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Zhang Q, Sun J, Bian H, Wang X, Zhang C, Dong K, Shen C, Liu T. The relationship between hope level and self-management behaviors in Chinese patients with type 2 diabetes mellitus: a chain-mediated role of social support and disease perception. BMC Psychol 2024; 12:446. [PMID: 39160623 PMCID: PMC11334329 DOI: 10.1186/s40359-024-01939-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 08/07/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND Type 2 diabetes mellitus is a chronic disease and one of the fastest- growing global health emergencies of the 21st century. The relationships between hope level, social support, disease perception, and self-management behaviors are still unclear. Therefore, this study aimed to create a structural equation model to investigate the underlying mechanisms of self-management behaviors in patients with type 2 diabetes mellitus and provide a theoretical basis for future interventions. METHODS By using cross-sectional studies and convenience sampling methods. A survey was conducted from June 2023 to April 2024 on 404 patients with type 2 diabetes mellitus at the First and Third Hospitals of Jinzhou Medical University. Data were collected using scales, including the General Information Questionnaire, the Herth Hope Scale, the Social Support Rating Scale, the Brief Disease Perception Questionnaire, and the Diabetes Self-Management Behavior Scale. Data were analyzed using descriptive analysis, Harman's one-way analysis of variance, Pearson's correlation test, structural equation modeling, and the bootstrap method to verify mediating effects. RESULTS Correlation analyses showed that all four variables were significantly correlated with each other (p < 0.01). Social support had the strongest correlation with self-management behavior (β = 0.554, p < 0.01), followed by hope level (β = 0.543, p < 0.01), and disease perception (β = -0.505, p < 0.01). The structural equation model indicated a strong overall fit (χ2/df = 3.378, GFI = 0.926, CFI = 0.924, IFI = 0.925, TLI = 0.903, RMSEA = 0.077). CONCLUSION Overall, the chain mediation of social support and disease perception was significant. In developing targeted intervention strategies, future research should prioritize enhancing hope, optimizing social support, and reducing negative perceptions of disease by patients as key areas of focus. At the same time, strengthening self-management abilities and health behaviors in patients with type 2 diabetes should not be neglected.
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Affiliation(s)
- Qian Zhang
- School of Nursing, Jinzhou Medical University, No 40, Section 3, Songpo Road, Jinzhou, 121001, China
| | - Jixia Sun
- Qingdao Central Hospital of Rehabilitation University (Qingdao Central Hospital), No.127, Siliu South Road, Shibei District, Qingdao, 266011, China
| | - Honglin Bian
- Qingdao Central Hospital of Rehabilitation University (Qingdao Central Hospital), No.127, Siliu South Road, Shibei District, Qingdao, 266011, China
| | - Xin Wang
- School of Nursing, Jinzhou Medical University, No 40, Section 3, Songpo Road, Jinzhou, 121001, China
- Department of Nursing, Huaian Hospital of Huaian City, 19 Shanyang Avenue, Huaian, 223200, China
| | - Chunyan Zhang
- School of Nursing, Jinzhou Medical University, No 40, Section 3, Songpo Road, Jinzhou, 121001, China
| | - Kairui Dong
- School of Nursing, Jinzhou Medical University, No 40, Section 3, Songpo Road, Jinzhou, 121001, China
| | - Chunlian Shen
- School of Nursing, Fujian Medical University, No. 1 Xuefu North Road, New University District, Fuzhou, Fujian, 350122, China
| | - Tao Liu
- School of Nursing, Jinzhou Medical University, No 40, Section 3, Songpo Road, Jinzhou, 121001, China.
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Parviniannasab AM, Faramarzian Z, Hosseini SA, Hamidizadeh S, Bijani M. The effect of social support, diabetes management self-efficacy, and diabetes distress on resilience among patients with type 2 diabetes: a moderated mediation analysis. BMC Public Health 2024; 24:477. [PMID: 38360647 PMCID: PMC10868118 DOI: 10.1186/s12889-024-18022-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 02/06/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Diabetes can result in distress. Improving Resilience is important in managing these conditions. It is also important to consider the mediating role of diabetes management self-efficacy (DMSE) between diabetes distress (DD) and Resilience. Likewise, understanding how social support (SS) buffers the impact of diabetes distress on Resilience is equally important. METHODS The present study used a cross-sectional design and included 403 participants diagnosed with type 2 diabetes (T2D). The study was conducted in the south of Iran. The participants were selected through convenience sampling from July 2022 to January 2023. Self-reported questionnaires, namely the Diabetes Distress Scale (DDS), Diabetes Management Self-Efficacy Scale (DMSE), Perceived Social Support Scale (PSSS), and Resilience Scale, were used for data collection in the present study. Structural equation modelling was used for moderated mediation analysis. RESULTS The results of the Pearson correlation analysis were indicative of a significant negative correlation (p < 0.01) between diabetes distress and diabetes management self-efficacy (r = - 0.607), social support (r = - 0.417), and Resilience (r = - 0.552). The findings further revealed that diabetes management self-efficacy had fully mediated the correlation between diabetes distress and Resilience. Moreover, the results indicated that social support had a moderating role in the DD-resilience link. CONCLUSIONS The present study's findings offer a new theoretical framework for T2DM that can benefit intervention designers. The results further suggest that promoting diabetes management self-efficacy can be an effective strategy to enhance Resilience and decrease diabetes distress. Also, nurses and other healthcare providers must pay close attention to support resources to improve the patients' Resilience and evaluate the distress associated with diabetes.
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Affiliation(s)
| | - Zohreh Faramarzian
- Department of Nursing, School of Nursing, Larestan University of Medical Sciences, Larestan, Iran
| | | | - Saeed Hamidizadeh
- Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mostafa Bijani
- Department of Medical Surgical Nursing, School of Nursing, Fasa University of Medical Sciences, Fasa, Iran
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Cho MK, Kim MY. Associated factors with depression and sleep quality in T1DM patients: a cross-sectional descriptive study. BMC Psychiatry 2023; 23:18. [PMID: 36624402 PMCID: PMC9830728 DOI: 10.1186/s12888-023-04516-2] [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: 08/09/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Individuals with type 1 diabetes (T1DM) may experience sleep problems, usually due to low blood sugar levels during sleep or performance of blood sugar management (e.g., blood sugar monitoring). This study aimed to identify the disease-related characteristics, psychosocial aspects, and related factors underlying sleep quality in patients with T1DM. METHODS This study employed a descriptive research design. The participants were 159 individuals with T1DM who completed online questionnaires. The data were analyzed using descriptive statistics, correlations, and multiple regression analyses. RESULTS The average score for depression in T1DM patients was 23.77 (SD 5.31), and sleep quality received a score of 4.58 (SD 3.22). Depression was positively correlated with sleep quality and negatively correlated with the total resilience score. The factors linked to depression in T1DM patients were duration of disease, sleep latency, sleep duration, sleep disturbance, and resilience-acceptance of self and life sub-factors, with an explanatory power of 44.4% for the depression variance. The associated factors with sleep quality in T1DM patients were complications, resilience-personal competence sub-factors, and depression, with an explanatory power of 37.4% for sleep quality variance. CONCLUSIONS The results of this study suggest that to improve sleep quality in patients with T1DM, it is necessary to develop and support disease management to prevent complications and implement interventions for improving resilience and reducing negative emotions such as depression.
