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Tu Q, Lin S, Hyun K, Hafiz N, Manandi D, Koh AS, Redfern J. The effects of multidisciplinary collaborative care on cardiovascular risk factors among patients with diabetes in primary care settings: A systematic review and meta-analysis. Prim Care Diabetes 2024; 18:381-392. [PMID: 38852029 DOI: 10.1016/j.pcd.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 05/22/2024] [Accepted: 05/26/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Multidisciplinary collaborative care has been widely recommended as an effective strategy for managing diabetes; however, the cardiovascular risk factors of patients with diabetes are often inadequately managed in primary care settings. This study aimed to assess the effect of multidisciplinary collaboration on cardiovascular risk factors among patients with diabetes in primary care settings. METHODS Five databases (i.e., Medline, Embase, CINAHL, SCOPUS and CENTRAL) were systematically searched to retrieve randomised controlled trials. Studies were eligible for inclusion if the interventions included a multidisciplinary team with professionals from at least three health disciplines and focused on patients with diabetes in primary care settings. A random-effects model was used to calculate the pooled effects. RESULTS In total, 19 studies comprising 6538 patients were included in the meta-analysis. The results showed that compared with usual care, multidisciplinary collaborative care significantly reduced cardiovascular risk factors, including mean systolic blood pressure (-3.27 mm Hg, 95 % confidence interval [CI]: -4.72 to -1.82, p < 0.01), diastolic blood pressure (-1.4 mm Hg, 95 % CI: -2.32 to -0.47, p < 0.01), glycated haemoglobin (-0.42 %, 95 % CI: -0.59 to -0.25, p < 0.01), low-density lipoprotein (-0.16 mmol/L, 95 % CI: -0.26 to -0.06, p < 0.01) and high-density lipoprotein (0.06 mmol/L, 95 % CI: 0.00-0.12, p < 0.05). The subgroup analysis showed multidisciplinary collaboration was more effective in reducing cardiovascular risk factors when it comprised team members from a number of different disciplines, combined pharmacological and non-pharmacological components, included both face-to-face and remote interactions and was implemented in high-income countries. CONCLUSION Multidisciplinary collaborative care is associated with reduced cardiovascular risk factors among patients with diabetes in primary care. Further studies need to be conducted to determine the optimal team composition.
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Affiliation(s)
- Qiang Tu
- Faculty of Medicine and Health, The University of Sydney, Australia.
| | | | - Karice Hyun
- Faculty of Medicine and Health, The University of Sydney, Australia; Department of Cardiology, Concord Hospital, Sydney, Australia
| | - Nashid Hafiz
- Faculty of Medicine and Health, The University of Sydney, Australia
| | - Deborah Manandi
- Faculty of Medicine and Health, The University of Sydney, Australia
| | - Angela S Koh
- National Heart Centre, Singapore, Singapore; Duke-National University of Singapore, Singapore
| | - Julie Redfern
- Faculty of Medicine and Health, The University of Sydney, Australia; The George Institute for Global Health, University of New South Wales, Sydney, Australia
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Su R, Whitmore C, Alliston P, Tanzini E, Kouzoukas E, Marttila J, Dragonetti R, Selby P, Sherifali D. Demystifying diabetes health coaching: A scoping review unveiling the 'who' and 'where' of health coaching for adults with type 2 diabetes. Diabet Med 2024; 41:e15327. [PMID: 38597813 DOI: 10.1111/dme.15327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/26/2024] [Accepted: 03/25/2024] [Indexed: 04/11/2024]
Abstract
Type 2 diabetes (T2D) is a complex chronic condition that requires ongoing self-management. Diabetes health coaching interventions provide personalized healthcare programming to address physical and psychosocial aspects of diabetes self-management. AIMS This scoping review aims to explore the contexts and settings of diabetes health coaching interventions for adults with T2D, using the RE-AIM framework. METHODS A search was completed in MEDLINE, PsycINFO, Emcare, Embase and Cochrane. Included citations described adults with exclusively T2D who had received a health coaching intervention. Citations were excluded if they focused on any other types of diabetes or diabetes prevention. RESULTS A total of 3418 records were identified through database and manual searches, with 29 citations selected for data extraction. Most health coaching interventions were delivered by health professionals, many employed lay health workers and a few included peer coaches. While many health coaching interventions were delivered remotely, in-person intervention settings were distributed among primary care, community health settings and non-healthcare sites. CONCLUSION The findings of this review suggest that diabetes health coaching may be implemented by a variety of providers in different settings. Further research is required to standardize training and implementation of health coaching and evaluate its long-term effectiveness.
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Affiliation(s)
- Rita Su
- INTREPID Lab, The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Carly Whitmore
- INTREPID Lab, The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Paige Alliston
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Elise Tanzini
- INTREPID Lab, The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Erika Kouzoukas
- INTREPID Lab, The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jennifer Marttila
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Rosa Dragonetti
- INTREPID Lab, The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Peter Selby
- INTREPID Lab, The Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Diana Sherifali
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
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Karki A, Vandelanotte C, Khalesi S, Dahal P, Rawal LB. The effect of health behavior interventions to manage Type 2 diabetes on the quality of life in low-and middle-income countries: A systematic review and meta-analysis. PLoS One 2023; 18:e0293028. [PMID: 37844107 PMCID: PMC10578590 DOI: 10.1371/journal.pone.0293028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 10/03/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Behavioral interventions targeted at managing Type 2 diabetes mellitus (T2DM) may have a positive effect on quality of life (QOL). Limited reviews have synthesized this effect in low- and middle-income countries (LMICs). This review and meta-analysis synthesised available evidence on the effect of behavioral interventions to manage T2DM on the QOL of people with T2DM in LMICs. METHODS Electronic databases PUBMED/MEDLINE, SCOPUS, CINAHL, Embase, Web of Science and PsycINFO were searched from May to June 2022. Studies published between January 2000 and May 2022, conducted in LMICs using randomized controlled trial design, using a health behavior intervention for T2DM management, and reporting QOL outcomes were included. Difference in QOL change scores between the intervention and control group was calculated as the standardized mean difference (SMD) of QOL scores observed between the intervention and control groups. Random-effects model was used for meta-analysis. RESULTS Of 6122 studies identified initially, 45 studies met the inclusion criteria (n = 8336). Of them, 31 involved diabetes self-management education and 14 included dietary and/or physical activity intervention. There was moderate quality evidence from the meta-analysis of mean QOL (n = 25) that health behavior intervention improved the QOL of people with T2DM (SMD = 1.62, 95%CI = 0.65-2.60 I2 = 0.96, p = 0.001). However, no significant improvements were found for studies (n = 7) separately assessing the physical component summary (SMD = 0.76, 95%CI = -0.03-1.56 I2 = 0.94, p = 0.060) and mental component summary (SMD = 0.43, 95%CI = -0.30-1.16 I2 = 0.94, p = 0.249) scores. High heterogeneity and imprecise results across studies resulted in low to moderate quality of evidence. CONCLUSION The findings suggest that health behavior interventions to manage T2DM may substantially improve the QOL of individuals with T2DM over short term. However, due to low to moderate quality of evidence, further research is required to corroborate our findings. Results of this review may guide future research and have policy implications for T2DM management in LMICs.
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Affiliation(s)
- Ashmita Karki
- School of Health, Medical and Applied Sciences, Appleton Institute, Central Queensland University, Rockhampton, Australia
| | - Corneel Vandelanotte
- School of Health, Medical and Applied Sciences, Appleton Institute, Central Queensland University, Rockhampton, Australia
| | - Saman Khalesi
- School of Health, Medical and Applied Sciences, Appleton Institute, Central Queensland University, Rockhampton, Australia
| | - Padam Dahal
- School of Health, Medical and Applied Sciences, Appleton Institute, Central Queensland University, Rockhampton, Australia
| | - Lal B. Rawal
- School of Health, Medical and Applied Sciences, Appleton Institute, Central Queensland University, Rockhampton, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Sydney Australia
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Thomas SA, Browning CJ, Charchar FJ, Klein B, Ory MG, Bowden-Jones H, Chamberlain SR. Transforming global approaches to chronic disease prevention and management across the lifespan: integrating genomics, behavior change, and digital health solutions. Front Public Health 2023; 11:1248254. [PMID: 37905238 PMCID: PMC10613497 DOI: 10.3389/fpubh.2023.1248254] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/18/2023] [Indexed: 11/02/2023] Open
Abstract
Chronic illnesses are a major threat to global population health through the lifespan into older age. Despite world-wide public health goals, there has been a steady increase in chronic and non-communicable diseases (e.g., cancer, cardiovascular and metabolic disorders) and strong growth in mental health disorders. In 2010, 67% of deaths worldwide were due to chronic diseases and this increased to 74% in 2019, with accelerated growth in the COVID-19 era and its aftermath. Aging and wellbeing across the lifespan are positively impacted by the presence of effective prevention and management of chronic illness that can enhance population health. This paper provides a short overview of the journey to this current situation followed by discussion of how we may better address what the World Health Organization has termed the "tsunami of chronic diseases." In this paper we advocate for the development, validation, and subsequent deployment of integrated: 1. Polygenic and multifactorial risk prediction tools to screen for those at future risk of chronic disease and those with undiagnosed chronic disease. 2. Advanced preventive, behavior change and chronic disease management to maximize population health and wellbeing. 3. Digital health systems to support greater efficiencies in population-scale health prevention and intervention programs. It is argued that each of these actions individually has an emerging evidence base. However, there has been limited research to date concerning the combined population-level health effects of their integration. We outline the conceptual framework within which we are planning and currently conducting studies to investigate the effects of their integration.
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Affiliation(s)
- Shane A Thomas
- Vice Chancellor’s Office, Federation University, Ballarat, VIC, Australia
| | - Colette J Browning
- Institute of Health and Wellbeing, Federation University, Ballarat, VIC, Australia
- Health Innovation and Transformation Centre (HITC), Federation University, Ballarat, VIC, Australia
| | - Fadi J Charchar
- Health Innovation and Transformation Centre (HITC), Federation University, Ballarat, VIC, Australia
| | - Britt Klein
- Health Innovation and Transformation Centre (HITC), Federation University, Ballarat, VIC, Australia
| | - Marcia G. Ory
- Center for Community Health and Aging, Texas A&M University, School of Public Health, College Station, TX, United States
| | - Henrietta Bowden-Jones
- National Problem Gambling Clinic, London, United Kingdom
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Samuel R. Chamberlain
- Department of Psychiatry, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Southern Gambling Service, and Southern Health NHS Foundation Trust, Southampton, United Kingdom
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Chen J, Yu G, Li W, Yang C, Ye X, Wu D, Wang Y, Du W, Xiao Z, Zeng S, Luo H, Li X, Wu Y, Liu S. A situational analysis of human resource and non-communicable diseases management for community health workers in Chengdu, China: a cross-sectional study. BMC Health Serv Res 2023; 23:1097. [PMID: 37833662 PMCID: PMC10576308 DOI: 10.1186/s12913-023-09880-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 08/07/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) pose a major challenge to health economic cost and residents' health status. Community health workers (CHWs) are the gatekeeper of primary health care. OBJECTIVE This study aimed to conduct a situational analysis of current human resource and requirements of NCDs-related training among CHWs in Chengdu with regard to address to understand the suggestions for improvement of challenges and barriers. METHODS A descriptive online cross-sectional survey was conducted among CHWs (doctors and nurses) from 23 districts and counties in Chengdu. Sociodemographic and NCDs-related variables were collected. Univariate analysis and multiple response analysis were used to describe the characteristics of these variables. RESULTS 711 doctors and 637 nurses completely responded. There were significant differences among gender, age, educational levels, professional title, working year, type of institution, urban circle and registration in general practice between doctors and nurses (P < 0.001). 60.6% of doctors were female, compared to 98.0% for nurses. 58.2% of doctors held a bachelor's degree compared with 45.4% of nurses, while 48.3% of nurses held a junior college degree compared with 25.7% of doctors. Higher levels of professional title and registration in general practice were found in doctors compared with nurses. The proportions of NCDs' category, NCDs-related roles and tasks, NCDs-related training contents and forms that CHWs have attend and hoped to gain more were significantly different between doctors and nurses (P < 0.001). In general, the proportions in nurses were much lower than those of doctors (P < 0.05). The top five diseases managed by CHWs were hypertension, diabetes, cerebrovascular disease, chronic respiratory diseases and mental diseases. The five most reported roles performed among doctors included the distribution of health education (91.4%), following up (85.9%), establishing archives (71.3%), medicine adjustment (64.7%) and treatment implementation (52.0%). The top three diseases managed by nurses were same with doctors. The top four and five tasks were contact with patients or health services (39.6%) and referral (16.6%) in nurses. Most CHWs had received primary and common diseases-related trainings, but they had few opportunities to study in a tertiary hospital (40.4% in doctors and 20.9% in nurses, respectively), attend domestic academic conferences (26.9% in doctors vs. 9.7% in nurses), and take part in training courses (44.9% in nurses). CHWs hoped that the above-discussed training contents and forms could be provided more in the future. Besides basic skills related trainings, some specific skills related trainings should be strengthened. CONCLUSION The qualifications in doctors were much better than those of nurses. The roles performed by CHWs in NCDs management are varied form common and frequent disease management to subsequent follow up and supervision. CHWs hope to receive more desired and oriented trainings. There is a need for building capacity of CHWs, optimizing and defining CHWs' role, facilitating postgraduate medical education support and strengthening multidisciplinary collaboration would be effective in NCDs management.
