-free diet, and if sufferers keep strictly to this, it is suggested that they will stay well. However, previous studies point out that people who are treated for coeliac disease, particularly women, experience various kinds of inconvenience in relation to having coeliac disease and to being treated with gluten-free diet.

DESIGN

A qualitative research design was chosen.

METHODS

A phenomenological approach as devised by Giorgi was used. Tape-recorded qualitative interviews with a total of 15 women who were being treated for coeliac disease were conducted in 2008 in Sweden.

RESULTS

The results demonstrated that coeliac disease can influence women's lives in different ways. The general structure of being a woman with coeliac disease was described as a striving towards a normalised lifeworld. Three conditions necessary to achieve a normalised life were described, namely being secure, being in control and being seen and included.

CONCLUSION

Understanding factors affecting the ability to live with coeliac disease as normally as possible can help caregivers, and others, to support these women in their aims.

RELEVANCE TO CLINICAL PRACTICE

Nurses should help women to adopt facilitating thoughts in relation to the disease and, in so doing, help them to select appropriate coping strategies.