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Affiliation(s)
- Mi-Kyoung Cho
- grid.254229.a0000 0000 9611 0917Department of Nursing Science, Chungbuk National University, Chungdae-Ro, Seowon-Gu, Cheongju, Korea
| | - Mi Young Kim
- College of Nursing, Hanyang University, 222 Wangsimni-Ro, Seongdong-Gu, Seoul, Korea.
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Pate R, Caswell N, Gardner KJ, Holyoak L. A structural equation model in adults with type 1 and 2 diabetes: exploring the interplay of psychological states and diabetes outcomes, and the mediating effect of resilience. Acta Diabetol 2022; 59:1575-1587. [PMID: 36038781 PMCID: PMC9581857 DOI: 10.1007/s00592-022-01955-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/04/2022] [Indexed: 11/01/2022]
Abstract
AIMS Type 1 and 2 diabetes mellitus (T1DM and T2DM) can lead to emotional distress and cognitive impairments, often caused by psychological factors such as low mood or anxiety; yet, few studies have explored the theoretical mechanisms underlying these relationships and within one study. This study explored the relationships between psychological states (anxiety/worry, fatigue) and diabetes outcomes (diabetes distress, cognitive dysfunction), and whether resilience mediated the association between these in T1DM and T2DM. METHODS A sample of 307 UK adults with a clinical diagnosis of diabetes (T1DM = 129; T2DM = 178) completed a cross-sectional online survey, composed of six questionnaires. Associations between variables were investigated using Pearson's correlations and Structural Equation Modelling (SEM). RESULTS Psychological states were significantly correlated with diabetes outcomes, and resilience was significantly related to both psychological states and diabetes outcomes. The SEM model achieved an acceptable model fit with a significant mediating effect of resilience between psychological states (anxiety/worry, fatigue) and diabetes outcomes (diabetes distress, cognitive dysfunction), with no significant differences between diabetes type. CONCLUSIONS We propose a new theoretical model of T1DM and T2DM that could be used to provide guidance for those designing interventions. These findings help to understand the complex nature of diabetes management, suggesting resilience could be a key factor in managing psychological states and diabetes outcomes.
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Affiliation(s)
- Rosalind Pate
- School of Psychology, University of Central Lancashire, Preston, UK
| | - Noreen Caswell
- School of Psychology, University of Central Lancashire, Preston, UK
| | | | - Lynda Holyoak
- School of Psychology, University of Central Lancashire, Preston, UK
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5
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Demirtaş A, Aykanat Girgin B, Güven A, Kırmızıbekmez H. Psychometric Properties of the Turkish Version of the Diabetes Strengths and Resilience Measure for Adolescents with Type 1 Diabetes. J Clin Res Pediatr Endocrinol 2022; 14:324-333. [PMID: 35633640 PMCID: PMC9422910 DOI: 10.4274/jcrpe.galenos.2022.2022-2-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/23/2022] [Indexed: 12/01/2022] Open
Abstract
Objective Resilience in diabetes refers to the capacity overcome diabetes-related challenges to achieve favorable psychosocial and health outcomes. Despite the known benefits of resilience in adolescents with type 1 diabetes mellitus (T1DM), there tends to be more emphasis on risk factors in research and practice. This study evaluated the psychometric properties of the Diabetes Strengths and Resilience Measure for Adolescents with Type 1 Diabetes (DSTAR-Teen) in Turkey. Methods This descriptive, methodological study was conducted between October 2020 and May 2021. The Turkish DSTAR-Teen was administered to 120 adolescents with T1DM, and the data were evaluated using Cronbach’s alpha coefficients, factor analyses, test-retest correlation, and item-total score correlations. Results The Turkish DSTAR-Teen has 12 items in two factors that explained 50.64% of the total variance. Confirmatory factor analysis revealed goodness-of-fit and comparative fit indices of 0.92 and 0.95, respectively. The total Cronbach’s alpha value of the scale was 0.85. Item-total score correlations ranged from 0.49 to 0.74 (p<0.001). Conclusion Our analyses showed that the Turkish DSTAR-Teen is a valid and reliable instrument in Turkish adolescents with T1DM. The Turkish DSTAR-Teen can be used to evaluate strengths and resilience associated with diabetes management in adolescents with T1DM in Turkey.
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Affiliation(s)
- Aslı Demirtaş
- Zeynep Kamil Maternity and Children Diseases Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Burcu Aykanat Girgin
- University of Health Sciences Turkey, Hamidiye Faculty of Nursing, Department of Pediatric Nursing, İstanbul, Turkey
| | - Ayla Güven
- Zeynep Kamil Maternity and Children Diseases Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Heves Kırmızıbekmez
- İstanbul Ümraniye Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
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Rodriguez LA, Thomas TW, Finertie H, Turner CD, Heisler M, Schmittdiel JA. Psychosocial and diabetes risk factors among racially/ethnically diverse adults with prediabetes. Prev Med Rep 2022; 27:101821. [PMID: 35656212 PMCID: PMC9152808 DOI: 10.1016/j.pmedr.2022.101821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/08/2022] [Accepted: 04/30/2022] [Indexed: 11/29/2022] Open
Abstract
Psychosocial factors such as self-efficacy may be important in helping high-risk adults prevent diabetes. We aimed to describe psychosocial and diabetes risk factors in adults with prediabetes and evaluate if these varied by demographic characteristics. Cross-sectional data came from baseline surveys and electronic health records (2018-2021) of adults with prediabetes enrolled in a randomized study of peer support for diabetes prevention at Kaiser Permanente Northern California and Michigan Medicine. Linear regression was used to compare differences between racial/ethnic groups, adjusting for age, sex, and clinic. Of 336 participants in the study, 62% were female; median age was 57; 41% were White, 35% African American, 9% Hispanic. Mean autonomous motivation was 6.6 and self-efficacy to prevent diabetes was 6.0 (1-7 scale); mean perceived social support was 47 (12-72 scale). Hispanic adults reported higher autonomous motivation and African American adults reported higher self-efficacy compared to White adults. Hispanic and African American adults had more diabetes risk factors than White adults, including greater family history of diabetes, hypertension, sugar-sweetened beverage consumption, physical inactivity and food insecurity. In conclusion, participants reported high levels of autonomous motivation and self-efficacy at baseline, with Hispanic and African American adults reporting higher levels of some psychosocial factors related to behavior change, suggesting a significant opportunity to engage a diverse population of adults with prediabetes in diabetes prevention strategies. However, Hispanic and African American participants showed greater diabetes risk factors levels. Diabetes prevention efforts should address both to reduce diabetes incidence.