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Affiliation(s)
- Jinhua Chen
- Department of General Practice, Chengdu first people's hospital, Chengdu, 610041, China
| | - Guo Yu
- Department of General Practice, Chengdu first people's hospital, Chengdu, 610041, China
| | - Wei Li
- Department of General Practice, Chengdu first people's hospital, Chengdu, 610041, China
| | - Chunyan Yang
- Department of General Practice, Chengdu first people's hospital, Chengdu, 610041, China
| | - Xiaoping Ye
- Department of General Practice, Chengdu first people's hospital, Chengdu, 610041, China
| | - Dan Wu
- Department of General Practice, Chengdu first people's hospital, Chengdu, 610041, China
| | - Yijun Wang
- Department of General Practice, Chengdu first people's hospital, Chengdu, 610041, China
| | - Wen Du
- Department of General Practice, Chengdu first people's hospital, Chengdu, 610041, China
| | - Zhu Xiao
- Department of General Practice, Chengdu first people's hospital, Chengdu, 610041, China
| | - Shuqin Zeng
- Shiyang Community Health Service Center, Chengdu Hi-tech Zone, Chengdu, 610041, China
| | - Honglin Luo
- Zhonghe Community Health Service Center, Chengdu Hi-tech Zone, Chengdu, 610041, China
| | - Xiuhua Li
- Guixi Community Health Service Center, Chengdu Hi-tech Zone, Chengdu, 610041, China
| | - Yuelei Wu
- Department of General Practice, Chengdu first people's hospital, Chengdu, 610041, China.
| | - Shuyi Liu
- Department of General Practice, Chengdu first people's hospital, Chengdu, 610041, China.
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Konnyu KJ, Yogasingam S, Lépine J, Sullivan K, Alabousi M, Edwards A, Hillmer M, Karunananthan S, Lavis JN, Linklater S, Manns BJ, Moher D, Mortazhejri S, Nazarali S, Paprica PA, Ramsay T, Ryan PM, Sargious P, Shojania KG, Straus SE, Tonelli M, Tricco A, Vachon B, Yu CH, Zahradnik M, Trikalinos TA, Grimshaw JM, Ivers N. Quality improvement strategies for diabetes care: Effects on outcomes for adults living with diabetes. Cochrane Database Syst Rev 2023; 5:CD014513. [PMID: 37254718 PMCID: PMC10233616 DOI: 10.1002/14651858.cd014513] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND There is a large body of evidence evaluating quality improvement (QI) programmes to improve care for adults living with diabetes. These programmes are often comprised of multiple QI strategies, which may be implemented in various combinations. Decision-makers planning to implement or evaluate a new QI programme, or both, need reliable evidence on the relative effectiveness of different QI strategies (individually and in combination) for different patient populations. OBJECTIVES To update existing systematic reviews of diabetes QI programmes and apply novel meta-analytical techniques to estimate the effectiveness of QI strategies (individually and in combination) on diabetes quality of care. SEARCH METHODS We searched databases (CENTRAL, MEDLINE, Embase and CINAHL) and trials registers (ClinicalTrials.gov and WHO ICTRP) to 4 June 2019. We conducted a top-up search to 23 September 2021; we screened these search results and 42 studies meeting our eligibility criteria are available in the awaiting classification section. SELECTION CRITERIA We included randomised trials that assessed a QI programme to improve care in outpatient settings for people living with diabetes. QI programmes needed to evaluate at least one system- or provider-targeted QI strategy alone or in combination with a patient-targeted strategy. - System-targeted: case management (CM); team changes (TC); electronic patient registry (EPR); facilitated relay of clinical information (FR); continuous quality improvement (CQI). - Provider-targeted: audit and feedback (AF); clinician education (CE); clinician reminders (CR); financial incentives (FI). - Patient-targeted: patient education (PE); promotion of self-management (PSM); patient reminders (PR). Patient-targeted QI strategies needed to occur with a minimum of one provider or system-targeted strategy. DATA COLLECTION AND ANALYSIS We dual-screened search results and abstracted data on study design, study population and QI strategies. We assessed the impact of the programmes on 13 measures of diabetes care, including: glycaemic control (e.g. mean glycated haemoglobin (HbA1c)); cardiovascular risk factor management (e.g. mean systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), proportion of people living with diabetes that quit smoking or receiving cardiovascular medications); and screening/prevention of microvascular complications (e.g. proportion of patients receiving retinopathy or foot screening); and harms (e.g. proportion of patients experiencing adverse hypoglycaemia or hyperglycaemia). We modelled the association of each QI strategy with outcomes using a series of hierarchical multivariable meta-regression models in a Bayesian framework. The previous version of this review identified that different strategies were more or less effective depending on baseline levels of outcomes. To explore this further, we extended the main additive model for continuous outcomes (HbA1c, SBP and LDL-C) to include an interaction term between each strategy and average baseline risk for each study (baseline thresholds were based on a data-driven approach; we used the median of all baseline values reported in the trials). Based on model diagnostics, the baseline interaction models for HbA1c, SBP and LDL-C performed better than the main model and are therefore presented as the primary analyses for these outcomes. Based on the model results, we qualitatively ordered each QI strategy within three tiers (Top, Middle, Bottom) based on its magnitude of effect relative to the other QI strategies, where 'Top' indicates that the QI strategy was likely one of the most effective strategies for that specific outcome. Secondary analyses explored the sensitivity of results to choices in model specification and priors. Additional information about the methods and results of the review are available as Appendices in an online repository. This review will be maintained as a living systematic review; we will update our syntheses as more data become available. MAIN RESULTS We identified 553 trials (428 patient-randomised and 125 cluster-randomised trials), including a total of 412,161 participants. Of the included studies, 66% involved people living with type 2 diabetes only. Participants were 50% female and the median age of participants was 58.4 years. The mean duration of follow-up was 12.5 months. HbA1c was the commonest reported outcome; screening outcomes and outcomes related to cardiovascular medications, smoking and harms were reported infrequently. The most frequently evaluated QI strategies across all study arms were PE, PSM and CM, while the least frequently evaluated QI strategies included AF, FI and CQI. Our confidence in the evidence is limited due to a lack of information on how studies were conducted. Four QI strategies (CM, TC, PE, PSM) were consistently identified as 'Top' across the majority of outcomes. All QI strategies were ranked as 'Top' for at least one key outcome. The majority of effects of individual QI strategies were modest, but when used in combination could result in meaningful population-level improvements across the majority of outcomes. The median number of QI strategies in multicomponent QI programmes was three. Combinations of the three most effective QI strategies were estimated to lead to the below effects: - PR + PSM + CE: decrease in HbA1c by 0.41% (credibility interval (CrI) -0.61 to -0.22) when baseline HbA1c < 8.3%; - CM + PE + EPR: decrease in HbA1c by 0.62% (CrI -0.84 to -0.39) when baseline HbA1c > 8.3%; - PE + TC + PSM: reduction in SBP by 2.14 mmHg (CrI -3.80 to -0.52) when baseline SBP < 136 mmHg; - CM + TC + PSM: reduction in SBP by 4.39 mmHg (CrI -6.20 to -2.56) when baseline SBP > 136 mmHg; - TC + PE + CM: LDL-C lowering of 5.73 mg/dL (CrI -7.93 to -3.61) when baseline LDL < 107 mg/dL; - TC + CM + CR: LDL-C lowering by 5.52 mg/dL (CrI -9.24 to -1.89) when baseline LDL > 107 mg/dL. Assuming a baseline screening rate of 50%, the three most effective QI strategies were estimated to lead to an absolute improvement of 33% in retinopathy screening (PE + PR + TC) and 38% absolute increase in foot screening (PE + TC + Other). AUTHORS' CONCLUSIONS There is a significant body of evidence about QI programmes to improve the management of diabetes. Multicomponent QI programmes for diabetes care (comprised of effective QI strategies) may achieve meaningful population-level improvements across the majority of outcomes. For health system decision-makers, the evidence summarised in this review can be used to identify strategies to include in QI programmes. For researchers, this synthesis identifies higher-priority QI strategies to examine in further research regarding how to optimise their evaluation and effects. We will maintain this as a living systematic review.
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Affiliation(s)
- Kristin J Konnyu
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Sharlini Yogasingam
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Johanie Lépine
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Katrina Sullivan
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Alun Edwards
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Michael Hillmer
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Sathya Karunananthan
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada
| | - John N Lavis
- McMaster Health Forum, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Stefanie Linklater
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Braden J Manns
- Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Canada
| | - David Moher
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Sameh Mortazhejri
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Samir Nazarali
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Canada
| | - P Alison Paprica
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Timothy Ramsay
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Peter Sargious
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Kaveh G Shojania
- University of Toronto Centre for Patient Safety, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Sharon E Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital and University of Toronto, Toronto, Canada
| | - Marcello Tonelli
- Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Canada
| | - Andrea Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital and University of Toronto, Toronto, Canada
- Epidemiology Division and Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Queen's University, Kingston, Canada
| | - Brigitte Vachon
- School of Rehabilitation, Occupational Therapy Program, University of Montreal, Montreal, Canada
| | - Catherine Hy Yu
- Department of Medicine, St. Michael's Hospital, Toronto, Canada
| | - Michael Zahradnik
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Thomas A Trikalinos
- Departments of Health Services, Policy, and Practice and Biostatistics, Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Noah Ivers
- Department of Family and Community Medicine, Women's College Hospital, Toronto, Canada
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7
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Luo J, Tao Y, Xu Y, Yang L, Zhang H, Chen Y, Liu X, Zhang Y, Lan R, Chen Y, Liu B, Deng T. Global comparison of the effect of non-pharmacological interventions on glycemic control in patients with type 2 diabetes: A network meta-analysis from 107 randomized controlled trials. J Diabetes Complications 2023; 37:108518. [PMID: 37267719 DOI: 10.1016/j.jdiacomp.2023.108518] [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: 10/04/2022] [Revised: 04/24/2023] [Accepted: 05/22/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the effectiveness of non-pharmacological interventions (NPIs) on glycemic control in patients with type 2 diabetes (T2D) and to provide guidance for clinical healthcare-giver. DESIGN Network meta-analysis (NMA). SETTING AND PARTICIPANTS Randomized controlled trials comparing the effect of NPIs with usual care, waitlist, or other NPIs on glycemic control in patients with T2D. METHODS This NMA was guided by frequentist framework. PubMed, Embase, the Cochrane Library Central Register of Controlled Trials, Cumulated Index to Nursing and Allied Health Literature, and Web of Science were searched from their inception until January 2023. The primary outcome was HbA1c and secondary outcomes were cardiovascular risk scores and related psychosocial scores. Mean differences and standardized mean differences were pooled using NMA. Study quality was assessed with the Confidence in Network Meta-analysis. RESULTS A total of 107 studies (10,496 participants) were included. The median sample size of the included studies was 64 (range, 10-563) and the median duration was 3 months (range, 1-24). Compared to usual care, all NPIs except acupuncture (MD: -0.28; 95 % CI: -1.02, 0.26) and psychological therapy (MD: -0.29; 95 % CI: -0.66, 0.08) showed significantly differences in improving glycemic control in patients with T2D. And according to the results of surface under the cumulative ranking analysis and Cluster ranking, meditation therapy was considered to the best choice when balancing the efficacy of glycemic control with self-efficacy and diabetes related problems, while nutrition therapy was considered to the best choice when balancing quality of life with risk of cardiovascular complications. CONCLUSIONS These findings validate the efficacy of NPIs for glycemic control in patients with T2D and suggest that healthcare-giver should consider both the efficacy of interventions and the psychosocial needs of patients when developing NPIs programs.
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Affiliation(s)
- Jingsong Luo
- Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Yanmin Tao
- Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Yaxin Xu
- Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; School of Nursing, Tongji University, Shanghai 200000, China
| | - Liping Yang
- Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Han Zhang
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Yufei Chen
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Xingting Liu
- Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Yunwu Zhang
- Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; Department of Biochemistry and Molecular Biology, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu 610041, China
| | - Ruixi Lan
- Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Yuxin Chen
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Beijia Liu
- Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Tingting Deng
- Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China.
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Sforzo GA, Kaye MP, Faber A, Moore M. Dosing of Health and Wellness Coaching for Obesity and Type 2 Diabetes: Research Synthesis to Derive Recommendations. Am J Lifestyle Med 2023; 17:374-385. [PMID: 37304739 PMCID: PMC10248368 DOI: 10.1177/15598276211073078] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023] Open
Abstract
Health and wellness coaching (HWC) is an effective intervention for lifestyle disease such as obesity and type 2 diabetes. The evolving HWC profession needs recommendations to guide clinical practice, particularly the appropriate dose of coaching. The purpose of this paper was to systematically review and synthesize HWC literature to derive HWC programming recommendations. Of 102 papers retrieved, 88 were retained with data extracted determining HWC session number, frequency, duration, program length, and total coaching load. Differential analysis yielded no statistical difference in programming variables for randomized control trials and other designs, nor for studies with significant findings v. those not finding statistical significance, allowing these data to be pooled. The HWC intervention for obesity was slightly more intense (15 sessions over 7-8 mo) than the diabetes programming (12 sessions over 9-10 mo). On average, HWC programming applied in the peer-reviewed literature was 12-15 sessions of 35-40 min duration over 7-9 months. These recommendations for HWC programming variables are put forth as initial practice guidelines and should be examined with comparative effectiveness study for optimization. HWC best practice guidelines for other patient groups (e.g., heart disease, cancer, and chronic pain) should also be studied once an adequate literature data base is available.
