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Smalls BL, Kruse-Diehr A, Ortz CL, Douthitt K, McLouth C, Shelton R, Taylor Z, Williams E. Older adults using social support to improve self-care (OASIS): Adaptation, implementation and feasibility of peer support for older adults with T2D in appalachia: A feasibility study protocol. PLoS One 2024; 19:e0300196. [PMID: 38498512 PMCID: PMC10947915 DOI: 10.1371/journal.pone.0300196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 02/21/2024] [Indexed: 03/20/2024] Open
Abstract
INTRODUCTION The prevalence of type 2 diabetes (T2D) is 17% higher in rural dwellers compared to their urban counterparts, and it increases with age, with an estimated 25% of older adults (≥ 65 years) diagnosed. Appropriate self-care is necessary for optimal clinical outcomes. Overall, T2D self-care is consistently poor among the general population but is even worse in rural-dwellers and older adults. In rural Kentucky, up to 23% of adults in Appalachian communities have been diagnosed with T2D and, of those, 26.8% are older adults. To attain optimal clinical outcomes, social environmental factors, including social support, are vital when promoting T2D self-care. Specifically, peer support has shown to be efficacious in improving T2D self-care behaviors and clinical and psychosocial outcomes related to T2D; however, literature also suggests self-selected social support can be obstructive when engaging in healthful activities. Currently available evidence-based interventions (EBIs) using peer support have not been used to prioritize older adults, especially those living in rural communities. METHOD To address this gap, we conducted formative research with stakeholders, and collaboratively identified an acceptable and feasible peer support EBI-peer health coaching (PHC)-that has resulted in improved clinical and psychosocial T2D-related outcomes among participants who did not reside in rural communities nor were ≥65 years. The goal of the proposed study is to use a 2x2 factorial design to test the adapted PHC components and determine their preliminary effectiveness to promote self-care behaviors and improve glycemic control among older adults living in Appalachian Kentucky. Testing the PHC components of the peer support intervention will be instrumental in promoting care for older adults in Appalachia, as it will allow for a larger scale intervention, which if effective, could be disseminated to community partners in Appalachia. TRIAL REGISTRATION This study was registered at www.clinicaltrials.gov (NCT06003634) in August 2023.
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Affiliation(s)
- Brittany L. Smalls
- Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States of America
| | - Aaron Kruse-Diehr
- Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States of America
| | - Courtney L. Ortz
- Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States of America
| | - Key Douthitt
- Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States of America
| | - Christopher McLouth
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY, United States of America
| | - Rachel Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Zoe Taylor
- Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY, United States of America
| | - Edith Williams
- Center for Community Health and Prevention, School of Medicine and Dentistry, University of Rochester, Rochester, NY, United States of America
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Park JI, Kim SW, Nam-Goong IS, Song KH, Yu JH, Jeong JY, Cho EH. Questionnaire-Based Survey of Diabetes Self-Care Activities and Barriers among Young Korean Adults with Early-Onset Diabetes. Yonsei Med J 2024; 65:42-47. [PMID: 38154479 PMCID: PMC10774646 DOI: 10.3349/ymj.2023.0183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/30/2023] [Accepted: 09/06/2023] [Indexed: 12/30/2023] Open
Abstract
PURPOSE Self-management of diabetes is a significant challenge. This study aimed to assess diabetes self-care activities and barriers among Korean young adults with diabetes mellitus. MATERIALS AND METHODS This study recruited 209 Korean adults with diabetes, with an onset age of 20-39 years, from four university hospitals. Demographic characteristics and the Summary of Diabetes Self-Care Activities (SDSCA) measure and Diabetes Self-Care Barriers Assessment Scale for Older Adults (DSCB-OA) scores were assessed using questionnaires. RESULTS The average age of study participants was 32.9±6.1 years. Their self-care activities, including adherence to recommended diabetes medication (5.6±2.4) and number of diabetes pills (5.5±2.3) in the SDSCA measure, were the most well-performed activities among all domains. Responses to inspection of the inside of shoes in the foot care activity (0.8±1.5) and specific exercise sessions in the exercise activity (1.6±1.9) reflected poor levels of compliance. According to the DSCB-OA questionnaire, the mean diabetes self-care barrier of DSCB-OA was 20.6±5.0 of total score 45. The greater perceived barriers to self-care on the DSCB-OA were having difficulty exercising regularly (1.9±0.7) and eating three meals and snacks leading to weight gain (1.9±0.8). CONCLUSION Young adults with early-onset diabetes showed a greater barrier to regular exercise and poor compliance with foot care and blood sugar testing. Healthcare providers must strengthen their relationship with young adults with diabetes to provide more education and guidelines for lifestyle modification focused on exercise and to promote higher compliance with diabetic self-care activities for improving clinical outcomes.