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Affiliation(s)
- Luis A. Rodriguez
- Kaiser Permanente Northern California, Division of Research, 2000 Broadway Oakland, CA 94612, USA
| | - Tainayah W. Thomas
- Kaiser Permanente Northern California, Division of Research, 2000 Broadway Oakland, CA 94612, USA
| | - Holly Finertie
- Kaiser Permanente Northern California, Division of Research, 2000 Broadway Oakland, CA 94612, USA
| | - Cassie D. Turner
- University of Michigan Medical School, Department of Internal Medicine, 1301 Catherine St. Ann Arbor, MI, USA
- VA Ann Arbor Healthcare System, VA Center for Clinical Management Research, 2800 Plymouth Rd, Bld. 16/300N-07, Ann Arbor, MI 48109, USA
| | - Michele Heisler
- University of Michigan Medical School, Department of Internal Medicine, 1301 Catherine St. Ann Arbor, MI, USA
- VA Ann Arbor Healthcare System, VA Center for Clinical Management Research, 2800 Plymouth Rd, Bld. 16/300N-07, Ann Arbor, MI 48109, USA
| | - Julie A. Schmittdiel
- Kaiser Permanente Northern California, Division of Research, 2000 Broadway Oakland, CA 94612, USA
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Romero-Castillo R, Pabón-Carrasco M, Jiménez-Picón N, Ponce-Blandón JA. Effects of Nursing Diabetes Self-Management Education on Glycemic Control and Self-Care in Type 1 Diabetes: Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095079. [PMID: 35564474 PMCID: PMC9100266 DOI: 10.3390/ijerph19095079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/14/2022] [Accepted: 04/18/2022] [Indexed: 11/16/2022]
Abstract
(1) Background: Type 1 diabetes is a chronic disease that creates a high demand and responsibility for patient self-care. Patient education, self-care training and the management of derived complications are great challenges for nurses. The objective of this project is to evaluate the efficacy of a therapeutic education program for type 1 diabetes. (2) Methods: Participants recruited to the study will be adult patients with diagnosed type 1 diabetes attending the clinic at the study site. A nurse diabetes educator will deliver a four-session education program. A two-group randomized controlled trial will be used in this study, with an intervention group and a control group. The subjects included in the experimental group will attend some health education sessions, while control group participants will receive the existing standard care provided by the endocrinology and nutrition unit of the hospital. Measurements and evaluations will be conducted at the baseline prior to the intervention and at 1 and 3 months from the intervention. (3) Conclusions: The primary outcome is improving patients' knowledge about diet and treatment management. Secondary outcomes are improving patients' glycemic control and mood. The findings from this study will help to determine the effect of diabetes education about self-care and treatment in patients with diabetes, as well as helping to decrease short-term and long-term complications and reduce health care costs.
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8
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Lin CL, Chang YT, Liu WC, Huang LC, Tsao SY, Chen YH, Chen RY. Exploring and Developing a New Culturally-Appropriate Diabetes Distress Scale in Taiwan. Front Public Health 2022; 10:838661. [PMID: 35372236 PMCID: PMC8968751 DOI: 10.3389/fpubh.2022.838661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 02/21/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction The aim of this study was to develop and validate a new diabetes distress scale suitable for Chinese and Taiwanese culture. Methods This study collected the current diabetes distress measurement tools, re-organized current definitions about the domains of diabetes distress, and then developed a new tool. Three hundred and ninety-five participants from four hospitals in northern Taiwan were recruited by cluster randomized sampling for validity test. Results We found the new diabetes distress scale had appropriate reliability and validity, including an acceptable model fit for the 12-item scale. Conclusions This new diabetes distress scale might be more directly related to emotional distress issues blood glucose control, improve the clinical conspicuity of diabetes distress, and even benefit the overall care of diabetic patients in Taiwan. Further studies about the validity and reliability of this new tool in a nationwide setting are needed.
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Affiliation(s)
- Ching-Ling Lin
- Endocrinology and Metabolism, Cathay General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- School of Medicine, National Tsing Hua University, Hsinchu, Taiwan
| | - Yao-Tsung Chang
- School of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Wen-Cheng Liu
- Endocrinology and Metabolism, Cathay General Hospital, Taipei, Taiwan
| | - Li-Chi Huang
- Endocrinology and Metabolism, Cathay General Hospital, Taipei, Taiwan
- School of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Shin-Yi Tsao
- Endocrinology and Metabolism, Cathay General Hospital, Taipei, Taiwan
| | - Yu-Hsin Chen
- Endocrinology and Metabolism, Cathay General Hospital, Taipei, Taiwan
| | - Ruey-Yu Chen
- School of Public Health, Taipei Medical University, Taipei, Taiwan
- *Correspondence: Ruey-Yu Chen
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Jin Y, Bhattarai M, Kuo WC, Bratzke LC. Relationship between resilience and self-care in people with chronic conditions: A systematic review and meta-analysis. J Clin Nurs 2022; 32:2041-2055. [PMID: 35194870 DOI: 10.1111/jocn.16258] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/27/2021] [Accepted: 02/09/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Living with chronic condition(s) is difficult, due in part to the complexities of effective disease self-care. Self-care has been considered a challenging process according to the literature which describes multiple barriers patients with chronic conditions experience. Resilience has the potential to buffer the adversities of daily self-care and maintain physical and emotional well-being. No systematic review and meta-analysis have been conducted to synthesise and quantify the relationship between resilience and self-care across chronic conditions. AIMS (1) To examine how the definitions and measurements of self-care and resilience align with the middle-range theory of self-care of chronic illness (i.e. self-care maintenance, self-care monitoring, and self-care management) and 3 Rs of resilience process from the society-to-cells framework (i.e. resistance, recovery and rebound) across different chronic conditions; and (2) to examine whether and the degree to which resilience is correlated with self-care across different chronic conditions. DESIGN Systematic review and meta-analysis, following PRISMA guidelines. METHODS PubMed, CINAHL, SocINDEX and PsychINFO were searched for quantitative studies published from January 2000 through July 2020. Descriptive data were summarised using numerical counting to provide an overview of the study characteristics. Definitions and measurements of self-care and resilience were synthesised narratively based on self-care and resilience theories. Numerical data with Pearson's product-moment correlation among observational studies were examined using meta-analysis. RESULTS This review included 20 articles, involving 9,269 individuals across 11 chronic conditions. Despite self-care and resilience being defined and operationalised in a variety of ways, most definitions shared some underlying core constructs. Meta-analysis showed a positive relationship between resilience and self-care across chronic conditions. Findings from interventional studies indicated a bidirectional relationship between resilience and self-care. CONCLUSIONS Overall, resilience was positively associated with self-care in people with chronic conditions. Longitudinal and experimental studies are needed to better understand the causal relationship between resilience and self-care. RELEVANT TO CLINICAL PRACTICE Resilience has the potential to buffer the adversities of daily self-care and maintain physical and emotional well-being. The positive relationship between resilience and self-care found in this review provides preliminary evidence for clinicians to not only focus on reducing barriers and risk factors of self-care but also to improve or increase patients' resilience through various evidence-based interventions.