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Affiliation(s)
- Gary A Sforzo
- Department of Exercise Science and Athletic Training, Ithaca College, Ithaca, NY, USA
| | - Miranda P Kaye
- Survey Research Center, Penn State University, University Park, PA, USA
| | - Aubrey Faber
- Department of Psychology, St John's University, Queens, NY, USA
| | - Margaret Moore
- Wellcoaches Corporation, Wellesley, MA, USA
- Institute of Coaching, McLean Hospital, Belmont, MA, USA
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Pachana NA. A passion for aging in cultural contexts: Dr. Colette Browning and her contributions within Australia and globally. Front Public Health 2022; 10:1017368. [PMID: 36544798 PMCID: PMC9760846 DOI: 10.3389/fpubh.2022.1017368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/03/2022] [Indexed: 12/12/2022] Open
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10
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Le HT, Le TA, Mac TD, Nguyen DN, Vu HN, Truong ATM, Quang Do AT, Bui HTT, Do HTT, Nguyen ATH, Nguyen TT, The Ngo N, Ngo TT. Non-communicable diseases prevention in remote areas of Vietnam: Limited roles of health education and community workers. PLoS One 2022; 17:e0273047. [PMID: 36155973 PMCID: PMC9512196 DOI: 10.1371/journal.pone.0273047] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 08/02/2022] [Indexed: 12/01/2022] Open
Abstract
Objective This study aimed to measure the exposure of residents to health education messages about non-communicable diseases (NCD)-related risk factors, and activities of village health workers (VHWs) in NCDs prevention and control in the mountainous setting of Vietnam. Method A cross-sectional study was performed in Dap Thanh commune (Ba Che, Quang Ninh province, Vietnam), a mountainous area. There were 151 residents aged 18 years or above recruited for this study. Information regarding exposure to messages about risk factors of NCDs, and activities of VHWs was collected via face-to-face interviews using a structured questionnaire. Multivariate logistic regression was employed to identify associated factors with exposing messages about NCD-related risk factors. Results The majority of participants heard about messages related to risk factors of NCDs in the last 30 days, from 56.3% (physical inactivity message), 59.6% (diet message), 75.5% (alcohol use message) to 79.5% (smoking message). Radio/television was the most common source of the messages (from 91.8% to 95.8%) and the majority of participants heard these messages from one source (from 77.1% to 80.9%). Most of sample reported the unavailability of VHWs in their locals (53.6%). Among locals having VHWs, health communication and education was the most common service provided (54.3%); however, only 30% received NCD management services. Participants who had other jobs were less likely to hear about diet-related messages (OR = 0.32; 95%CI = 0.11–0.92), and those ever smoking were more likely to hear these messages in the last 30 days (OR = 6.86; 95%CI = 1.06–44.51). People who had diabetes mellitus were more likely to hear physical activity-related messages in the last 30 days (OR = 2.55; 95%CI = 1.20–5.41). Conclusion Our findings indicated that health communication regarding risk factors of NCDs in mountainous areas in Vietnam was insufficient, and the role of health workers as formal information source was not recognized. Efforts should be made to increase the capacity and involvement of VHWs in health education and NCD prevention in mountainous regions.
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Affiliation(s)
- Hang Thi Le
- VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Tuan Anh Le
- VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Tuan Dang Mac
- VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Dua Nhu Nguyen
- VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Ha Ngoc Vu
- VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Anh Thi Mai Truong
- VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Anh Tran Quang Do
- VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Hoai Thi Thu Bui
- VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Huong Thi Thu Do
- VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Anh Thi Hoang Nguyen
- VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Trung Thanh Nguyen
- VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Ngoc The Ngo
- Hospital of Vietnam National University, Hanoi, Vietnam
| | - Tam Thi Ngo
- Faculty of Medicine, Dai Nam University, Hanoi, Vietnam
- * E-mail:
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Ren B, Wang N, Lei S, Lin S, Chen Y, Liu L, Xiang Y, Feng B. Effects of community family doctors-led intervention for self-management and medication adherence in type 2 diabetes mellitus patients: study protocol of a cluster randomised controlled trial. BMJ Open 2022; 12:e058670. [PMID: 35840300 PMCID: PMC9295656 DOI: 10.1136/bmjopen-2021-058670] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The management of diabetes has become a critical public health issue in China. The development of community-based type 2 diabetes management in China has not yet reached an ideal state, and the most suitable management methods for diabetic patients are still being explored. Few studies have used community-based family doctors to perform interventions of appropriate intensity. This protocol describes a planned randomised controlled trial to evaluate the effectiveness of a family doctor-led intervention model for diabetes self-management and medication adherence in type 2 diabetes mellitus patients. METHODS AND ANALYSIS This is a Standard Protocol Items: Recommendations for Interventional Trials-compliant cluster randomised controlled trial. The study will be conducted at four CHCs (community health centers). The control group will receive conventional medical services and health education. The intervention group will receive an intervention led by community family doctors based on the conventional medical services and health education. It will include five parts: usual care, a medication reminder, a 4-week plan, a weekly phone interview and a monthly interview. The primary outcomes are changes in fasting blood glucose, glycosylated haemoglobin, self-management knowledge and behaviour, and medication adherence from baseline to the 3rd and 6th months. The secondary outcome is the proportion of people whose blood sugar and glycosylated haemoglobin are under control in the 3rd and 6th months. ETHICS AND DISSEMINATION The study proposal was approved by the Biomedical Ethics Committee of the Medical Department of Xi'an Jiaotong University (no. 2021-1371). The findings will be published in peer-reviewed journals and presented at scientific conferences. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Registry, ChiCTR2100051685.
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Affiliation(s)
- Biqi Ren
- The Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Ningsheng Wang
- The Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Shuang Lei
- The Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Shuzhi Lin
- The Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yue Chen
- The School of Public Health, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Lianye Liu
- Department of Endocrinology, Weinan Central Hospital, Wei Nan, Shaanxi, China
| | - Yufang Xiang
- The Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Bianling Feng
- The Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Interprofessional Collaboration and Diabetes Management in Primary Care: A Systematic Review and Meta-Analysis of Patient-Reported Outcomes. J Pers Med 2022; 12:jpm12040643. [PMID: 35455759 PMCID: PMC9029958 DOI: 10.3390/jpm12040643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 02/05/2023] Open
Abstract
The global spread of diabetes poses serious threats to public health requiring a patient-centered approach based both on interprofessional collaboration (IPC) given by the cooperation of several different health professionals, and patients’ perspective through the assessment of Patient-Reported Outcomes (PROs). The aim of the present study is to evaluate the impact of interprofessional collaboration interventions, for the management of type 2 diabetes in primary care settings, through PROs. A systematic review and meta-analysis was conducted querying the PubMed, Scopus and Embase databases. Out of the 1961 papers initially retrieved, 19 met the inclusion criteria. Interprofessional collaboration is significantly associated with an increase in both patient’s satisfaction (SMD 0.32 95% CI 0.05–0.59) and in the mental well-being component of the HRQoL (SMD 0.18; 95% CI 0.06–0.30), and there was also promising evidence supporting the association between an interprofessional approach and an increase in self-care and in generic and specific quality-of-life. No statistical differences were found, supporting the positive impact on IPC interventions on the physical component of the HRQoL, depression, emotional distress, and self-efficacy. In conclusion, the effect of IPC impacts positively on the few areas assessed by PROMs. Policymakers should promote the widespread adoption of a collaborative approach as well as to endorse an active engagement of patients across the whole process of care.
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Effectiveness of Strategies for Nutritional Therapy for Patients with Type 2 Diabetes and/or Hypertension in Primary Care: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074243. [PMID: 35409925 PMCID: PMC8998242 DOI: 10.3390/ijerph19074243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/05/2022] [Accepted: 03/07/2022] [Indexed: 02/04/2023]
Abstract
A central aspect to the management of type 2 Diabetes Mellitus (T2DM) and hypertension is promoting a healthy lifestyle, and nutritional therapy (NT) can support patients achieving glycemic control and blood pressure targets. This systematic review aimed to evaluate the effectiveness of NT in the management of patients with T2DM and/or hypertension in primary care. Primary outcomes were HbA1c, systolic blood pressure (SBP) and diastolic blood pressure (DBP). Thirty-nine studies were included, thirty on T2DM and nine on hypertension. With a moderate quality of evidence, educational/counseling programs and food replacement programs in primary care likely reduce HbA1c on patients with T2DM (mean difference (MD): −0.37, 95% CI: −0.57 to −0.17, 7437 patients, 27 studies; MD: −0.54, 95% CI: −0.75 to −0.32, 440 patients, 2 studies, respectively). Mediterranean diet for T2DM was accessed by one study, and no difference between the groups was found. Educational and counseling programs likely reduce DBP in patients with hypertension (MD: −1.79, 95% CI: −3.46, −0.12, 2840 patients, 9 studies, moderate quality of the evidence), but the effect in SBP was unclear due to risk of bias and imprecision. Nutritional therapy strategies (i.e., educational/counseling programs and food replacement programs) in primary care improved HbA1c in patients with T2DM and DBP in individuals with hypertension.
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McDaniel CC, Kavookjian J, Whitley HP. Telehealth delivery of motivational interviewing for diabetes management: A systematic review of randomized controlled trials. PATIENT EDUCATION AND COUNSELING 2022; 105:805-820. [PMID: 34366228 PMCID: PMC8912910 DOI: 10.1016/j.pec.2021.07.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 07/15/2021] [Accepted: 07/22/2021] [Indexed: 05/09/2023]
Abstract
OBJECTIVES The objective of this systematic review was to explore and report the evidence and gaps in the literature for randomized controlled trials (RCTs) studying the effects of motivational interviewing (MI)-based telehealth interventions on outcomes among persons with diabetes (PWD) or prediabetes. METHODS Following a modified Cochrane approach, we searched Pubmed, CENTRAL, CINAHL, PsycINFO, and Clinicaltrials.gov. Included studies were RCTs published in English before March 25, 2021 evaluating MI-based telehealth on outcomes for adults with diabetes or prediabetes. RESULTS A total of 21 retained articles captured results for 6436 PWD. Among the most commonly investigated outcomes, 60% of articles documented A1C reductions (ranging from<1% to>3%), 56% documented systolic blood pressure reductions, 57% documented diabetes self-efficacy/empowerment improvements, and 40% documented physical activity improvements. Conversely, diastolic blood pressure, lipid panels, body mass index, depressive symptoms, and quality of life were frequently measured outcomes, where MI-based telehealth yielded minor effects (<30% of articles demonstrating improvements). CONCLUSIONS MI-based telehealth seems most effective for improving A1C, systolic blood pressure, diabetes self-efficacy, and physical activity behaviors. Variability in outcome assessment and intervention heterogeneity were key challenges impeding comparisons across retained articles. PRACTICE IMPLICATIONS MI-based telehealth interventions demonstrate promising results for improving outcomes in PWD.
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Affiliation(s)
- Cassidi C McDaniel
- Department of Health Outcomes Research and Policy, Auburn University Harrison School of Pharmacy, Auburn, AL, USA.
| | - Jan Kavookjian
- Department of Health Outcomes Research and Policy, Auburn University Harrison School of Pharmacy, Auburn, AL, USA
| | - Heather P Whitley
- Department of Pharmacy Practice, Auburn University Harrison School of Pharmacy, Auburn, AL, USA
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Hangaard S, Laursen SH, Andersen JD, Kronborg T, Vestergaard P, Hejlesen O, Udsen FW. The Effectiveness of Telemedicine Solutions for the Management of Type 2 Diabetes: A Systematic Review, Meta-Analysis, and Meta-Regression. J Diabetes Sci Technol 2021; 17:794-825. [PMID: 34957864 DOI: 10.1177/19322968211064633] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous systematic reviews have aimed to clarify the effect of telemedicine on diabetes. However, such reviews often have a narrow focus, which calls for a more comprehensive systematic review within the field. Hence, the objective of the present systematic review, meta-analysis, and meta-regression is to evaluate the effectiveness of telemedicine solutions versus any comparator without the use of telemedicine on diabetes-related outcomes among adult patients with type 2 diabetes (T2D). METHODS This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We considered telemedicine randomized controlled trials (RCT) including adults (≥18 years) diagnosed with T2D. Change in glycated hemoglobin (HbA1c, %) was the primary outcome. PubMed, EMBASE, and the Cochrane Library Central Register of Controlled Trials (CENTRAL) were searched on October 14, 2020. An overall treatment effect was estimated using a meta-analysis performed on the pool of included studies based on the mean difference (MD). The revised Cochrane risk-of-bias tool was applied and the certainty of evidence was graded using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. RESULTS The final sample of papers included a total of 246, of which 168 had sufficient information to calculate the effect of HbA1c%. The results favored telemedicine, with an MD of -0.415% (95% confidence interval [CI] = -0.482% to -0.348%). The heterogeneity was great (I2 = 93.05%). A monitoring component gave rise to the higher effects of telemedicine. CONCLUSIONS In conclusion, telemedicine may serve as a valuable supplement to usual care for patients with T2D. The inclusion of a telemonitoring component seems to increase the effect of telemedicine.
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Affiliation(s)
- Stine Hangaard
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg, Denmark
| | - Sisse H Laursen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Department of Nursing, University College of Northern Denmark, Aalborg, Denmark
| | - Jonas D Andersen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Thomas Kronborg
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg, Denmark
| | - Peter Vestergaard
- Steno Diabetes Center North Denmark, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ole Hejlesen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Flemming W Udsen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Rahul A, Chintha S, Anish TS, Prajitha KC, Indu PS. Effectiveness of a Non-pharmacological Intervention to Control Diabetes Mellitus in a Primary Care Setting in Kerala: A Cluster-Randomized Controlled Trial. Front Public Health 2021; 9:747065. [PMID: 34869163 PMCID: PMC8636158 DOI: 10.3389/fpubh.2021.747065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 10/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Despite being the first Indian state with a dedicated Non-Communicable Disease (NCD) program, glycemic control among a large proportion of patients is low in Kerala. This study tries to find evidence for a standardized non-pharmacological strategy delivered through Junior Public Health Nurses (JPHNs) in achieving and maintaining glycemic control among diabetic patients registered with NCD clinics of primary health care settings. Design: A cluster randomized controlled trial was conducted among adult patients with Diabetes Mellitus attending NCD clinics of primary care settings of South Kerala, India. JPHNs of the intervention group received additional module-based training while standard management continued in the control group. Sequence generation was done by random permuted blocks method and a cluster of 12 patients was selected from each of the 11 settings by computer-generated random numbers. Patients were followed up for 6 months with monthly monitoring of Fasting Blood Sugar (FBS), Post-Prandial Blood Sugar (PPBS), blood pressure, Body Mass Index (BMI), and health-related behaviors. Knowledge and skills/practice of JPHNs were also evaluated. Analysis of Covariance was done to study the final outcome adjusting for the baseline values and a model for glycemic control was predicted using multilevel modeling. Results: We analyzed 72 participants in the intervention group and 60 participants in the control group according to the intention-to-treat principle. The intervention was associated with a significant reduction in FBS (p < 0.001) and PPBS (p < 0.001) adjusting for the baseline values. The achievement of glycemic control was 1.5 (95% CI: 1.05-2.3) times better with intervention and they showed a better trend of maintenance of glycemic control (FBS, p = 0.003 and PPBS, p = 0.039). Adjusting for clustering and the baseline values, the intervention showed a significant effect on FBS (B = -3.1, SE = 0.57; p < 0.001) and PPBS (B = -0.81, SE = 0.3; p < 0.001) with time. Drug adherence score (p < 0.001), hours of physical activity (p < 0.001), BMI (p = 0.002), fruit intake (p = 0.004), and green leafy vegetable intake (p = 0.01) were the major predictors of FBS control. The practice/skills score of the JPHNs significantly improved with intervention (p < 0.001) adjusting for baseline values. Conclusion: A well-designed health worker intervention package incorporated into the existing health system can translate into attitude change and skill development in the health workers which can reflect in the improvement of glycemic control among the patients. Trial registration: [URL: http://www.ctri.nic.in], identifier [CTRI/2017/11/010622].
