Impact of Diabetes Disclosure on Perceptions of Eating and Self-Care Behaviors

Making the leap and finding your feet: A qualitative study of disclosure and social support in university students with type 1 diabetes

University poses unique challenges surrounding disclosure for students living with type 1 diabetes, with implications for social support and self-management. Semi-structured interviews with students and peer interviewers living with type 1 diabetes explored university experiences of disclosure and social support. Thematic analysis identified three major themes: disclosure as a measured process, the need for lived experience for true understanding and personal growth and self-awareness. Findings emphasize the need to scaffold the university transition for individuals with type 1 diabetes as disclosure can elicit effective social support. In addition, the importance of lived experience suggests support from students with type 1 diabetes could considerably impact diabetes management.

CDE Perspectives of Providing New-Onset Type 1 Diabetes Education Using Formal Vignettes and Simulation

Purpose

The purpose of this article is to describe the 4 Parent Education Through Simulation-Diabetes (PETS-D) nurse certified diabetes educators’ (CDEs) perspectives of teaching parents of children with newly diagnosed type 1 diabetes mellitus (T1DM) early diabetes management skills using formal vignettes and a human patient simulator/human patient simulation (HPS) to augment/enhance the teaching–learning process.

Methods

A qualitative descriptive approach was used. Four CDEs were interviewed by phone about their teaching experiences. Meticulous notes were taken. Data were analyzed using qualitative content analysis.

Results

The vignettes (and use of HPS) provided structure, especially for parents who were struggling to learn. Certified diabetes educators described a short learning curve to master the use of the HPS manikin. Human patient simulation-enhanced education was described as helpful for teaching multiple caregivers about diabetes. Certified diabetes educators also described factors that affect parent learning, mechanical issues with the HPS, and additional space requirements for HPS-enhanced education.

Conclusion

Vignettes and HPS-enhanced education can successfully be used to educate parents of children with new-onset T1DM and were preferred by the CDEs when compared with previous teaching strategies. The results of this study support the use of both vignette-based and HPS-enhanced education when a child is newly diagnosed with T1DM. Further studies need to be done to see if these effects persist with different populations, during different stages of the disease, and for individuals with other chronic illnesses.

How does psychoeducation help? A review of the effects of providing information about Tourette syndrome and attention-deficit/hyperactivity disorder

Tourette syndrome (TS) and attention-deficit/hyperactivity disorder (ADHD) are common neurodevelopmental disorders that often co-occur. They are both stigmatized and misunderstood conditions. This review critically appraises studies examining interventions using psychoeducational approaches in TS and ADHD. Studies examining the impact of providing educational information (or diagnostic label) about TS and ADHD to parents, teachers and peers (child and adult) were identified by searching relevant electronic databases, reference lists and citations, and consulting colleagues. Twenty-two studies were identified, 20 of which involved teachers or peers. The studies indicate that providing educational information increases knowledge, positive attitudes and behaviours towards individuals with TS and ADHD. Provision of a diagnostic label alone appears insufficient. Parental education may improve treatment enrolment and adherence. While the findings are encouraging, there are a number of gaps in the literature. These include the effects of giving information to parents, whether changes are maintained over time, or are generalizable to the population. Studies are needed to investigate the optimal way to present educational information in everyday contexts in order to improve the lives of those with TS and ADHD.

Maintaining an outward image: a Korean immigrant's life with type 2 diabetes mellitus and hypertension

Type 2 diabetes mellitus (DM) and hypertension (HTN) disproportionately affect minority populations in the United States, including Korean American immigrants (KAI). We conducted qualitative interviews with middle-aged KAI in Maryland living with DM and HTN to examine the illness experience to inform future intervention strategies. Study results show that participants utilized strategies to maintain respect and Korean identity, including an image of being healthy and in control of their behavior in the public arena. These strategies included the lack of disclosure of their illness, even to family members, and avoiding outside assistance when engaging in problem solving. Maintaining an outward image of health was a common goal that affected the self-care of KAI in this study, a finding that might prove significant in the management of other chronic illnesses affecting this population. The study findings demonstrate the importance of in-depth understanding of specific populations when treating chronic illness, and caretakers' sensitivity to each population's unique cultural issues regarding identity, image, and disclosure.

Factors affecting the disclosure of diabetes by ethnic minority patients: a qualitative study among Surinamese in the Netherlands

Background

Diabetes and related complications are common among ethnic minority groups. Community-based social support interventions are considered promising for improving diabetes self-management. To access such interventions, patients need to disclose their diabetes to others. Research on the disclosure of diabetes in ethnic minority groups is limited. The aim of our study was to explore why diabetes patients from ethnic minority populations either share or do not share their condition with people in their wider social networks.