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Affiliation(s)
- Yuanyuan Jin
- School of Nursing, University of Wisconsin-Madison, 701 Highland Avenue, Madison, Wisconsin, 53705, USA
| | - Muna Bhattarai
- College of Nursing, Texas A&M University, Bryan, Texas, USA
| | - Wan-Chin Kuo
- School of Nursing, University of Wisconsin-Madison, 701 Highland Avenue, Madison, Wisconsin, 53705, USA
| | - Lisa C Bratzke
- School of Nursing, University of Wisconsin-Madison, 701 Highland Avenue, Madison, Wisconsin, 53705, USA
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Emery KA, Robins J, Salyer J, Thurby-Hay L, Djira G. Type 2 Diabetes Self-Management Variables and Predictors. Clin Nurs Res 2021; 31:1250-1262. [PMID: 34961341 DOI: 10.1177/10547738211067322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Guided by the Self and Family-Management framework, relationships between diabetes distress, self-efficacy, resilience and outcomes of A1c, quality of life and health status were explored. A cross sectional descriptive design was used. 78 individuals were enrolled from US clinics. Data were analyzed to test for associations, main effects and interactions and predictors of self-management. Results indicated low diabetes distress (M = 20.53), high self-efficacy (M = 7.32), moderate resilience (M = 80.27), and mean A1c 7.35%/56.88 mmol/mol. 76% scored above the mental health norm, 46% scored above the physical health norm. Average weighted quality of life = -1.74. Diabetes distress was negatively associated with self-efficacy, resilience, physical health, mental health, and quality of life. Self-efficacy was positively associated with resilience, physical health and quality of life. Resilience was positively associated with physical health, mental health and quality of life. Positive associations were found between quality of life, physical and mental health. No associations were found between A1c and variables in the study. Multiple significant interactions were found with A1c, mental health and quality of life outcomes. Terms in the model included treatment regimen, years since diagnosis, provider collaboration and history of diabetes self-management education. Distress was a significant predictor of health status and quality of life. The results confirm self-management facilitators self-efficacy and resilience and barrier diabetes distress and their relationships with outcomes in the framework. This study contributes to the understanding of the emotional aspect of diabetes. Continuing this work will allow researchers to better understand self-management, support self-management efforts and better outcomes.
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Affiliation(s)
| | - Jo Robins
- Virginia Commonwealth University, Richmond, VA, USA
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Steinhardt MA, Brown SA, Lehrer HM, Dubois SK, Wright JI, Whyne EZ, Sumlin LL, Harrison L, Woo J. Diabetes Self-Management Education and Support Culturally Tailored for African Americans: COVID-19-Related Factors Influencing Restart of the TX STRIDE Study. Sci Diabetes Self Manag Care 2021; 47:290-301. [PMID: 34318725 PMCID: PMC8446891 DOI: 10.1177/26350106211027956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Purpose The purpose of this substudy was to determine the most acceptable way to
restart the Texas Strength Through Resilience in Diabetes Education (TX
STRIDE) study safely using remote technologies. Following the emergence of
COVID-19, all in-person TX STRIDE intervention and data collection sessions
were paused. Methods Qualitative descriptive methods using telephone interviews were conducted
during the research pause. A structured interview guide was developed to
facilitate data collection and coding. Forty-seven of 59 Cohort 1
participants were interviewed (mean age = 60.7 years; 79% female; mean time
diagnosed with type 2 diabetes = 11 years). Results Data categories and subcategories were generated from the interview responses
and included: personal experiences with COVID-19, effects of COVID-19 on
diabetes self-management, psychosocial and financial effects of COVID-19,
and recommendations for program restart. Although some participants lacked
technological knowledge, they expressed eagerness to learn how to use remote
meeting platforms to resume intervention and at-home data-collection
sessions. Six months after the in-person intervention was paused, TX STRIDE
restarted remotely with data collection and class sessions held via Zoom. A
majority of participants (72.9%) transitioned to the virtual platform
restart. Conclusions Qualitative findings guided the appropriate implementation of technology for
the study, which facilitated a successful restart. High retention of
participants through the study transition provides evidence that
participants are invested in learning how to manage their diabetes despite
the challenges and distractions imposed by COVID-19.