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Affiliation(s)
- Arya Rahul
- Department of Community Medicine, Government Medical College, Thiruvananthapuram, India
| | - Sujatha Chintha
- Department of Community Medicine, Government Medical College, Thiruvananthapuram, India
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Assessment of Patient, Physician, Caregiver, and Healthcare Provider-Related Factors Influencing "Glycemic Happiness" of Persons with Type 2 Diabetes Mellitus: An Observational Survey. Clin Pract 2021; 11:715-727. [PMID: 34698091 PMCID: PMC8544509 DOI: 10.3390/clinpract11040087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 08/28/2021] [Accepted: 08/31/2021] [Indexed: 11/24/2022] Open
Abstract
A multicentric cross-sectional observational survey was conducted to understand the patient, physician, nurse, caregiver, and diabetes counselor/educator-related factors that define the “glycemic happiness” of persons with type 2 diabetes mellitus (T2DM). Five sets of questionnaires based on a five-point Likert scale were used. A total of 167 persons with T2DM, 167 caregivers, and 34 each of physicians, nurses, and diabetes counselors/educators participated. For persons with T2DM, an adequate understanding of diabetes (mean score ± standard deviation: 4.2 ± 0.9), happiness and satisfaction with life (4.1 ± 0.8), flexibility (4.2 ± 0.8) and convenience (4.2 ± 0.7) of treatment, and confidence to handle hypo/hyperglycemic episodes (4.0 ± 0.9) were the factors positively associated with glycemic happiness. Caregivers’ factors included information from physicians on patient care (4.5 ± 0.6), constructive conversations with persons with T2DM (4.2 ± 0.8), helping them with regular glucose monitoring (4.2 ± 0.9), and caregivers’ life satisfaction (4.2 ± 0.8). Factors for physicians, nurses, and diabetes counselors/educators were belief in their ability to make a difference in the life of persons with T2DM (4.8 ± 0.4, 4.4 ± 0.5, and 4.5 ± 0.5), satisfaction from being able to help them (4.9 ± 0.3, 4.6 ± 0.5, and 4.6 ± 0.5), and professional satisfaction (4.9 ± 0.4, 4.4 ± 0.6, and 4.7 ± 0.4). Our survey identified the key factors pertaining to different stakeholders in diabetes care, which cumulatively define the glycemic happiness of persons with T2DM.
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Winkley K, Upsher R, Stahl D, Pollard D, Kasera A, Brennan A, Heller S, Ismail K. Psychological interventions to improve self-management of type 1 and type 2 diabetes: a systematic review. Health Technol Assess 2021; 24:1-232. [PMID: 32568666 DOI: 10.3310/hta24280] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND For people with diabetes mellitus to achieve optimal glycaemic control, motivation to perform self-management is important. The research team wanted to determine whether or not psychological interventions are clinically effective and cost-effective in increasing self-management and improving glycaemic control. OBJECTIVES The first objective was to determine the clinical effectiveness of psychological interventions for people with type 1 diabetes mellitus and people with type 2 diabetes mellitus so that they have improved (1) glycated haemoglobin levels, (2) diabetes self-management and (3) quality of life, and fewer depressive symptoms. The second objective was to determine the cost-effectiveness of psychological interventions. DATA SOURCES The following databases were accessed (searches took place between 2003 and 2016): MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, PsycINFO, EMBASE, Cochrane Controlled Trials Register, Web of Science, and Dissertation Abstracts International. Diabetes conference abstracts, reference lists of included studies and Clinicaltrials.gov trial registry were also searched. REVIEW METHODS Systematic review, aggregate meta-analysis, network meta-analysis, individual patient data meta-analysis and cost-effectiveness modelling were all used. Risk of bias of randomised and non-randomised controlled trials was assessed using the Cochrane Handbook (Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928). DESIGN Systematic review, meta-analysis, cost-effectiveness analysis and patient and public consultation were all used. SETTING Settings in primary or secondary care were included. PARTICIPANTS Adolescents and children with type 1 diabetes mellitus and adults with types 1 and 2 diabetes mellitus were included. INTERVENTIONS The interventions used were psychological treatments, including and not restricted to cognitive-behavioural therapy, counselling, family therapy and psychotherapy. MAIN OUTCOME MEASURES Glycated haemoglobin levels, self-management behaviours, body mass index, blood pressure levels, depressive symptoms and quality of life were all used as outcome measures. RESULTS A total of 96 studies were included in the systematic review (n = 18,659 participants). In random-effects meta-analysis, data on glycated haemoglobin levels were available for seven studies conducted in adults with type 1 diabetes mellitus (n = 851 participants) that demonstrated a pooled mean difference of -0.13 (95% confidence interval -0.33 to 0.07), a non-significant decrease in favour of psychological treatment; 18 studies conducted in adolescents/children with type 1 diabetes mellitus (n = 2583 participants) that demonstrated a pooled mean difference of 0.00 (95% confidence interval -0.18 to 0.18), indicating no change; and 49 studies conducted in adults with type 2 diabetes mellitus (n = 12,009 participants) that demonstrated a pooled mean difference of -0.21 (95% confidence interval -0.31 to -0.10), equivalent to reduction in glycated haemoglobin levels of -0.33% or ≈3.5 mmol/mol. For type 2 diabetes mellitus, there was evidence that psychological interventions improved dietary behaviour and quality of life but not blood pressure, body mass index or depressive symptoms. The results of the network meta-analysis, which considers direct and indirect effects of multiple treatment comparisons, suggest that, for adults with type 1 diabetes mellitus (7 studies; 968 participants), attention control and cognitive-behavioural therapy are clinically effective and cognitive-behavioural therapy is cost-effective. For adults with type 2 diabetes mellitus (49 studies; 12,409 participants), cognitive-behavioural therapy and counselling are effective and cognitive-behavioural therapy is potentially cost-effective. The results of the individual patient data meta-analysis for adolescents/children with type 1 diabetes mellitus (9 studies; 1392 participants) suggest that there were main effects for age and diabetes duration. For adults with type 2 diabetes mellitus (19 studies; 3639 participants), baseline glycated haemoglobin levels moderated treatment outcome. LIMITATIONS Aggregate meta-analysis was limited to glycaemic control for type 1 diabetes mellitus. It was not possible to model cost-effectiveness for adolescents/children with type 1 diabetes mellitus and modelling for type 2 diabetes mellitus involved substantial uncertainty. The individual patient data meta-analysis included only 40-50% of studies. CONCLUSIONS This review suggests that psychological treatments offer minimal clinical benefit in improving glycated haemoglobin levels for adults with type 2 diabetes mellitus. However, there was no evidence of benefit compared with control interventions in improving glycated haemoglobin levels for people with type 1 diabetes mellitus. FUTURE WORK Future work should consider the competency of the interventionists delivering a therapy and psychological approaches that are matched to a person and their life course. STUDY REGISTRATION This study is registered as PROSPERO CRD42016033619. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 28. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kirsty Winkley
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Rebecca Upsher
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Daniel Stahl
- Department of Biostatistics, Institute of Psychiatry, King's College London, London, UK
| | - Daniel Pollard
- Health Economics and Decision Science, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Architaa Kasera
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alan Brennan
- Health Economics and Decision Science, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Simon Heller
- Academic Unit of Diabetes, Endocrinology and Metabolism, Department of Oncology & Metabolism, University of Sheffield, Sheffield, UK
| | - Khalida Ismail
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Sieczkowska SM, de Lima AP, Swinton PA, Dolan E, Roschel H, Gualano B. Health Coaching Strategies for Weight Loss: A Systematic Review and Meta-Analysis. Adv Nutr 2021; 12:1449-1460. [PMID: 33339042 DOI: 10.1093/advances/nmaa159] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/01/2020] [Accepted: 11/11/2020] [Indexed: 02/07/2023] Open
Abstract
Health coaching has emerged as a potential supporting tool for health professionals to overcome behavioral barriers, but its efficacy in weight management remains unclear. We conducted a systematic review and meta-analysis to synthesize and evaluate the quality of evidence supporting the use of self-reported health coaching for weight loss. Seven electronic databases (PubMed, Web of Science, Scopus, Cochrane, Psyinfo, Virtual Health Library, and Scielo) were independently searched from inception to May 2020. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation recommendations. Any study that investigated a self-reported health coaching intervention with the goal of inducing weight loss in individuals of any age, health, or training status was considered for inclusion. Quantitative data were analyzed using multilevel hierarchical metaregression models conducted within a Bayesian framework. A total of 653 studies were screened and 38 were selected for inclusion. The quality of evidence supporting outcomes based on the entire evidence base was very low and studies were deemed to have high risk of bias. Meta-analysis of controlled studies provided evidence of an effect favoring coaching compared with usual care but was trivial in magnitude [effect size (ES)0.5: -0.09; 95% credible interval (CrI): -0.17, -0.02]. The multilevel extension of Egger's regression-intercept test indicated the existence of publication bias, whereas a sensitivity analysis based only on those studies deemed to be of high quality provided no evidence of an effect of coaching on weight loss (ES0.5: -0.04; 95% CrI: -0.12, 0.09). Considered collectively, the results of this investigation indicate that the available evidence is not of sufficient quality to support the use of self-reported health coaching as a health care intervention for weight loss. This trial was registered at Prospective Register of Systematic Reviews (PROSPERO) as CRD42020159023.
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Affiliation(s)
- Sofia Mendes Sieczkowska
- Applied Physiology & Nutrition Research Group; School of Physical Education and Sport; Laboratory of Assessment and Conditioning in Rheumatology; School of Medicine, FMUSP, University of Sao Paulo, Sao Paulo, SP, BR
| | - Alisson Padilha de Lima
- Applied Physiology & Nutrition Research Group; School of Physical Education and Sport; Laboratory of Assessment and Conditioning in Rheumatology; School of Medicine, FMUSP, University of Sao Paulo, Sao Paulo, SP, BR.,School of Physical Education, Faculty IELUSC, Joinville-SC, BR
| | - Paul Alan Swinton
- School of Health Sciences, Robert Gordon University, Aberdeen, United Kingdom
| | - Eimear Dolan
- Applied Physiology & Nutrition Research Group; School of Physical Education and Sport; Laboratory of Assessment and Conditioning in Rheumatology; School of Medicine, FMUSP, University of Sao Paulo, Sao Paulo, SP, BR
| | - Hamilton Roschel
- Applied Physiology & Nutrition Research Group; School of Physical Education and Sport; Laboratory of Assessment and Conditioning in Rheumatology; School of Medicine, FMUSP, University of Sao Paulo, Sao Paulo, SP, BR
| | - Bruno Gualano
- Applied Physiology & Nutrition Research Group; School of Physical Education and Sport; Laboratory of Assessment and Conditioning in Rheumatology; School of Medicine, FMUSP, University of Sao Paulo, Sao Paulo, SP, BR
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Upsher R, Onabajo D, Stahl D, Ismail K, Winkley K. The Effectiveness of Behavior Change Techniques Underpinning Psychological Interventions to Improve Glycemic Levels for Adults With Type 2 Diabetes: A Meta-Analysis. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2021; 2:699038. [PMID: 36994330 PMCID: PMC10012110 DOI: 10.3389/fcdhc.2021.699038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/18/2021] [Indexed: 11/13/2022]
Abstract
An existing systematic review and meta-analysis found a significant reduction in glycemic levels for adults with type 2 diabetes who received a psychological intervention over control conditions. To help develop effective interventions in the future, there is a need to understand the active ingredients which underpin these psychological interventions. We conducted a secondary meta-analysis including 67 randomized controlled trials (RCTs) reported in English. We reviewed the psychological intervention descriptions of the included studies of the existing review and extracted the behavior change techniques (BCTs) according to the BCT taxonomy (BCTTv1). We also extracted information on primary behavioral target versus primary outcome, and presence of fidelity assessment. The most frequent BCTs across RCTs were ‘social support (unspecified)’ (n=50), ‘problem solving’ (n=38) and ‘goal setting (behavior’) (n=30). These BCTs were independently associated with a significant reduction in glycemic levels (HbA1c) compared to control conditions, but not significantly different from studies that did not include these BCTs. Meta-regressions revealed no significant associations between HbA1c, and psychological intervention category (counselling versus cognitive behavioral therapy interventions) (p=0.84), frequency of BCTs per psychological intervention (p=0.29), primary behavioral target versus primary outcome (p=0.48), or presence of fidelity assessment (p=0.15). Social support (unspecified), problem solving, and goal setting (behavior) could be useful BCTs to develop psychological interventions for people with type 2 diabetes to improve glycemic levels. However, more research is required to understand which combination of individual BCTs are most effective for this population.Systematic Review RegistrationRegistered with the international prospective register of systematic reviews registration (PROSPERO) CRD42016033619.