Methods

We conducted a qualitative study using semi-structured interviews with 32 Surinamese patients who were being treated for type 2 diabetes by general practitioners in Amsterdam, the Netherlands.

Results

Most patients disclosed their diabetes only to very close family members. The main factor inhibiting disclosure to people outside this group was the Surinamese cultural custom that talking about disease is taboo, as it may lead to shame, gossip, and social disgrace for the patient and their family. Nevertheless, some patients disclosed their diabetes to people outside their close family circles. Factors motivating this decision were mostly related to a need for facilities or support for diabetes self-management.

Conclusions

Cultural customs inhibited Surinamese patients in disclosing their diabetes to people outside their very close family circles. This may influence their readiness to participate in community-based diabetes self-management programmes that involve other groups. What these findings highlight is that public health researchers and initiatives must identify and work with factors that influence the disclosure of diabetes if they are to develop community-based diabetes self-management interventions for ethnic minority populations.

Impact of Tourette Syndrome: a preliminary investigation of the effects of disclosure on peer perceptions and social functioning

Individuals with Tourette Syndrome (TS) often experience social difficulties, which may be caused or compounded by others' negative perceptions of persons with the disorder. As a result, researchers and clinicians have called for the development of attitude change strategies. One such strategy is preventative disclosure, in which one informs others about his or her condition. To date, no known research exists exploring the effects of this type of disclosure with TS. In an attempt to examine the effects of TS disclosure, adults (N = 369) read vignettes that varied in a 2 (male vs. female character) x 2 (preventative disclosure of disorder vs. nondisclosure) design. Respondents answered several questions regarding the character presented in the vignette, which when factor-analyzed, resulted in four factors (social rejection, attributions of a drug/alcohol problem, perceptions of psychological/medical problems, and general concern). The results of this preliminary study are promising, in that the data suggest that preventative disclosure of TS may reduce social rejection, minimize concern, and decrease perceptions of drug and alcohol problems. No effect of character gender was found. Implications of these findings, limitations to the current study, and directions for future research are discussed.

Disclosure of attention-deficit/hyperactivity disorder may minimize risk of social rejection

The vast majority of young adults with Attention-Deficit/Hyperactivity Disorder (ADHD) report interpersonal difficulties, which are likely exacerbated by others' negative perceptions of ADHD. Therefore, researchers and clinicians have called for the development of attitude change strategies. One strategy is preventative disclosure, in which one selectively informs and educates others about their condition. No known research has explored preventative disclosure with ADHD. To examine the effects of disclosure, 306 young adults read vignettes that varied in a two (ADHD symptom presentation: hyperactive/impulsive vs. inattentive) by two (preventative disclosure vs. nondisclosure) design. A factor analysis of the questions following each vignette resulted in two factors: Socially Rejecting Attitudes (alpha = .82) and Potential Benefits with Treatment (alpha = .61). Results suggest that preventative disclosure may greatly reduce Socially Rejecting Attitudes (d = -.95). When ADHD was disclosed, respondents were more likely to report that the character would benefit from treatment (d = .39). A character presenting with hyperactive/ impulsive (compared to inattentive) symptoms was more likely to be viewed as potentially benefiting from treatment (d = .50). If the results of the present study replicate with clinical samples, preventative disclosure could have a significant impact on the psychosocial functioning of people with ADHD.

Cystic fibrosis disclosure may minimize risk of negative peer evaluations

BACKGROUND

Given the relatively lower body weight associated with cystic fibrosis (CF) and the visible regimen associated with eating, there is a risk that individuals with CF may be mistakenly perceived to have an eating disorder or otherwise be negatively evaluated. Based upon a theoretical model, this study explored whether disclosing CF would curtail negative peer perceptions.

METHODS

Young adult respondents (N = 391) read vignettes that varied in a 2 (male vs. female character) x 2 (preventative disclosure of disorder vs. nondisclosure) design and answered 28 questions, which resulted in three subscales that were validated using confirmatory factor analysis: Abnormal Behavior, Hiding an Eating Disorder, and Worry. Vignettes depicted a lunchtime interaction including concerns about gaining weight and taking enzymes before eating.

RESULTS

Disclosure of CF significantly reduced perceptions of abnormal behavior, ameliorated perceptions of an eating disorder, and alleviated respondents' worries. Manipulations of vignette character gender did not result in any significant differences; however, female respondents reported significantly more worry for the character than males.

CONCLUSIONS

Individuals who disclose their CF may potentially curtail negative peer perceptions. Those who choose not to disclose may risk having their thinness and appropriate self-care misperceived as signs of an eating disorder.