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Affiliation(s)
- Mary A Steinhardt
- Department of Kinesiology and Health Education, College of Education, The University of Texas at Austin, Austin, Texas
| | - Sharon A Brown
- School of Nursing, The University of Texas at Austin, Austin, Texas
| | - H Matthew Lehrer
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Susan K Dubois
- Department of Kinesiology and Health Education, College of Education, The University of Texas at Austin, Austin, Texas.,Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - Jaylen I Wright
- Department of Kinesiology and Health Education, College of Education, The University of Texas at Austin, Austin, Texas
| | - Erum Z Whyne
- Department of Kinesiology and Health Education, College of Education, The University of Texas at Austin, Austin, Texas
| | - Lisa L Sumlin
- School of Nursing, The University of Texas at Austin, Austin, Texas
| | - Louis Harrison
- Department of Curriculum & Instruction, College of Education, The University of Texas at Austin, Austin, Texas
| | - Jihun Woo
- Department of Kinesiology and Health Education, College of Education, The University of Texas at Austin, Austin, Texas
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12
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Hsu HC, Chen SY, Lee YJ, Chen WY, Wang RH. Pathways of diabetes distress, decisional balance, self-efficacy and resilience to quality of life in insulin-treated patients with type 2 diabetes: A 9-month prospective study. J Clin Nurs 2021; 30:1070-1078. [PMID: 33434303 DOI: 10.1111/jocn.15652] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/04/2021] [Accepted: 01/06/2021] [Indexed: 01/04/2023]
Abstract
AIMS AND OBJECTIVES To construct a path model addressing influences of diabetes distress, self-efficacy of injecting insulin, resilience and decisional balance of injecting insulin to quality of life (QoL) in insulin-treated patients with type 2 diabetes (T2DM). BACKGROUND Insulin regimens more negatively impact QoL than oral medication treatments in patients with T2DM. Understanding the factors and influencing pathways associated with subsequent QoL will help nurses design timely interventions to improve QoL of insulin-treated T2DM patients. DESIGN A 9-month prospective design was employed in this study. METHODS Self-reported questionnaires were used to collect data from 185 insulin-treated T2DM patients. At baseline, diabetes distress and self-efficacy of injecting insulin were collected, while QoL, resilience and decisional balance of injecting insulin were collected 9 months later. Data were collected from February 2017 to February 2018. Structural equation modelling was used for analysis. This study was conducted based on the STROBE. RESULTS Low baseline diabetes distress and high 9-month decisional balance of injecting insulin directly associated with high 9-month QoL. High baseline self-efficacy of injecting insulin and high 9-month resilience directly associated with high 9-month decisional balance of insulin injection and indirectly associated with high 9-month QoL. High baseline diabetes distress directly and indirectly associated with poor 9-month QoL. CONCLUSIONS Diabetes distress, self-efficacy of injecting insulin, resilience and decisional balance of injecting insulin play different roles in associating with QoL in insulin-treated T2DM patients. RELEVANCE TO CLINICAL PRACTICE Nurses could provide educational programs focusing on enhancing decisional balance of injecting insulin to improve QoL in insulin-treated patients. Improving self-efficacy of injecting insulin and resilience could be promising strategies to improve the decisional balance of injecting insulin. More timely assessment of diabetes distress and intervention might be powerful strategies to improve subsequent QoL in these patients.
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Affiliation(s)
- Hui-Chun Hsu
- Lee's Endocrinology Clinic, Pingtung City, Taiwan
| | - Shi-Yu Chen
- Tri-Service General Hospital, Taipei City, Taiwan
| | | | - Wan-Yi Chen
- Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung City, Taiwan
| | - Ruey-Hsia Wang
- College of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
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Lee JI, Burdick KE, Ko CH, Liu TL, Lin YC, Lee MB. Prevalence and factors associated with suicide ideation and psychiatric morbidity among inpatients of a general hospital: A consecutive three-year study. Kaohsiung J Med Sci 2020; 37:427-433. [PMID: 33336553 DOI: 10.1002/kjm2.12336] [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: 10/19/2020] [Revised: 11/10/2020] [Accepted: 11/22/2020] [Indexed: 11/12/2022] Open
Abstract
Using a self-administered questionnaire (the five-item Brief Symptom Rating Scale, BSRS-5), determine the prevalence of suicide ideation (SI), psychiatric morbidity (PM), and the factors associated with these conditions in a general hospital in Taiwan. All individuals aged 12 years or older, who were admitted to a Medical University Hospital between August 2014 and December 2016, were asked to fill out the BSRS-5 at admission. The study was conducted in a medical inpatient setting, excluding Intensive Care Units and the Emergency Service Department. The 93,129 participants were recruited for analysis. Pearson's correlation, regression analysis and path analysis were performed to test the association between SI and each item of psychopathology and to determine the discrimination validity of individual BSRS-5 items for predicting SI. The prevalence rate was 2.3% for SI and 2.0% for PM among all participants. PM was more prevalent in females and those aged 25-54 years. Individuals with PM had a significantly higher rate of SI (44.6%) than did others (1.4%). The prevalence of PM was varied by department, e.g., Psychiatry (44.3%), Rehabilitation Medicine (7.9%), and Nephrology (5.2%). The regression analysis and path analysis with structural equation model indicated that depression, hostility, anxiety, and inferiority were significant independent predictors of SI. The BSRS-5 is an efficient and useful screening tool to identify psychological distress and SI among inpatients in a general hospital. Its integration into the electronic medical chart facilitates identifying patients at risk.
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Affiliation(s)
- Jia-In Lee
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Katherine E Burdick
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Chih-Hung Ko
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tai-Ling Liu
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi Chun Lin
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Been Lee
- National Taiwan Suicide Prevention Center, Taipei, Taiwan.,Department of Psychiatry, National Taiwan University College of Medicine & National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
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14
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Suhaimi AF, Ibrahim N, Tan KA, Silim UA, Moore G, Ryan B, Castle DJ. Effectiveness of a culturally adapted biopsychosocial intervention (POHON SIHAT) in improving self-efficacy in patients with diabetes attending primary healthcare clinics in Putrajaya, Malaysia: study protocol of a randomised controlled trial. BMJ Open 2020; 10:e033920. [PMID: 32066607 PMCID: PMC7044963 DOI: 10.1136/bmjopen-2019-033920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION People with diabetes are often associated with multifaceted factors and comorbidities. Diabetes management frameworks need to integrate a biopsychosocial, patient-centred approach. Despite increasing efforts in promotion and diabetes education, interventions integrating both physical and mental health components are still lacking in Malaysia. The Optimal Health Programme (OHP) offers an innovative biopsychosocial framework to promote overall well-being and self-efficacy, going beyond education alone and has been identified as relevant within the primary care system. Following a comprehensive cultural adaptation process, Malaysia's first OHP was developed under the name 'Pohon Sihat' (OHP). The study aims to evaluate the effectiveness of the mental health-based self-management and wellness programme in improving self-efficacy and well-being in primary care patients with diabetes mellitus. METHODS AND ANALYSIS This biopsychosocial intervention randomised controlled trial will engage patients (n=156) diagnosed with type 2 diabetes mellitus (T2DM) from four primary healthcare clinics in Putrajaya. Participants will be randomised to either OHP plus treatment as usual. The 2-hour weekly sessions over five consecutive weeks, and 2-hour booster session post 3 months will be facilitated by trained mental health practitioners and diabetes educators. Primary outcomes will include self-efficacy measures, while secondary outcomes will include well-being, anxiety, depression, self-care behaviours and haemoglobin A1c glucose test. Outcome measures will be assessed at baseline, immediately postintervention, as well as at 3 months and 6 months postintervention. Where appropriate, intention-to-treat analyses will be performed. ETHICS AND DISSEMINATION This study has ethics approval from the Medical Research and Ethics Committee, Ministry of Health Malaysia (NMRR-17-3426-38212). Study findings will be shared with the Ministry of Health Malaysia and participating healthcare clinics. Outcomes will also be shared through publication, conference presentations and publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT03601884.