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Affiliation(s)
- Rebecca Upsher
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- *Correspondence: Rebecca Upsher,
| | - Deborah Onabajo
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Daniel Stahl
- Department of Biostatistics, Institute of Psychiatry, King’s College London, London, United Kingdom
| | - Khalida Ismail
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Kirsty Winkley
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, James Clerk Maxwell Building, London, United Kingdom
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21
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Ethnic Variations in Healthcare Service Utilization and Access in Vietnamese Mountainous Setting. ScientificWorldJournal 2021; 2021:6650303. [PMID: 33976587 PMCID: PMC8087479 DOI: 10.1155/2021/6650303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/14/2021] [Accepted: 04/17/2021] [Indexed: 11/17/2022] Open
Abstract
Evidence of health service use and access across different target groups is essential for policy development, health promotion, and promotion of equity in healthcare. This study aims to look at ethnic variations in health service use and access among residents in mountainous areas of Vietnam. A cross-sectional descriptive study was conducted on 321 adults from two mountainous communes in Bac Kan province. Healthcare service use and access were evaluated by using a structured questionnaire. Zero-inflated Poisson regression was used to examine the ethnic variations in the healthcare service use and access. Of 321 mountainous residents, 63.6% used health services in the previous 12 months, of which 24.9% respondents used inpatient services and 47.9% used outpatient services. The number of outpatient medical services used by the Tay participant was higher than that of the Kinh and other ethnic groups (p < 0.05). Multivariate regression results showed that compared to Kinh people, Tay people had a higher number of outpatient service use (Coef. = 0.25, p=0.04), while people in other ethnicities had a lower number of service use (Coef. = -0.64, p=0.01). Meanwhile, no difference was found among groups regarding the number of inpatient service use (p > 0.05). This study showed the ethnic differences in outpatient use of health services among communities living in the northern mountainous setting of Vietnam.
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Duffy S, Norton D, Kelly M, Chavez A, Tun R, Ramírez MNDG, Chen G, Wise P, Svenson J. Using Community Health Workers and a Smartphone Application to Improve Diabetes Control in Rural Guatemala. GLOBAL HEALTH, SCIENCE AND PRACTICE 2020; 8:699-720. [PMID: 33361237 PMCID: PMC7784066 DOI: 10.9745/ghsp-d-20-00076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 09/01/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND The global prevalence of diabetes has nearly doubled since 1980. Seventy-five percent of patients with diabetes live in low- and middle-income countries, such as Guatemala, where health care systems are often poorly equipped for chronic disease management. Community health workers (CHWs) and mobile health technology have increasingly been applied to the diabetes epidemic in these settings, although mostly in supportive rather than primary roles in diabetes management. We sought to improve diabetes care in rural Guatemala through the development of a CHW-led diabetes program and a smartphone application to provide CHWs with clinical decision support. METHODS We worked with our local partners to develop a program model and the smartphone application (using the CommCare platform) and to train CHWs. We recruited patients with type 2 diabetes living in rural communities. Program evaluation used a single-group, pre-post design. Primary outcomes were hemoglobin A1c and the percentage of patients meeting A1c goals compared with baseline. We also followed a variety of process metrics, including application reliability. RESULTS Eighty-nine patients enrolled during the study period. The hemoglobin A1c percentage decreased significantly at 3 months (-1.0; 95% CI=-1.7, -0.6), 6 months (-1.5; 95% CI=-2.2, -0.8), 9 months (-1.3; 95% CI=-2.0, -0.6), and 12 months (-1.0; 95% CI=-1.7, -0.4). The percentage of patients with A1c ≤ 8% increased significantly at 3 months (23.6% to 44.4%, P=.007), 6 months (22.0% to 44.0%, P=.015), and 9 months (23.9% to 45.7%, P=.03). CHWs and supervising physicians agreed with application medication recommendations >90% of the time. CONCLUSION Our results suggest that CHWs can safely and effectively manage diabetes with the assistance of a smartphone application and remote physician supervision. This model should be evaluated versus other standards of care and could be adapted to other low-resource settings and chronic diseases.
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Affiliation(s)
- Sean Duffy
- University of Wisconsin School of Medicine and Public Health, Department of Family Medicine and Community Health, Madison, WI, USA.
| | - Derek Norton
- University of Wisconsin School of Medicine and Public Health, Department of Biostatistics and Medical Informatics, Madison, WI, USA
| | - Mark Kelly
- University of California-Los Angeles David Geffen School of Medicine, Internal Medicine Residency Program, Los Angeles, CA, USA
| | | | - Rafael Tun
- Hospital Obras Sociales Monseñor Gregorio Schaffer, San Lucas Tolimán, Guatemala
| | - Mariana Niño de Guzmán Ramírez
- University of Wisconsin School of Medicine and Public Health, Department of Family Medicine and Community Health, Madison, WI, USA
| | - Guanhua Chen
- University of Wisconsin School of Medicine and Public Health, Department of Biostatistics and Medical Informatics, Madison, WI, USA
| | - Paul Wise
- Stanford University School of Medicine, Stanford, CA, USA
| | - Jim Svenson
- University of Wisconsin School of Medicine and Public Health, Department of Emergency Medicine, Madison, WI, USA
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23
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Asante E, Bam V, Diji AKA, Lomotey AY, Owusu Boateng A, Sarfo-Kantanka O, Oparebea Ansah E, Adjei D. Pilot Mobile Phone Intervention in Promoting Type 2 Diabetes Management in an Urban Area in Ghana: A Randomized Controlled Trial. DIABETES EDUCATOR 2020; 46:455-464. [PMID: 32998649 DOI: 10.1177/0145721720954070] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE The purpose of the study was to evaluate the feasibility and effectiveness of a nurse-led mobile phone call intervention on glycemic management and adherence to self-management practices among patients with type 2 diabetes mellitus (T2DM) in Ghana. METHODS This was a pilot randomized controlled trial to compare diabetes care as usual to a mobile phone call intervention delivered by nurses in addition to care as usual over a 12-week period in a tertiary referral hospital in Ghana. Sixty patients with T2DM were randomized to either the intervention or the control arm. The intervention group received up to 16 mobile phone calls (mean duration = 12 minutes) from a diabetes specialist nurse in addition to their care as usual. The control group received only care as usual. The primary outcome was the change in A1C over the 12-week period. The secondary outcomes were changes in self-reported adherence to medication and diabetes self-management measures over the 12-week period. RESULTS Mean baseline A1C was comparable between the intervention and control groups (9.54%, SD = 2.00% vs 9.07%, SD = 1.72%, P = .334). After 12 weeks, A1C was significantly lower in the intervention group compared to the control group. The difference in mean A1C in the control group rose by +0.26 ± 1.30% (P = .282; 95% CI, -0.23 to 0.75), whereas that of the intervention group reduced by -1.51 ± 2.67% (P = .004; 95% CI, -2.51 to -0.51). No improvements in self-management were recorded in the control group. In the intervention group, however, the only significant improvement was recorded in the area of foot care practices. Participant recruitment and retention were 100% without any attrition. About 87% (n = 26) of the intervention group completed at least 70% (≥11) of the calls. At the end of the trial, participants who received the intervention rated their satisfaction as 89.3% on average. CONCLUSION A mobile phone follow-up call by nurses emphasizing adherence to self-management practices is feasible and can improve short- to medium-term glycemic management among patients with T2DM.
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Affiliation(s)
- Ernest Asante
- Department of Nursing, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Victoria Bam
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | | | | | | | - Dennis Adjei
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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24
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An S, Song R. Effects of health coaching on behavioral modification among adults with cardiovascular risk factors: Systematic review and meta-analysis. PATIENT EDUCATION AND COUNSELING 2020; 103:2029-2038. [PMID: 32448627 DOI: 10.1016/j.pec.2020.04.029] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/29/2020] [Accepted: 04/25/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES This meta-analysis examined effects of health coaching on physical activities, dietary behaviors, health responsibility, stress management, and smoking behaviors among populations with cardiovascular risk factors. METHODS Multiple electronic databases were searched for randomized controlled trials utilizing health coaching for people with cardiovascular risk factors to lead behavioral changes. The included studies were pooled to estimate the effect size for health coaching interventions on each of the health behaviors. RESULTS This meta-analysis included 15 randomized trials. Motivational interviewing and education sessions were common coaching interventions with telephone calls or face-to-face contacts as the main contact methods. Health coaching for health behaviors showed small but significant effect sizes on physical activities, dietary behaviors, health responsibility, and stress management except for smoking behaviors. CONCLUSION The study findings support that health coaching can induce positive behavioral changes among individuals with cardiovascular risk factors. Health coaching delivered by either expert or peer coaches would be easy to apply in clinical settings. PRACTICAL IMPLICATIONS Health care professionals should be aware that health coaching could provide effective motivation strategies to improve compliance of those who need to initiate and maintain their health behaviors. Health coaching could be easily delivered via telephone calls, text messages, or short-term face-to-face coaching.
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Affiliation(s)
- Seonuk An
- Chungnam National University, Daejeon 35015, Republic of Korea
| | - Rhayun Song
- Chungnam National University, Daejeon 35015, Republic of Korea.
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25
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Polhuis CMM, Bouwman LI, Vaandrager L, Soedamah-Muthu SS, Koelen MA. Systematic review of salutogenic-oriented lifestyle randomised controlled trials for adults with type 2 diabetes mellitus. PATIENT EDUCATION AND COUNSELING 2020; 103:764-776. [PMID: 31711677 DOI: 10.1016/j.pec.2019.10.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 10/18/2019] [Accepted: 10/19/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Describe the characteristics (development, intensity, deliverers, setting, strategies) and assess the effect of salutogenic-oriented lifestyle interventions on physical and psychosocial health outcomes in adults with type 2 diabetes mellitus (T2DM). METHOD PubMed, Scopus and PsycINFO were systematically searched for randomised controlled trials (RCTs) published up to August 2019 that complied with predefined salutogenic criteria: the participant as a whole, the participant's active involvement and the participant's individual learning process. Characteristics of the salutogenic-oriented interventions with and without significant results were compared and qualitatively summarised. RESULTS Twenty-eight RCTs were identified. Salutogenic oriented interventions that significantly improved both physical and psychosocial health were characterized by being based on formative research, culturally targeted, and delivered in 10-20 sessions in group settings, whereas salutogenic oriented interventions that neither improved physical or psychosocial health significantly were characterized by being individually tailored and delivered in less than 10 group sessions in individual settings. CONCLUSIONS This systematic review suggests that salutogenic-oriented lifestyle interventions are effective for physical and psychosocial health in the short term. More research is needed to determine how intervention characteristics moderate (long-term) effectiveness. PRACTICE IMPLICATIONS The results provide a basis for purposefully developing effective salutogenic interventions for adults with T2DM.
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Affiliation(s)
- C M M Polhuis
- Health and Society, Wageningen University, Wageningen, The Netherlands.
| | - L I Bouwman
- Health and Society, Wageningen University, Wageningen, The Netherlands
| | - L Vaandrager
- Health and Society, Wageningen University, Wageningen, The Netherlands
| | - S S Soedamah-Muthu
- Center of Research on Psychological and Somatic disorders (CORPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands; Institute for Food, Nutrition and Health, University of Reading, Reading, United Kingdom
| | - M A Koelen
- Health and Society, Wageningen University, Wageningen, The Netherlands
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26
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Almutairi N, Hosseinzadeh H, Gopaldasani V. The effectiveness of patient activation intervention on type 2 diabetes mellitus glycemic control and self-management behaviors: A systematic review of RCTs. Prim Care Diabetes 2020; 14:12-20. [PMID: 31543458 DOI: 10.1016/j.pcd.2019.08.009] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/13/2019] [Accepted: 08/29/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Type 2 diabetes mellitus T2DM is a major health challenge and associated with several complications and mortality. Self-management behaviors SMBs such as healthy diet, physical activity, blood glucose self-monitoring, foot care and medication adherence are critical part of diabetic care. Empowered or activated patients, are more likely to practice better SMBs. However, the effectiveness of patient activation intervention on T2DM glycemic control and SMBs is not totally well understood. AIM To assess the effectiveness of patient activation intervention on T2DM glycemic control and SMBs. METHOD A systematic search was undertaken through five databases to find relevant studies published between 2004 and 2018. We included randomized controlled trials with sample size ≥120 and follow up period of ≥12 months and assess the effectiveness of patient activation intervention on T2DM glycemic control and SMBs. RESULTS 10 RCTs were identified for analysis. The total sample size is 3728 and the combined mean age is 57.3 years. The combined mean BMI is 31.2kg/m2 (obese). Seven intervention demonstrated a significant reduction in HbA1c, ranged from 0.36 to 0.80%. All interventions presented an improvement in at least one self-management behavior. DISCUSSION AND CONCLUSION Patient activation intervention showed a significant positive effect on T2DM glycemic control and SMBs, particularly physical activity, healthy diet, foot care and blood glucose self-monitoring. The effectiveness on SMBs was seen across different intervention strategies, modes of delivery, length of intervention, and number of providers. Better effectiveness on HbA1c was associated with poorly controlled participants, culturally tailored-intervention, and in-person sessions intervention combined with telephone calls follow up.
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Affiliation(s)
- Nasser Almutairi
- School of Health & Society, University of Wollongong, NSW, Australia
| | | | - Vinod Gopaldasani
- School of Health & Society, University of Wollongong, NSW, Australia
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27
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Li Z, Chen Q, Yan J, Liang W, Wong WCW. Effectiveness of motivational interviewing on improving Care for Patients with type 2 diabetes in China: A randomized controlled trial. BMC Health Serv Res 2020; 20:57. [PMID: 31973759 PMCID: PMC6979352 DOI: 10.1186/s12913-019-4776-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 11/22/2019] [Indexed: 11/12/2022] Open
Abstract
Background To assess the effects of a motivational interviewing (MI)-based patient empowerment program (PEP) on type 2 diabetes mellitus (DM) patient self-management compared to traditional diabetes health education. Methods Two hundred and twenty-five patients, recruited from community health centers (CHCs) and the family medicine clinic in the University of Hong Kong-Shenzhen Hospital in Shenzhen, were randomly assigned to the intervention or control groups. Patients in the intervention group (n = 117) received a four-session PEP in small groups over 1 month by trained nurses and doctors. The control group (n = 108) received the traditional lecture-style health education on DM. All the patients were followed up for 3 months. Outcomes included problem areas in diabetes (PAID) that measures diabetes-related emotional distress, patient enablement index (PEI), mental health, patient satisfaction respectively as well as lifestyle behaviors were assessed at baseline, post-activity and 3 months. Results At post-intervention and the 3-month follow-up, the PAID score improved significantly in the intervention group (12.7 ± 13.6, 5.8 ± 7.6) compared to the control group (22.7 ± 22.8, 11.7 ± 14.6). No difference was found between groups for changes to exercise, diet, and medication adherence. The PEI score improved significantly at the 3-month follow-up in the MI group (7.27 ± 2.45 vs 5.81 ± 2.97). Conclusion The PEP has a significant effect on improving diabetes-related distress, but MI was not significantly different from the traditional health education programs when it comes to the readiness to change. Trial registration NCT04120844, ClinicalTrials.Gov. Date of registration: October 9th 2019 (Retrospectively registered).