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Affiliation(s)
- Ji In Park
- Department of Internal Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Sang-Wook Kim
- Department of Internal Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Il Sung Nam-Goong
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Kee-Ho Song
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Ji Hee Yu
- Department of Internal Medicine, Korea University College of Medicine, Ansan, Korea
| | - Ji Yun Jeong
- Department of Internal Medicine, Soonchunhyang University Gumi Hospital, Gumi, Korea.
| | - Eun-Hee Cho
- Department of Internal Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea.
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Bukhsh A, Goh BH, Zimbudzi E, Lo C, Zoungas S, Chan KG, Khan TM. Type 2 Diabetes Patients' Perspectives, Experiences, and Barriers Toward Diabetes-Related Self-Care: A Qualitative Study From Pakistan. Front Endocrinol (Lausanne) 2020; 11:534873. [PMID: 33329377 PMCID: PMC7729167 DOI: 10.3389/fendo.2020.534873] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 08/25/2020] [Indexed: 01/03/2023] Open
Abstract
Objective: This study aimed to qualitatively explore perspectives, practices, and barriers to self-care practices (eating habits, physical activity, self-monitoring of blood glucose, and medicine intake behavior) in urban Pakistani adults with type 2 diabetes mellitus (T2DM). Methods: Pakistani adults with T2DM were recruited from the outpatient departments of two hospitals in Lahore. Semistructured interviews were conducted and audiorecorded until thematic saturation was reached. Two researchers thematically analyzed the data independently using NVivo® software with differences resolved by a third researcher. Results: Thirty-two Pakistani adults (aged 35-75 years, 62% female) participated in the study. Six themes were identified from qualitative analysis: role of family and friends, role of doctors and healthcare, patients' understanding about diabetes, complication of diabetes and other comorbidities, burden of self care, and life circumstances. A variable experience was observed with education and healthcare. Counseling by healthcare providers, family support, and fear of diabetes-associated complications are the key enablers that encourage study participants to adhere to diabetes-related self-care practices. Major barriers to self care are financial constraints, physical limitations, extreme weather conditions, social gatherings, loving food, forgetfulness, needle phobia, and a hectic job. Conclusion: Respondents identified many barriers to diabetes self care, particularly related to life situations and diabetes knowledge. Family support and education by healthcare providers were key influencers to self-care practices among Pakistani people with diabetes.
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Affiliation(s)
- Allah Bukhsh
- School of Pharmacy, Monash University, Subang Jaya, Malaysia
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Bey-Hing Goh
- School of Pharmacy, Monash University, Subang Jaya, Malaysia
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
- Biofunctional Molecule Exploratory Research Group, School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
- Malaysia School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Edward Zimbudzi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Nephrology, Monash Health, Melbourne, VIC, Australia
| | - Clement Lo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Monash Diabetes, Monash Health, Melbourne, VIC, Australia
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Kok-Gan Chan
- Division of Genetics and Molecular Biology, Faculty of Science, Institute of Biological Sciences, University of Malaya, Kuala Lumpur, Malaysia
- Guangdong Provincial Key Laboratory of Marine Biology, Institute of Marine Sciences, Shantou University, Shantou, China
| | - Tahir Mehmood Khan
- School of Pharmacy, Monash University, Subang Jaya, Malaysia
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
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Wackström N, Koponen AM, Suominen S, Tarkka IM, Simonsen N. Does chronic pain hinder physical activity among older adults with type 2 diabetes? Health Psychol Behav Med 2020; 8:362-382. [PMID: 34040877 PMCID: PMC8114375 DOI: 10.1080/21642850.2020.1807350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 08/01/2020] [Indexed: 11/29/2022] Open
Abstract
Background: Physical activity (PA) is a key component in management of type 2 diabetes (T2D). Pain might be a barrier to PA especially among older adults with T2D, but surprisingly few studies have investigated the association between chronic pain and PA. Our aim was to evaluate the prevalence of chronic pain among older adults with T2D and to examine the association between chronic pain and PA while taking important life-contextual factors into account. Methods: Data of this register-based, cross-sectional study were collected in a survey among adults with T2D (n=2866). In the current study, only respondents aged 65-75 years were included (response rate 63%, n=1386). Data were analysed by means of descriptive statistics and multivariate logistic regression analysis. Results: In total, 64% reported chronic pain. In specific groups, e.g. women and those who were obese, the prevalence was even higher. Among respondents experiencing chronic pain, frequent pain among women and severe pain among both genders were independently associated with decreased likelihood of being physically active. Moreover, the likelihood of being physically active decreased with higher age and BMI, whereas it increased with higher autonomous motivation and feelings of energy. Among physically active respondents suffering from chronic pain, neither intensity nor frequency of pain explained engagement in exercise (as compared with incidental PA). Instead, men were more likely to exercise regularly as were those with good perceived health and higher autonomous motivation. Conclusions: The prevalence of chronic pain is high among older adults with T2D. This study shows that among those suffering from chronic pain, severe pain is independently and inversely associated with being physically active, as is frequent pain, but only among women. Moreover, the findings show the importance of autonomous motivation and health variables for both incidental PA and exercise among older adults with T2D experiencing chronic pain.