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Affiliation(s)
- Aida Farhana Suhaimi
- Department of Psychiatry and Mental Health, Hospital Putrajaya Malaysia, Selangor, Malaysia
- Department of Psychiatry, Universiti Putra Malaysia, Faculty of Medicine and Health Sciences, Serdang, Malaysia
| | - Normala Ibrahim
- Department of Psychiatry, Universiti Putra Malaysia, Faculty of Medicine and Health Sciences, Serdang, Malaysia
| | - Kit-Aun Tan
- Department of Psychiatry, Universiti Putra Malaysia, Faculty of Medicine and Health Sciences, Serdang, Malaysia
| | - Umi Adzlin Silim
- Department of Psychiatry and Mental Health, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Gaye Moore
- Centre for Palliative Care, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Brigid Ryan
- International Unit, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - David J Castle
- Department of Psychiatry, St. Vincent's Mental Health, Melbourne, Victoria, Australia
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Zhao F, Suhonen R, Katajisto J, Leino‐Kilpi H. Factors associated with subsequent diabetes-related self-care activities: The role of social support and optimism. Nurs Open 2020; 7:195-205. [PMID: 31871703 PMCID: PMC6917939 DOI: 10.1002/nop2.379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/06/2019] [Accepted: 09/02/2019] [Indexed: 01/20/2023] Open
Abstract
Aim This study aimed to explore how social support (external factor), optimism (internal factor) and their interaction associated with diabetes-related self-care activities (DRSCA) over 3 months among people with type 2 diabetes mellitus (T2DM). Design Both questionnaire-based and telephone-based survey were used. The data were collected face to face, the first time by questionnaire and the second time by telephone. Methods One hundred and fifty-five patients completed valid survey questionnaires (response rate was about 70% in the first and 62% in the second round). The association of social support and optimism with subsequent DRSCA was examined after adjusting for demographics and disease information. Results Based on results, optimism was significantly associated with subsequent DRSCA. In the dimensions of social support, objective social support and support use were significantly associated with subsequent DRSCA. The results showed that the mediation of optimism between the dimensions of social support and DRSCA was not significant after controlling for covariates. The results also indicated that social support and optimism played directly an important role in improving diabetes-related self-care activities.
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Affiliation(s)
- FangFang Zhao
- Department of Nursing ScienceFaculty of MedicineUniversity of TurkuTurkuFinland
- School of NursingFaculty of MedicineNantong UniversityNantongChina
| | - Riitta Suhonen
- Department of Nursing ScienceFaculty of MedicineUniversity of TurkuTurkuFinland
- Turku University Hospital and City of TurkuWelfare DivisionTurkuFinland
| | - Jouko Katajisto
- Department of Mathematics and StatisticsUniversity of TurkuTurkuFinland
| | - Helena Leino‐Kilpi
- Department of Nursing ScienceFaculty of MedicineUniversity of TurkuTurkuFinland
- Turku University HospitalTurkuFinland
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16
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Xu J, Luo D, Zhu M, Wang H, Shi Y, Ya D, Lin Z, Gu Z. Translation and its Psychometric Characteristic of the Diabetes Strengths and Resilience Measure among Chinese Adolescents with type 1 Diabetes. J Pediatr Nurs 2020; 50:e2-e7. [PMID: 31526592 DOI: 10.1016/j.pedn.2019.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/27/2019] [Accepted: 08/27/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE This study is designed to develop a Chinese version of the Diabetes Strengths and Resilience Measure for Adolescents (DSTAR-Teen) and evaluate its psychometric characteristics. DESIGN AND METHODS One hundred and twenty adolescents with type 1 diabetes (Mean age = 16.3 ± 5.1, 51.7% male, Mean HbA1c = 7.6 ± 2.2%) were enrolled from one national endocrine center in China. Participants were administered with the DSTAR-Teen and the related psychosocial instruments to evaluate the reliability and validity. The DSTAR-Teen was adapted into Chinese version prior to data collection. RESULTS The Chinese DSTAR-Teen demonstrated adequate reliability (Cronbach's α coefficients = 0.90, intraclass correlation coefficient = 0.98). A minimum detectable change at the 95% confidence level was 5.8 points. In exploratory and confirmatory factorial analyses, a three-factor structure emerged with a variance of 67.4%, demonstrating construct validity. Moreover, resilience was significantly associated with glycated hemoglobin, diabetes distress and self-care behavior as hypothesized, further supporting validity. CONCLUSION The Chinese version of the DSTAR-Teen is a psychometrically sound instrument that may capture the adaptive attitudes and behaviors associated with diabetes management. PRACTICE IMPLICATIONS This scale can be used in both clinical and research settings with the aim of identifying diabetes specific strengths and improving the health outcomes in adolescents with type 1 diabetes.
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Affiliation(s)
- Jingjing Xu
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing, Jiangsu, China
| | - Dan Luo
- School of Nursing, Peking University, Beijing, China
| | - Min Zhu
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing, Jiangsu, China
| | - Hong Wang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing, Jiangsu, China
| | - Yun Shi
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing, Jiangsu, China
| | - Dan Ya
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing, Jiangsu, China
| | - Zheng Lin
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Nursing, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing, Jiangsu, China.
| | - Zejuan Gu
- School of Nursing, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Nursing, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing, Jiangsu, China.
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17
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Abstract
Purpose
The purpose of this paper is to develop a research framework for exploring and improving patient empowerment through the analysis of the effects produced by a satisfying physician relationship on patient involvement in the healthcare process.
Design/methodology/approach
The authors begin with a literature review of patient empowerment in healthcare, useful to highlight the importance of relational aspects. Then, the authors tested the hypotheses of the research through the analysis of 450 questionnaires. The results are analyzed through covariance-based structural equation modeling.