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Affiliation(s)
- Zhe Li
- Family Medicine Department, The University of Hong Kong - Shenzhen Hospital, 1, Haiyuan 1st Road, Futian District, Shenzhen, China
| | - Qingqi Chen
- Family Medicine Department, The University of Hong Kong - Shenzhen Hospital, 1, Haiyuan 1st Road, Futian District, Shenzhen, China
| | - Jingya Yan
- WHO Health Promoting Hospital Office, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Wei Liang
- Endocrinology Department, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - William C W Wong
- Family Medicine Department, The University of Hong Kong - Shenzhen Hospital, 1, Haiyuan 1st Road, Futian District, Shenzhen, China. .,Clinical Associate Professor, Department of Family Medicine and Primary Care, The University of Hong Kong, 1, Haiyuan 1st Road, Futian District, Shenzhen, China.
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Leite RGOF, Banzato LR, Galendi JSC, Mendes AL, Bolfi F, Veroniki AA, Thabane L, Nunes-Nogueira VDS. Effectiveness of non-pharmacological strategies in the management of type 2 diabetes in primary care: a protocol for a systematic review and network meta-analysis. BMJ Open 2020; 10:e034481. [PMID: 31932394 PMCID: PMC7045081 DOI: 10.1136/bmjopen-2019-034481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 11/26/2019] [Accepted: 12/10/2019] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Despite the increasing number of drugs and various guidelines on the management of type 2 diabetes mellitus (T2DM), several patients continue with the disease uncontrolled. There are several non-pharmacological treatments available for managing T2DM, but various of them have never been compared directly to determine the best strategies. OBJECTIVE This study will evaluate the comparative effects of non-pharmacological strategies in the management of T2DM in primary care or community settings. METHODS AND ANALYSIS We will perform a systematic review and network meta-analysis (NMA), and will include randomised controlled trials if one of the following interventions were applied in adult patients with T2DM: nutritional therapy, physical activity, psychological interventions, social interventions, multidisciplinary lifestyle interventions, diabetes self-management education and support (DSMES), technology-enabled DSMES, interventions delivered only either by pharmacists or by nurses, self-blood glucose monitoring in non-insulin-treated T2DM, health coaching, benchmarking and usual care. The primary outcome will be glycaemic control (glycated haemoglobin (HbA1c) (%)), and the secondary outcomes will be weight loss, quality of life, patient satisfaction, frequency of cardiovascular events and deaths, number of patients in each group with HbA1c <7, adverse events and medication adherence. We have developed search strategies for Embase, Medline, Latin American and Caribbean Health Sciences Literature, Cochrane Central Register of Controlled Trials, Trip database, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature Australasian Medical Index and Chinese Biomedical Literature Database. Four reviewers will assess the studies for their eligibility and their risk of bias in pairs and independently. An NMA will be performed using a Bayesian hierarchical model, and the treatment hierarchy will be obtained using the surface under the cumulative ranking curve. To determine our confidence in an overall treatment ranking from the NMA, we will follow the Grading of Recommendations Assessment, Development and Evaluation approach. ETHICS AND DISSEMINATION As no primary data collection will be undertaken, no formal ethical assessment is required. We plan to present the results of this systematic review in a peer-reviewed scientific journal, conferences and the popular press. PROSPERO REGISTRATION NUMBER CRD42019127856.
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Affiliation(s)
| | - Luísa Rocco Banzato
- Department of Internal Medicine, São Paulo State University/UNESP, Medical School, Botucatu, São Paulo, Brazil
| | - Julia Simões Corrêa Galendi
- Department of Internal Medicine, São Paulo State University/UNESP, Medical School, Botucatu, São Paulo, Brazil
| | - Adriana Lucia Mendes
- Department of Internal Medicine, São Paulo State University/UNESP, Medical School, Botucatu, São Paulo, Brazil
| | - Fernanda Bolfi
- Department of Internal Medicine, São Paulo State University/UNESP, Medical School, Botucatu, São Paulo, Brazil
| | - Areti Angeliki Veroniki
- Department of Primary Education, School of Education, University of Ioannina, loannina, Greece
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Institute of Reproductive and Developmental Biology, Department of Surgery & Cancer, Faculty of Medicine, Imperial College, London, United Kingdom
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Departments of Pediatrics and Anesthesia, McMaster University, Hamilton, ON, Canada
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Correia JC, Lachat S, Lagger G, Chappuis F, Golay A, Beran D. Interventions targeting hypertension and diabetes mellitus at community and primary healthcare level in low- and middle-income countries:a scoping review. BMC Public Health 2019; 19:1542. [PMID: 31752801 PMCID: PMC6873661 DOI: 10.1186/s12889-019-7842-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 10/24/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Hypertension (HTN) and diabetes mellitus (DM) are highly prevalent in low- and middle-income countries (LMIC) and a leading cause of morbidity and mortality. Recent evidence on effectiveness of primary care interventions has attracted renewed calls for their implementation. This review aims to synthesize evidence pertaining to primary care interventions on these two diseases, evaluated and tested in LMICs. METHODS Two reviewers conducted an electronic search of three databases (Pubmed, EMBASE and Web of Science) and screened for eligible articles. Interventions covering health promotion, prevention, treatment, or rehabilitation activities at the PHC or community level were included. Studies published in English, French, Portuguese and Spanish, from January 2007 to January 2017, were included. Key extraction variables included the 12 criteria identified by the Template for Intervention Description and Replication (TIDieR) checklist and guide. The Innovative Care for Chronic Conditions Framework (ICCCF) was used to guide analysis and reporting of results. RESULTS 198 articles were analyzed. The strategies focused on healthcare service organization (76.5%), community level (9.7 %), creating a positive policy environment (3.6%) and strategies covering multiple domains (10.2%). Studies included related to the following topics: description or testing of interventions (n=81; 41.3%), implementation or evaluation projects (n=42; 21.4%), quality improvement initiatives (n=15; 7.7%), screening and prevention efforts (n=26; 13.2%), management of HTN or DM (n=13; 6.6%), integrated health services (n=10; 5.1%), knowledge and attitude surveys (n=5; 2.5%), cost-effective lab tests (n=2; 1%) and policy making efforts (n=2; 1%). Most studies reported interventions by non-specialists (n=86; 43.4%) and multidisciplinary teams (n=49; 25.5%). CONCLUSION Only 198 articles were found over a 10 year period which demonstrates the limited published research on highly prevalent diseases in LMIC. This review shows the variety and complexity of approaches that have been tested to address HTN and DM in LMICs and highlights the elements of interventions needed to be addressed in order to strengthen delivery of care. Most studies reported little information regarding implementation processes to allow replication. Given the need for multi-component complex interventions, study designs and evaluation techniques will need to be adapted by including process evaluations versus simply effectiveness or outcome evaluations.
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Affiliation(s)
- Jorge César Correia
- Division of Tropical and Humanitarian Medicine, Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | - Sarah Lachat
- Division of Tropical and Humanitarian Medicine, Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | - Grégoire Lagger
- Division of Therapeutic Patient Education for Chronic Diseases. Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | - Alain Golay
- Division of Therapeutic Patient Education for Chronic Diseases. Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | - David Beran
- Division of Tropical and Humanitarian Medicine, Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
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Yao J, Wang H, Yin X, Yin J, Guo X, Sun Q. The association between self-efficacy and self-management behaviors among Chinese patients with type 2 diabetes. PLoS One 2019; 14:e0224869. [PMID: 31710631 PMCID: PMC6844544 DOI: 10.1371/journal.pone.0224869] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 10/23/2019] [Indexed: 11/18/2022] Open
Abstract
Background Self-management is the cornerstone of diabetes care, however, despite the numerous recommendations available for self-management, type-2 diabetes mellitus (T2DM) patients’ performance is suboptimal in China. This study aimed to explore the association between self-efficacy and self-management behaviors among Chinese T2DM patients, which might provide evidence to inform effective self-management interventions for these patients. Methods A cross-sectional survey was conducted using a multi-stage stratified randomized sampling in Shandong Province, China. The Diabetes Empowerment Scale-Short Form (DES-SF) was used to measure patients’ self-efficacy to manage diabetes. Latent class analysis (LCA) was used to explore the observed classes of self-management behaviors (dietary control, physical exercise, regular medication and self-monitoring of blood glucose). A two-class solution for self-management behaviors was tested to be the fittest based on LCA; we labelled active and inactive self-management groups. Univariate and multivariate logistic regression analysis were used to examine the associations between self-efficacy and self-management behaviors. Results A total of 2166 T2DM patients were included in the analysis. The mean DES-SF score was 31.9 (standard deviation: 5.2). The estimated proportions of T2DM in the active and inactive groups were 54.8% and 45.2%, respectively. The multivariate logistic regression showed that higher DES-SF score was significantly associated with higher possibility of active self-management behaviors (odds ratio = 1.06; 95% confidence interval: 1.04–1.08). Conclusions Self-efficacy in managing diabetes is associated with self-management behaviors among Chinese T2DM patients. To improve self-management behaviors, multiple strategies should be conducted to improve patients’ self-efficacy.
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Affiliation(s)
- Jingjing Yao
- School of Health Care management, NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Haipeng Wang
- School of Health Care management, NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Xiao Yin
- Jinan Central Hospital, Jinan, China
| | - Jia Yin
- School of Health Care management, NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Xiaolei Guo
- Shandong Center for Disease Control and Prevention, Jinan, China
| | - Qiang Sun
- School of Health Care management, NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, China
- * E-mail:
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Dineen-Griffin S, Garcia-Cardenas V, Williams K, Benrimoj SI. Helping patients help themselves: A systematic review of self-management support strategies in primary health care practice. PLoS One 2019; 14:e0220116. [PMID: 31369582 PMCID: PMC6675068 DOI: 10.1371/journal.pone.0220116] [Citation(s) in RCA: 211] [Impact Index Per Article: 42.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 07/09/2019] [Indexed: 12/11/2022] Open
Abstract
Background Primary health professionals are well positioned to support the delivery of patient self-management in an evidence-based, structured capacity. A need exists to better understand the active components required for effective self-management support, how these might be delivered within primary care, and the training and system changes that would subsequently be needed. Objectives (1) To examine self-management support interventions in primary care on health outcomes for a wide range of diseases compared to usual standard of care; and (2) To identify the effective strategies that facilitate positive clinical and humanistic outcomes in this setting. Method A systematic review of randomized controlled trials evaluating self-management support interventions was conducted following the Cochrane handbook & PRISMA guidelines. Published literature was systematically searched from inception to June 2019 in PubMed, Scopus and Web of Science. Eligible studies assessed the effectiveness of individualized interventions with follow-up, delivered face-to-face to adult patients with any condition in primary care, compared with usual standard of care. Matrices were developed that mapped the evidence and components for each intervention. The methodological quality of included studies were appraised. Results 6,510 records were retrieved. 58 studies were included in the final qualitative synthesis. Findings reveal a structured patient-provider exchange is required in primary care (including a one-on-one patient-provider consultation, ongoing follow up and provision of self-help materials). Interventions should be tailored to patient needs and may include combinations of strategies to improve a patient’s disease or treatment knowledge; independent monitoring of symptoms, encouraging self-treatment through a personalized action plan in response worsening symptoms or exacerbations, psychological coping and stress management strategies, and enhancing responsibility in medication adherence and lifestyle choices. Follow-up may include tailored feedback, monitoring of progress with respect to patient set healthcare goals, or honing problem-solving and decision-making skills. Theoretical models provided a strong base for effective SMS interventions. Positive outcomes for effective SMS included improvements in clinical indicators, health-related quality of life, self-efficacy (confidence to self-manage), disease knowledge or control. An SMS model has been developed which sets the foundation for the design and evaluation of practical strategies for the construct of self-management support interventions in primary healthcare practice. Conclusions These findings provide primary care professionals with evidence-based strategies and structure to deliver SMS in practice. For this collaborative partnership approach to be more widely applied, future research should build on these findings for optimal SMS service design and upskilling healthcare providers to effectively support patients in this collaborative process.
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Affiliation(s)
- Sarah Dineen-Griffin
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
- * E-mail:
| | | | - Kylie Williams
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
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Sun W, Li Y, Hu Y, Rao X, Xu X, Browning CJ, Thomas SA. Perspectives on the Training of Chinese Primary Health Care Physicians to Reduce Chronic Illnesses and Their Burden. Front Public Health 2019; 7:168. [PMID: 31312627 PMCID: PMC6614344 DOI: 10.3389/fpubh.2019.00168] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/06/2019] [Indexed: 01/01/2023] Open
Abstract
This paper is a commentary on the training of Chinese Primary Health Care Doctors to reduce chronic illness and its burden. First, we will consider the policy position of the Chinese government concerning the development of a competent and enlarged primary physician workforce to deliver the proposed primary health care system reforms. We then turn to a review of the drivers of the high burden of chronic illnesses especially in older people in China. We argue that the curriculum for the training of primary health care medical practitioners should match the demonstrated high prevalence chronic illnesses and their risk factors and that there needs to specific competencies in prevention and mitigation of the diseases and their risk factors.