Findings
This paper highlights how empowerment is a more complex phenomenon, needing many dimensions to be investigated. The hypotheses were tested, and correlations computed, highlighting a medium-strong positive correlation between physician relationship and patient involvement determining satisfying patient empowerment.
Research limitations/implications
The considerations conducted in the paper are restricted to physician relationship and needs further research aimed to analyze and evaluate the changes in the patient behaviors influenced by empowerment.
Practical implications
The research points offer new insight into patient empowerment and allow the healthcare provider to create new opportunities for promoting patient empowerment through the development of quality relationship for effective patient involvement.
Originality/value
The study developed contributes new insight about patient empowerment in the healthcare management literature, proving the key role of satisfying physician relationship useful for future researches.
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18
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Chew BH, Vos RC, Fernandez A, Shariff Ghazali S, Shamsuddin NH, Ismail M, Rutten GE. The effectiveness of an emotion-focused educational programme in reducing diabetes distress in adults with type 2 diabetes mellitus at 12-month follow-up: a cluster randomized controlled trial. Ther Adv Endocrinol Metab 2019; 10:2042018819853761. [PMID: 31210922 PMCID: PMC6545652 DOI: 10.1177/2042018819853761] [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: 03/15/2019] [Accepted: 05/09/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Diabetes distress (DD) is an increasingly important part of clinical medicine, diabetes self-management and research topic in people with diabetes mellitus. The present study evaluated the effectiveness of a value-based emotion-focused educational program in Malay adults with type 2 diabetes (VEMOFIT) at 12-month follow-up compared with a program with systematic attention to participants' emotions (attention-control). METHODS VEMOFIT consisted of four biweekly group sessions and a booster session after 3 months; the attention-control program consisted of three sessions over the same period. Intention-to-treat analysis with multilevel mixed modelling was done to estimate the intervention effect. RESULTS Participants (n = 124) randomized to VEMOFIT (n = 53) or attention-control (n = 71). Mean (SD) age 55.7 (9.7) years, median diabetes duration 7.0 (8.0) years and mean HbA1c level 9.7% (82 mmol/mol). The mean DD (DDS-17 scale) level decreased in both groups (from 3.4 to 3.3 versus 3.1-2.5, respectively), significantly more in the attention-control group [adjusted difference -0.6, 95% confidence interval (CI) -1.1, -0.2]. The VEMOFIT group had a significant improvement in self-efficacy (DMSES, range 0-200; adjusted difference 16.4, 99.4% CI 1.9, 30.9). Other outcomes did not differ. CONCLUSIONS Because the attention-control program resulted in a decreased DD 1 year later, its implementation on a larger scale seems justified. TRIAL REGISTRATION NCT02730078; NMRR-15-1144-24803.
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Affiliation(s)
| | - Rimke C. Vos
- Department of Public Health and Primary Care/ LUMC Campus The Hague, Leiden University Medical Center, The Netherlands
| | - Aaron Fernandez
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Sazlina Shariff Ghazali
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Nurainul Hana Shamsuddin
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | | | - Guy E.H.M. Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
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Wang RH, Lin KC, Hsu HC, Lee YJ, Shin SJ. Determinants for quality of life trajectory patterns in patients with type 2 diabetes. Qual Life Res 2018; 28:481-490. [PMID: 30276505 DOI: 10.1007/s11136-018-2013-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2018] [Indexed: 01/09/2023]
Abstract
PURPOSE The purpose of the study was to identify quality of life (QoL) trajectory patterns and the determinants in patients with Type 2 diabetes (T2DM). METHODS A longitudinal design was employed. Totally, 466 patients with T2DM recruited from five diabetic clinics in Taiwan were participants of this study. Demographic and disease characteristics, biomedical factors (HbA1c levels and body mass index), psychosocial factors (self-care behaviors, social support, resilience, diabetes distress), and QoL were collected at baseline. QoL was further measured every 6 months for four waves after baseline. Latent class growth analysis was used to identify QoL trajectory patterns. The multinomial logistic regression was further applied to explore the important determinants of different QoL trajectory patterns. RESULTS The "steadily poor" (n = 27, 5.8%), "consistently moderate" (n = 174, 37.3%), and "consistently good" (n = 265, 56.9%) trajectory patterns were identified. The HbA1c levels (OR 2.16) and diabetes distress (OR 1.18) were important for determining participants in the "steadily poor" QoL trajectory pattern. HbA1c levels (OR 1.25) and diabetes distress (OR 1.14) were important for determining participants in the "consistently moderate" QoL trajectory pattern. CONCLUSIONS To prevent development of relatively worse QoL trajectory patterns in patients with T2DM in a timelier manner, healthcare providers could regularly assess the QoL and provide intervention, especially for those with high HbA1c levels and high diabetes distress. Meanwhile, early intervention for decreasing HbA1c levels and diabetes distress may improve the trajectory development of QoL in patients with T2DM.
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Affiliation(s)
- Ruey-Hsia Wang
- College of Nursing, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, Kaohsiung City, 807, Taiwan, ROC. .,Department of Medical Research, Kaohsiung Medical University Hospital, 100, Shih-Chuan 1st Road, Kaohsiung City, 807, Taiwan, ROC.
| | - Kuan-Chia Lin
- Institute of Hospital and Health Care Administration, National Yang-Ming University, 155, Sec. 2, Linong st., Beitou District, Taipei City, 11221, Taiwan, ROC.,Preventive Medicine Research Center, National Yang-Ming University, 155, Sec. 2, Linong st., Beitou District, Taipei City, 11221, Taiwan, ROC
| | - Hui-Chun Hsu
- Lee's Endocrinology Clinic, 396, Guangdong Rd., Pingtung City, 900, Pingtung County, Taiwan, ROC
| | - Yau-Jiunn Lee
- Lee's Endocrinology Clinic, 396, Guangdong Rd., Pingtung City, 900, Pingtung County, Taiwan, ROC
| | - Shyi-Jang Shin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, 100, Shih-Chuan 1st Road, Kaohsiung City, 807, Taiwan, ROC
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Chew BH, Vos RC, Pouwer F, Rutten GEHM. The associations between diabetes distress and self-efficacy, medication adherence, self-care activities and disease control depend on the way diabetes distress is measured: Comparing the DDS-17, DDS-2 and the PAID-5. Diabetes Res Clin Pract 2018; 142:74-84. [PMID: 29802952 DOI: 10.1016/j.diabres.2018.05.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 02/09/2018] [Accepted: 05/09/2018] [Indexed: 02/08/2023]
Abstract
AIMS To examine whether diabetes distress (DD), when measured by three different instruments, was associated differently with self-efficacy, self-care activity, medication adherence and disease control in people with Type 2 diabetes mellitus. METHODS A cross-sectional study in three health clinics. DD was assessed with the 17-item Diabetes Distress Scale, the 2-item DDS-2 (DDS-2) and the 5-item Problem Areas in Diabetes Scale (PAID-5). Dependent variables included self-efficacy, self-care activities, medication adherence, HbA1c, systolic and diastolic blood pressure (SBP, DBP). Multiple linear and logistic regression were used in analyses. RESULTS In total 338 participants (56% women), with a mean age of 61 years and diabetes duration of 9.8 years, were included. DDS-2 was an independent determinant of SBP (β = 1.89, 95% CI 0.14, 3.64), DBP (β = 1.19, 95% CI 0.16, 2.21) and blood pressure target (OR = 2.09, 95% CI 1.12, 3.83). PAID-5 was an independent determinant of medication adherence (adjusted β = -0.05, 95% CI -0.08, -0.01) and self-care activities (OR = 0.50, 95% CI 0.26, 0.99). CONCLUSIONS Associations of DD with important aspects of diabetes care are substantially influenced by confounders and depend on the way DD is measured. Our findings call for a judicious use of different DD measures in clinical practice and research. The study is registered on ClinicalTrials.gov (NCT02730754).
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Affiliation(s)
- Boon-How Chew
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia; University of Utrecht, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Huispost Str. 6.131, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
| | - Rimke C Vos
- University of Utrecht, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Huispost Str. 6.131, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Guy E H M Rutten
- University of Utrecht, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Huispost Str. 6.131, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
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Hsu HC, Lee YJ, Wang RH. Influencing Pathways to Quality of Life and HbA1c in Patients With Diabetes: A Longitudinal Study That Inform Evidence-Based Practice. Worldviews Evid Based Nurs 2018; 15:104-112. [PMID: 29443437 DOI: 10.1111/wvn.12275] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2017] [Indexed: 01/27/2023]
Abstract
BACKGROUND Determining possible associated factors and the influencing pathways to hemoglobin A1C (HbA1C) levels and quality of life (QoL) will facilitate the development of effective interventions to improve the physical and psychosocial health of patients with type 2 diabetes mellitus (T2DM). OBJECTIVES To test a hypothesized model that addressed the pathways among personal characteristics, social support, diabetes distress, and self-care behaviors to HbA1C and QoL. METHODS A total of 382 adults with T2DM were recruited. Self-reported questionnaires and medical records were used to collect data regarding personal characteristics, diabetes distress, and social support at baseline. The self-care behaviors characters were collected 6 months later, as well as QoL and HbA1C levels 1 year later. RESULTS The 12-month QoL directly affected 12-month HbA1C levels. The 6-month self-care behaviors directly affected 12-month QoL, and indirectly affected 12-month HbA1C levels through 12-month QoL. Baseline diabetes distress directly affected 12-month QoL. Moreover, baseline diabetes distress indirectly affected 12-month HbA1C levels through 12-month QoL. Baseline social support directly affected baseline diabetes distress and 6-month self-care behaviors. In addition, baseline social support indirectly affected 12-month QoL through baseline diabetes distress. Baseline social support also indirectly affected 12-month QoL through 6-month self-care behaviors. LINKING EVIDENCE TO ACTION Enhancing QoL is important to improve HbA1C levels. Enhancing self-care behaviors is essential to improve subsequent HbA1C control and QoL. Reducing diabetes distress is crucial to improve subsequent QoL. Improving social support is suggested a favorable strategy to reduce diabetes distress and enhance subsequent self-care behaviors in patients with T2DM.
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Affiliation(s)
- Hui-Chun Hsu
- Department of Diabetes Management, Lee's Endocrinology Clinic, Pingtung, Taiwan
| | - Yau-Jiunn Lee
- Department Head, Lee's Endocrinology Clinic, Pingtung, Taiwan
| | - Ruey-Hsia Wang
- College of Nursing, Kaohsiung Medical University, and Adjunct Researcher, Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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22
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Chew BH, Vos RC, Stellato RK, Rutten GEHM. Diabetes-Related Distress and Depressive Symptoms Are Not Merely Negative over a 3-Year Period in Malaysian Adults with Type 2 Diabetes Mellitus Receiving Regular Primary Diabetes Care. Front Psychol 2017; 8:1834. [PMID: 29089913 PMCID: PMC5651035 DOI: 10.3389/fpsyg.2017.01834] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 10/02/2017] [Indexed: 02/05/2023] Open
Abstract
For people with type 2 diabetes mellitus (T2DM) the daily maintenance of physical and psychological health is challenging. However, the interrelatedness of these two health domains, and of diabetes-related distress (DRD) and depressive symptoms, in the Asian population is still poorly understood. DRD and depressive symptoms have important but distinct influences on diabetes self-care and disease control. Furthermore, the question of whether changes in DRD or depressive symptoms follow a more or less natural course or depend on disease and therapy-related factors is yet to be answered. The aim of this study was to identify the factors influencing changes in DRD or depressive symptoms, at a 3-year follow-up point, in Malaysian adults with T2DM who received regular primary diabetes care. Baseline data included age, sex, ethnicity, marital status, educational level, employment status, health-related quality of life (WHOQOL-BREF), insulin use, diabetes-related complications and HbA1c. DRD was assessed both at baseline and after 3 years using a 17-item Diabetes Distress Scale (DDS-17), while depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9). Linear mixed models were used to examine the relationship between baseline variables and change scores in DDS-17 and PHQ-9. Almost half (336) of 700 participants completed both measurements. At follow-up, their mean (SD) age and diabetes duration were 60.6 (10.1) years and 9.8 (5.9) years, respectively, and 54.8% were women. More symptoms of depression at baseline was the only significant and independent predictor of improved DRD at 3 years (adjusted β = -0.06, p = 0.002). Similarly, worse DRD at baseline was the only significant and independent predictor of fewer depressive symptoms 3 years later (adjusted β = -0.98, p = 0.005). Thus, more "negative feelings" at baseline could be a manifestation of initial coping behaviors or a facilitator of a better psychological coaching by physicians or nurses that might be beneficial in the long term. We therefore conclude that initial negative feelings should not be seen as a necessarily adverse factor in diabetes care.
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Affiliation(s)
- Boon-How Chew
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
- *Correspondence: Boon-How Chew ;
| | - Rimke C. Vos
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Rebecca K. Stellato
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Guy E. H. M. Rutten
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
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