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Affiliation(s)
- Wenmin Sun
- Health and Family Planning Capacity Building and Continuing Education Center of Shenzhen Municipality, Shenzhen, China
| | - Yang Li
- Health and Family Planning Capacity Building and Continuing Education Center of Shenzhen Municipality, Shenzhen, China
| | - Yiting Hu
- Health and Family Planning Capacity Building and Continuing Education Center of Shenzhen Municipality, Shenzhen, China
- Shenzhen International Primary Health Care Research Institute, Shenzhen, China
| | - Xin Rao
- Health and Family Planning Capacity Building and Continuing Education Center of Shenzhen Municipality, Shenzhen, China
- Shenzhen International Primary Health Care Research Institute, Shenzhen, China
| | - Xingzhi Xu
- Health and Family Planning Capacity Building and Continuing Education Center of Shenzhen Municipality, Shenzhen, China
- Shenzhen International Primary Health Care Research Institute, Shenzhen, China
| | - Colette Joy Browning
- Shenzhen International Primary Health Care Research Institute, Shenzhen, China
- School of Nursing and Healthcare Professions, Federation University, Ballarat, VIC, Australia
- Research School in Population Health, Australian National University, Canberra, ACT, Australia
| | - Shane Andrew Thomas
- Shenzhen International Primary Health Care Research Institute, Shenzhen, China
- Research School in Population Health, Australian National University, Canberra, ACT, Australia
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Long H, Huang W, Zheng P, Li J, Tao S, Tang S, Abdullah AS. Barriers and Facilitators of Engaging Community Health Workers in Non-Communicable Disease (NCD) Prevention and Control in China: A Systematic Review (2006⁻2016). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112378. [PMID: 30373205 PMCID: PMC6266440 DOI: 10.3390/ijerph15112378] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/22/2018] [Accepted: 10/23/2018] [Indexed: 12/13/2022]
Abstract
Background: Non-communicable diseases (NCDs) have become a dominant disease burden in China. Although China has a prevention-centered NCD strategy, the implementation effect in the community has been subjected to manpower and financial difficulties. Engaging community health workers (CHWs) in community-based interventions may be a cost-effective approach to relieve the resource shortage and improve health. This review aimed to synthesize evidence on types of NCD-related care that was provided by CHWs in China, and to identify relevant barriers and facilitators. Methods: A literature search was conducted in Medline, PubMed, ProQuest, and Google Scholar databases for English-written, peer-reviewed articles published from 1996 to 2016 that reported findings from NCD-related interventions delivered by CHWs in China. Each article was extracted independently by two researchers. Results: Twenty distinct studies met the inclusion criteria. The two most common types of CHW-led NCD-related care were diabetes and hypertension management (n = 7) and mental health care (n = 7). Thirteen studies discussed the barriers and 16 studies reported facilitators. The most common barriers included lack of support (n = 6), lack of resources (n = 4), and heavy reliance on technology (n = 4). The common facilitators included an integrated health system (n = 9), community and patient trust (n = 5), high quality training (n = 5), and CHWs’ capacity (n = 5). Fourteen studies mentioned training content, while only eight described detailed procedures and duration. Conclusions: This review suggests that trained and supervised Chinese CHWs had the capacity to provide grassroots NCDs preventive interventions. In order to increase the generalizability and sustainability of such programs, studies with robust designs are needed to explore the effectiveness of CHW-led programs, and the intervention strategies to improve the practice of CHWs in various settings.
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Affiliation(s)
- Hongfei Long
- Global Health Program, Duke Kunshan University, Kunshan 215347, Jiangsu, China.
| | - Wenting Huang
- Global Health Program, Duke Kunshan University, Kunshan 215347, Jiangsu, China.
| | - Pinpin Zheng
- Department of Preventive Medicine, School of Public Health, Fudan University, Shanghai 200032, China.
| | - Jiang Li
- Department of Preventive Medicine, School of Public Health, Fudan University, Shanghai 200032, China.
| | - Sha Tao
- Department of Preventive Medicine, School of Public Health, Fudan University, Shanghai 200032, China.
| | - Shenglan Tang
- Global Health Program, Duke Kunshan University, Kunshan 215347, Jiangsu, China.
- Duke Global Health Institute, Duke University, Durham, NC 27710, USA.
| | - Abu S Abdullah
- Global Health Program, Duke Kunshan University, Kunshan 215347, Jiangsu, China.
- Duke Global Health Institute, Duke University, Durham, NC 27710, USA.
- Boston University School of Medicine, Boston Medical Center, Boston, MA 02118, USA.
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Chapman A, Browning CJ, Enticott JC, Yang H, Liu S, Zhang T, Thomas SA. Effect of a Health Coach Intervention for the Management of Individuals With Type 2 Diabetes Mellitus in China: A Pragmatic Cluster Randomized Controlled Trial. Front Public Health 2018; 6:252. [PMID: 30283767 PMCID: PMC6156528 DOI: 10.3389/fpubh.2018.00252] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 08/15/2018] [Indexed: 12/31/2022] Open
Abstract
Aim: To determine the effect of a health coach intervention for the management of glycemic control, as well as physiological, psychological and self-care outcomes of patients with type 2 diabetes mellitus (T2DM), compared with usual care. Methods: This pragmatic cluster RCT was conducted in the Fengtai district of Beijing from August 2011 to December 2013. Forty-one community health stations (CHSs) were cluster randomized (stratified geographically, 1:1 ratio) and eligible, randomly selected T2DM patients were sequentially contacted by CHSs. Control participants received usual care according to the Chinese Guideline for Diabetes Prevention and Management. Intervention participants received 18-months of health coaching based on principles of Motivational Interviewing (MI) plus usual care. Medical and pathology fees were waived for both groups. Outcome assessment was performed at baseline, 6, 12, and 18-months. The primary outcome was glycated hemoglobin (HbA1c); secondary outcomes encompassed a suite of physiological, psychological and self-care measures. Results: No differential treatment effect was found at 18-months for HbA1c (adj. difference -0.07, 95% CI -0.53 to 0.39, p = 0.769) or any specified secondary outcomes. Interestingly, both groups displayed a statistically and clinically significant within-group improvement of the same magnitude at 18-months for HbA1c (intervention: mean change -3.65, 95% CI -3.92 to -3.37; control: mean change -3.38, 95% CI -3.67 to -3.08). Conclusions: The lack of differential treatment effects observed indicate that it may be premature to recommend the routine delivery of health coach interventions based on MI principles for the management of T2DM in China. However, the large, comparable within-group improvement in mean HbA1c promotes the establishment of free, regular clinical health assessments for individuals with T2DM in China. TRIAL REGISTRATION ISRCTN registry - ISRCTN01010526 (https://doi.org/10.1186/ISRCTN01010526).
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Affiliation(s)
- Anna Chapman
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Research, Deakin University, Geelong, VIC, Australia
- Monash Health, Clayton, VIC, Australia
- International Institute for Primary Health Care Research, Shenzhen, China
| | - Colette J. Browning
- International Institute for Primary Health Care Research, Shenzhen, China
- Research School of Population Health, Australian National University, Acton, ACT, Australia
| | - Joanne C. Enticott
- School of Primary and Allied Health Care, Monash University, Notting Hill, VIC, Australia
- School of Clinical Sciences, Monash University, Dandenong, VIC, Australia
| | - Hui Yang
- International Institute for Primary Health Care Research, Shenzhen, China
- School of Primary and Allied Health Care, Monash University, Notting Hill, VIC, Australia
| | - Shuo Liu
- Key Laboratory of Carcinogenesis and Translational Research, Beijing Office for Cancer Prevention and Control, Peking University Cancer Hospital and Institute, Beijing, China
| | - Tuohong Zhang
- School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Shane A. Thomas
- International Institute for Primary Health Care Research, Shenzhen, China
- Research School of Population Health, Australian National University, Acton, ACT, Australia
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Huang W, Long H, Li J, Tao S, Zheng P, Tang S, Abdullah AS. Delivery of public health services by community health workers (CHWs) in primary health care settings in China: a systematic review (1996-2016). Glob Health Res Policy 2018; 3:18. [PMID: 29992191 PMCID: PMC5989355 DOI: 10.1186/s41256-018-0072-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 05/04/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Community Health Workers (CHWs) have been widely used in response to the shortage of skilled health workers especially in resource limited areas. China has a long history of involving CHWs in public health intervention project. CHWs in China called village doctors who have both treatment and public health responsibilities. This systematic review aimed to identify the types of public health services provided by CHWs and summarized potential barriers and facilitating factors in the delivery of these services. METHODS We searched studies published in Chinese or English, on Medline, PubMed, Cochrane, Google Scholar, and CNKI for public health services delivered by CHWs in China, during 1996-2016. The role of CHWs, training for CHWs, challenges, and facilitating factors were extracted from reviewed studies. RESULTS Guided by National Basic Public Health Service Standards, services provided by CHW covered five major areas of noncommunicable diseases (NCDs) including diabetes and/or hypertension, cancer, mental health, cardiovascular diseases, and common NCD risk factors, as well as general services including reproductive health, tuberculosis, child health, vaccination, and other services. Not many studies investigated the barriers and facilitating factors of their programs, and none reported cost-effectiveness of the intervention. Barriers challenging the sustainability of the CHWs led projects were transportation, nature of official support, quantity and quality of CHWs, training of CHWs, incentives for CHWs, and maintaining a good rapport between CHWs and target population. Facilitating factors included positive official support, integration with the existing health system, financial support, considering CHW's perspectives, and technology support. CONCLUSION CHWs appear to frequently engage in implementing diverse public health intervention programs in China. Facilitators and barriers identified are comparable to those identified in high income countries. Future CHWs-led programs should consider incorporating the common barriers and facilitators identified in the current study to maximize the benefits of these programs.
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Affiliation(s)
- Wenting Huang
- Global Health Program, Duke Kunshan University, Jiangsu, 215347 China
| | - Hongfei Long
- Global Health Program, Duke Kunshan University, Jiangsu, 215347 China
| | - Jiang Li
- Department of Preventive Medicine, School of Public Health, Fudan University, Shanghai, 200032 China
| | - Sha Tao
- Department of Preventive Medicine, School of Public Health, Fudan University, Shanghai, 200032 China
| | - Pinpin Zheng
- Department of Preventive Medicine, School of Public Health, Fudan University, Shanghai, 200032 China
| | - Shenglan Tang
- Global Health Program, Duke Kunshan University, Jiangsu, 215347 China
- Duke Global Health Institute, Duke University, Durham, NC 27710 USA
| | - Abu S. Abdullah
- Global Health Program, Duke Kunshan University, Jiangsu, 215347 China
- Duke Global Health Institute, Duke University, Durham, NC 27710 USA
- Boston University School of Medicine, Boston Medical Center, Boston, MA 02118 USA
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Pirbaglou M, Katz J, Motamed M, Pludwinski S, Walker K, Ritvo P. Personal Health Coaching as a Type 2 Diabetes Mellitus Self-Management Strategy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Am J Health Promot 2018; 32:1613-1626. [PMID: 29658286 DOI: 10.1177/0890117118758234] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Personal health coaching (PHC) programs have become increasingly utilized as a type 2 diabetes mellitus (T2DM) self-management intervention strategy. This article evaluates the impact of PHC programs on glycemic management and related psychological outcomes. DATA SOURCES Electronic databases (CINAHL, MEDLINE, PubMed, PsycINFO, and Web of Science). STUDY INCLUSION AND EXCLUSION CRITERIA Randomized controlled trials (RCT) published between January 1990 and September 2017 and focused on the effectiveness of PHC interventions in adults with T2DM. DATA EXTRACTION Using prespecified format guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. DATA SYNTHESIS Quantitative synthesis for primary (ie, hemoglobin A1c [HbA1c]) and qualitative synthesis for selected psychological outcomes. RESULTS Meta-analyses of 22 selected publications showed PHC interventions favorably impact HbA1c levels in studies with follow-ups at ≤3 months (-0.32% [95% confidence interval, CI = -0.55 to -0.09%]), 4 to 6 months (-0.50% [95% CI = -0.65 to -0.35%], 7 to 9 months (-0.66% [95% CI = -1.04 to -0.28%]), and 12 to 18 months (-0.24% [95% CI = -0.38 to -0.10%]). Subsequent subgroup analyses led to no conclusive patterns, except for greater magnitude of effect size in studies with conventional (2-arm) RCT design. CONCLUSIONS The PHC appears effective in improving glycemic control. Further research is required to assess the effectiveness of specific program components, training, and supervision approaches and to determine the cost-effectiveness of PHC interventions.
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Affiliation(s)
- Meysam Pirbaglou
- 1 School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Joel Katz
- 1 School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada.,2 Department of Psychology, York University, Toronto, Ontario, Canada
| | - Mehras Motamed
- 1 School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Sarah Pludwinski
- 1 School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Krista Walker
- 2 Department of Psychology, York University, Toronto, Ontario, Canada
| | - Paul Ritvo
- 1 School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada.,2 Department of Psychology, York University, Toronto, Ontario, Canada.,3 University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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Ong SE, Koh JJK, Toh SAES, Chia KS, Balabanova D, McKee M, Perel P, Legido-Quigley H. Assessing the influence of health systems on Type 2 Diabetes Mellitus awareness, treatment, adherence, and control: A systematic review. PLoS One 2018; 13:e0195086. [PMID: 29596495 PMCID: PMC5875848 DOI: 10.1371/journal.pone.0195086] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 03/18/2018] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Type 2 Diabetes Mellitus (T2DM) is reported to affect one in 11 adults worldwide, with over 80% of T2DM patients residing in low-to-middle-income countries. Health systems play an integral role in responding to this increasing global prevalence, and are key to ensuring effective diabetes management. We conducted a systematic review to examine the health system-level factors influencing T2DM awareness, treatment, adherence, and control. METHODS AND FINDINGS A protocol for this study was published on the PROSPERO international prospective register of systematic reviews (PROSPERO 2016: CRD42016048185). Studies included in this review reported the effects of health systems factors, interventions, policies, or programmes on T2DM control, awareness, treatment, and adherence. The following databases were searched on 22 February 2017: Medline, Embase, Global health, LILACS, Africa-Wide, IMSEAR, IMEMR, and WPRIM. There were no restrictions on date, language, or study designs. Two reviewers independently screened studies for eligibility, extracted the data, and screened for risk of bias. Thereafter, we performed a narrative synthesis. A meta-analysis was not conducted due to methodological heterogeneity across different aspects of included studies. 93 studies were included for qualitative synthesis; 7 were conducted in LMICs. Through this review, we found two key health system barriers to effective T2DM care and management: financial constraints faced by the patient and limited access to health services and medication. We also found three health system factors that facilitate effective T2DM care and management: the use of innovative care models, increased pharmacist involvement in care delivery, and education programmes led by healthcare professionals. CONCLUSIONS This review points to the importance of reducing, or possibly eliminating, out-of-pocket costs for diabetes medication and self-monitoring supplies. It also points to the potential of adopting more innovative and integrated models of care, and the value of task-sharing of care with pharmacists. More studies which identify the effect of health system arrangements on various outcomes, particularly awareness, are needed.
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Affiliation(s)
- Suan Ee Ong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Joel Jun Kai Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Sue-Anne Ee Shiow Toh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Endocrinology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Dina Balabanova
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Pablo Perel
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- World Heart Federation, Geneva, Switzerland
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Wei J, Zheng H, Wang L, Wang Q, Wei F, Bai L. Effects of telephone call intervention on cardiovascular risk factors in T2DM: A meta-analysis. J Telemed Telecare 2017; 25:93-105. [PMID: 29228855 DOI: 10.1177/1357633x17745456] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Mobile health interventions utilising telephone calls are promising tools for diabetes management. However, there is still a lack of convincing evidence demonstrating their beneficial effects on cardiovascular risk factors. The aim of this meta-analysis of randomised controlled trials was to assess the effect of telephone calls on glycaemic control and other cardiovascular risk factors in type 2 diabetes mellitus patients. Methods Two independent reviewers searched three online databases (PubMed, the Cochrane Library and EMBASE) to identify relevant English-language randomised controlled trials up to September 2017. Randomised controlled trials that assessed the effects of telephone calls on glycaemic control and other cardiovascular risk factors in type 2 diabetes mellitus patients were included. Effect size was calculated for changes in glycosylated haemoglobin A1c, weight, blood pressure and lipid levels using fixed- or random-effects models. Results Eighteen studies involving 3954 patients were included in the meta-analysis. Compared with usual care, telephone calls significantly decreased glycosylated haemoglobin A1c, by 0.12% (95% confidence interval: −0.22% to −0.02%). Univariate regression analysis showed that none of the covariates (number of participants, baseline age, baseline glycosylated haemoglobin A1c, duration of diabetes, call maker, number of calls and duration of study) had an impact on glycosylated haemoglobin A1c. For other cardiovascular risk factors, telephone calls significantly reduced systolic blood pressure by 0.19 mm Hg (95% confidence interval: −0.34% to −0.03%) but non-significantly changed diastolic blood pressure, body mass index, low-density lipoprotein cholesterol, total cholesterol, triglyceride or high-density cholesterol levels. Conclusions This meta-analysis supports the hypothesis that telephone calls offer moderate benefits for glycosylated haemoglobin A1c and systolic blood pressure reduction among type 2 diabetes mellitus patients. However, the data remain insufficient regarding the association of telephone calls with lowered diastolic blood pressure, body mass index or improved lipoprotein profiles.
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Affiliation(s)
- Junping Wei
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, China
| | - Huijuan Zheng
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, China
| | - Liansheng Wang
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, China
| | - Qiuhong Wang
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, China
| | - Fan Wei
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, China
| | - Litao Bai
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, China
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40
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Flood D, Hawkins J, Rohloff P. A Home-Based Type 2 Diabetes Self-Management Intervention in Rural Guatemala. Prev Chronic Dis 2017; 14:E65. [PMID: 28796597 PMCID: PMC5553353 DOI: 10.5888/pcd14.170052] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Diabetes self-management education (DSME) is a fundamental element of type 2 diabetes care. Although 75% of adults with diabetes worldwide live in low-income and middle-income countries (LMICs), limited DSME research has been conducted in LMICs. The objective of this study was to evaluate a home-based DSME intervention in rural Guatemala. METHODS We conducted a prospective study of a DSME intervention using a quasi-experimental, single-group pretest-posttest design. We enrolled 90 participants in the intervention, which consisted of 6 home visits (May 2014-July 2016) conducted by a diabetes educator using a curriculum culturally and linguistically tailored to rural Mayan populations. Primary outcomes were changes in mean hemoglobin A1c (HbA1c) and mean systolic and diastolic blood pressure at baseline and at 12 months. Secondary outcomes were diabetes knowledge and self-care activities at baseline and intervention completion. RESULTS HbA1c decreased significantly from baseline to 12 months (absolute mean change, -1.5%; 95% confidence interval [CI], -1.9% to -1.0%; P < .001). Systolic blood pressure also improved significantly at 12 months (-6.2 mm Hg; 95% CI, -10.1 to -2.2 mm Hg; P = .002); changes in diastolic blood pressure were not significant (-1.6 mm Hg; 95% CI, -3.9 to -0.7 mm Hg; P = .17). We also found significant improvements in diabetes knowledge and self-care activities from baseline to intervention completion. CONCLUSION DSME interventions can be successfully delivered in a setting with an underresourced health system, high poverty rate, and unique cultural characteristics like Mayan Guatemala. Our findings point to the need for more DSME research in resource-limited settings globally.
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Affiliation(s)
- David Flood
- Wuqu' Kawoq, Santiago Sacatepéquez, Sacatepéquez, Guatemala.,Medicine Pediatric Residency Program, University of Minnesota, Minneapolis, Minnesota
| | | | - Peter Rohloff
- Wuqu' Kawoq, Santiago Sacatepéquez, Sacatepéquez, Guatemala.,Division of Global Health Equity, Brigham and Women's Hospital, 75 Francis St, Boston MA 02115.
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Sforzo GA, Kaye MP, Todorova I, Harenberg S, Costello K, Cobus-Kuo L, Faber A, Frates E, Moore M. Compendium of the Health and Wellness Coaching Literature. Am J Lifestyle Med 2017; 12:436-447. [PMID: 30542254 PMCID: PMC6236633 DOI: 10.1177/1559827617708562] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 04/14/2017] [Accepted: 04/17/2017] [Indexed: 11/16/2022] Open
Abstract
Health and wellness coaching (HWC) for lifestyle behavior change is emerging as a
practice, role, and profession, in diverse health care, employee wellness, and
community settings. Health care professionals apply HWC as a behavior change
methodology for the prevention and treatment of diabetes, hypertension,
hyperlipidemia, heart disease, cancer, and other chronic disorders. The purpose
of this systematic review was to provide a comprehensive and organized
compendium of HWC literature. To date, extant HWC literature remains scattered
with no meaningful summary accessible. Lack of comprehensive summary stems from
lack of consensus on HWC definition and standards. We applied a recently
proposed, standardized definition of HWC to determine compendium inclusion
criteria for peer-reviewed, data-based literature from relevant search engines
(ie, PubMed, PsychInfo, and CINAHL). A systematic review process was executed
and ultimately yielded 219 articles meeting HWC inclusion criteria. Of these,
150 were data-based and the remainder were expert opinion or review-style
articles. A summary of results generally reveals HWC as a promising intervention
for chronic diseases though further research is needed in most categories. The
resulting HWC compendium organizes and describes the quantity and quality of
available literature for the use and benefit of HWC practitioners and
researchers.
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Affiliation(s)
- Gary A Sforzo
- Department of Exercise & Sport Sciences, Ithaca College, Ithaca, New York (GAS, SH, KC, LC).,Clearinghouse for Military Family Readiness at Penn State University, University Park, Pennsylvania (MPK, AF).,Institute of Coaching, McLean Hospital, Belmont, Massachusetts (IT, MM).,Harvard Medical School, Boston, Massachusetts (IT, EF, MM).,Stroke Institute for Research and Recovery, Spaulding Rehabilitation Hospital, Boston, Massachusetts (EF).,Wellcoaches Corporation, Wellesley, Massachusetts (MM)
| | - Miranda P Kaye
- Department of Exercise & Sport Sciences, Ithaca College, Ithaca, New York (GAS, SH, KC, LC).,Clearinghouse for Military Family Readiness at Penn State University, University Park, Pennsylvania (MPK, AF).,Institute of Coaching, McLean Hospital, Belmont, Massachusetts (IT, MM).,Harvard Medical School, Boston, Massachusetts (IT, EF, MM).,Stroke Institute for Research and Recovery, Spaulding Rehabilitation Hospital, Boston, Massachusetts (EF).,Wellcoaches Corporation, Wellesley, Massachusetts (MM)
| | - Irina Todorova
- Department of Exercise & Sport Sciences, Ithaca College, Ithaca, New York (GAS, SH, KC, LC).,Clearinghouse for Military Family Readiness at Penn State University, University Park, Pennsylvania (MPK, AF).,Institute of Coaching, McLean Hospital, Belmont, Massachusetts (IT, MM).,Harvard Medical School, Boston, Massachusetts (IT, EF, MM).,Stroke Institute for Research and Recovery, Spaulding Rehabilitation Hospital, Boston, Massachusetts (EF).,Wellcoaches Corporation, Wellesley, Massachusetts (MM)
| | - Sebastian Harenberg
- Department of Exercise & Sport Sciences, Ithaca College, Ithaca, New York (GAS, SH, KC, LC).,Clearinghouse for Military Family Readiness at Penn State University, University Park, Pennsylvania (MPK, AF).,Institute of Coaching, McLean Hospital, Belmont, Massachusetts (IT, MM).,Harvard Medical School, Boston, Massachusetts (IT, EF, MM).,Stroke Institute for Research and Recovery, Spaulding Rehabilitation Hospital, Boston, Massachusetts (EF).,Wellcoaches Corporation, Wellesley, Massachusetts (MM)
| | - Kyle Costello
- Department of Exercise & Sport Sciences, Ithaca College, Ithaca, New York (GAS, SH, KC, LC).,Clearinghouse for Military Family Readiness at Penn State University, University Park, Pennsylvania (MPK, AF).,Institute of Coaching, McLean Hospital, Belmont, Massachusetts (IT, MM).,Harvard Medical School, Boston, Massachusetts (IT, EF, MM).,Stroke Institute for Research and Recovery, Spaulding Rehabilitation Hospital, Boston, Massachusetts (EF).,Wellcoaches Corporation, Wellesley, Massachusetts (MM)
| | - Laura Cobus-Kuo
- Department of Exercise & Sport Sciences, Ithaca College, Ithaca, New York (GAS, SH, KC, LC).,Clearinghouse for Military Family Readiness at Penn State University, University Park, Pennsylvania (MPK, AF).,Institute of Coaching, McLean Hospital, Belmont, Massachusetts (IT, MM).,Harvard Medical School, Boston, Massachusetts (IT, EF, MM).,Stroke Institute for Research and Recovery, Spaulding Rehabilitation Hospital, Boston, Massachusetts (EF).,Wellcoaches Corporation, Wellesley, Massachusetts (MM)
| | - Aubrey Faber
- Department of Exercise & Sport Sciences, Ithaca College, Ithaca, New York (GAS, SH, KC, LC).,Clearinghouse for Military Family Readiness at Penn State University, University Park, Pennsylvania (MPK, AF).,Institute of Coaching, McLean Hospital, Belmont, Massachusetts (IT, MM).,Harvard Medical School, Boston, Massachusetts (IT, EF, MM).,Stroke Institute for Research and Recovery, Spaulding Rehabilitation Hospital, Boston, Massachusetts (EF).,Wellcoaches Corporation, Wellesley, Massachusetts (MM)
| | - Elizabeth Frates
- Department of Exercise & Sport Sciences, Ithaca College, Ithaca, New York (GAS, SH, KC, LC).,Clearinghouse for Military Family Readiness at Penn State University, University Park, Pennsylvania (MPK, AF).,Institute of Coaching, McLean Hospital, Belmont, Massachusetts (IT, MM).,Harvard Medical School, Boston, Massachusetts (IT, EF, MM).,Stroke Institute for Research and Recovery, Spaulding Rehabilitation Hospital, Boston, Massachusetts (EF).,Wellcoaches Corporation, Wellesley, Massachusetts (MM)
| | - Margaret Moore
- Department of Exercise & Sport Sciences, Ithaca College, Ithaca, New York (GAS, SH, KC, LC).,Clearinghouse for Military Family Readiness at Penn State University, University Park, Pennsylvania (MPK, AF).,Institute of Coaching, McLean Hospital, Belmont, Massachusetts (IT, MM).,Harvard Medical School, Boston, Massachusetts (IT, EF, MM).,Stroke Institute for Research and Recovery, Spaulding Rehabilitation Hospital, Boston, Massachusetts (EF).,Wellcoaches Corporation, Wellesley, Massachusetts (MM)
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Gao C, Zhou L, Liu Z, Wang H, Bowers B. Mobile application for diabetes self-management in China: Do they fit for older adults? Int J Med Inform 2017; 101:68-74. [PMID: 28347449 PMCID: PMC5418079 DOI: 10.1016/j.ijmedinf.2017.02.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 12/13/2016] [Accepted: 02/07/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Despite the exponential proliferation of Chinese diabetes applications, none are designed to meet the needs of the largest potential user population. The purpose of this study is to examine the features and contents of Chinese diabetes mobile applications in terms of their suitability for use by older adults with diabetes. METHODS A search of the Apple application store and the 360 Mobile Assistant was conducted to identify Chinese diabetes applications. Next, we compared the features and contents of all the included and most popular diabetes applications with both the International Diabetes Federation (IDF) clinical guideline and recommended usability criteria for older adults respectively. RESULTS Seventy-one diabetes apps were randomly selected (from a pool of 552 diabetes apps) and reviewed. The features of most apps failed to include content areas of known importance for managing diabetes in older adults. Usability of all tested applications was rated moderate to good. CONCLUSIONS Designing maximally effective medical applications would benefit from attention to both usability and content guidelines targeted for the largest potential user population. Despite the preponderance of older adults in the potential user group, failing to consider the relevance of content, in addition to usability for the specific population will ultimately limit the usefulness of the app.
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Affiliation(s)
- Chenchen Gao
- School of Nursing, Second Military Medical University, Shanghai, China.
| | - Lanshu Zhou
- School of Nursing, Second Military Medical University, Shanghai, China.
| | - Zhihui Liu
- School of Nursing, Second Military Medical University, Shanghai, China.
| | - Haocen Wang
- School of Nursing, University of Wisconsin-Madison, WI, United States.
| | - Barbara Bowers
- School of Nursing, University of Wisconsin-Madison, WI, United States.
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