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Affiliation(s)
- Nanna Wackström
- Folkhälsan Research Center, Public Health Research Program, Helsinki, Finland
- Health Sciences, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Anne M. Koponen
- Folkhälsan Research Center, Public Health Research Program, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Sakari Suominen
- Department of Public Health, University of Turku, Turku, Finland
- School of Health and Education, University of Skövde, Skövde, Sweden
| | - Ina M. Tarkka
- Health Sciences, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Nina Simonsen
- Folkhälsan Research Center, Public Health Research Program, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
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van Puffelen A, Kasteleyn M, de Vries L, Rijken M, Heijmans M, Nijpels G, Schellevis F. Self-care of patients with type 2 diabetes mellitus over the course of illness: implications for tailoring support. J Diabetes Metab Disord 2020; 19:81-89. [PMID: 32550159 DOI: 10.1007/s40200-019-00479-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 12/17/2019] [Indexed: 11/28/2022]
Abstract
Purpose Type 2 diabetes requires patients to make lifestyle changes and perform daily self-care. To determine at what stages patients may need particular self-management support, we examined (1) whether patients' performance of self-care related to their diabetes duration, and (2) whether illness characteristics (treatment and complications) and diabetes-related distress influenced this relationship. Methods Cross-sectional data from 590 type 2 diabetes patients were analysed through linear and logistic regression analysis. Self-care behaviours were assessed by the revised Summary of Diabetes Self-Care Activities (SDSCA) measure. Diabetes duration (model 1), treatment and complications (model 2), and distress, as assessed by the Problem Areas In Diabetes (PAID) scale (model 3), were stepwise included. Sociodemographic characteristics were added to all models to account for confounding. Results Patients with a longer history of diabetes were less physically active, but monitored their blood glucose levels more frequently than more recently diagnosed patients. These relationships were mediated by the presence of complications and the use of insulin, with lower levels of physical activity being found among patients with macrovascular complications and higher frequencies of glucose monitoring among patients on insulin. All predictors together explained maximally 5% of the variance in self-care, except for glucose monitoring (37%) and smoking (11%). Conclusion Type 2 diabetes patients' self-care activity changes over the course of illness. To provide tailored self-management support, diabetes care providers should take into account patients' phase of illness, including their treatment and complications, as well as their personal characteristics and distress level.
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Affiliation(s)
- Anne van Puffelen
- NIVEL (the Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN Utrecht, the Netherlands
| | - Marise Kasteleyn
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, the Netherlands
| | - Lianne de Vries
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, location VUmc, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
| | - Mieke Rijken
- NIVEL (the Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN Utrecht, the Netherlands
- Department of Health and Social Management, University of Eastern Finland, PO Box 1627, FI-70211 Kuopio, Finland
| | - Monique Heijmans
- NIVEL (the Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN Utrecht, the Netherlands
| | - Giel Nijpels
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, location VUmc, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
| | - François Schellevis
- NIVEL (the Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN Utrecht, the Netherlands
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, location VUmc, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
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Hussain S, Chowdhury TA. The Impact of Comorbidities on the Pharmacological Management of Type 2 Diabetes Mellitus. Drugs 2019; 79:231-242. [PMID: 30742277 DOI: 10.1007/s40265-019-1061-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Diabetes mellitus affects over 20% of people aged > 65 years. With the population of older people living with diabetes growing, the condition may be only one of a number of significant comorbidities that increases the complexity of their care, reduces functional status and inhibits their ability to self-care. Coexisting comorbidities may compete for the attention of the patient and their healthcare team, and therapies to manage comorbidities may adversely affect a person's diabetes. The presence of renal or liver disease reduces the types of antihyperglycemic therapies available for use. As a result, insulin and sulfonylurea-based therapies may have to be used, but with caution. There may be a growing role for sodium-glucose co-transporter 2 (SGLT-2) inhibitors in diabetic renal disease and for glucagon-like peptide (GLP)-1 therapy in renal and liver disease (nonalcoholic steatohepatitis). Cancer treatments pose considerable challenges in glucose therapy, especially the use of cyclical chemotherapy or glucocorticoids, and cyclical antihyperglycemic regimens may be required. Clinical trials of glucose lowering show reductions in microvascular and, to a lesser extent, cardiovascular complications of diabetes, but these benefits take many years to accrue, and evidence specifically in older people is lacking. Guidelines recognize that clinicians managing patients with type 2 diabetes mellitus need to be mindful of comorbidity, particularly the risks of hypoglycemia, and ensure that patient-centered therapeutic management of diabetes is offered. Targets for glucose control need to be carefully considered in the context of comorbidity, life expectancy, quality of life, and patient wishes and expectations. This review discusses the role of chronic kidney disease, chronic liver disease, cancer, severe mental illness, ischemic heart disease, and frailty as comorbidities in the therapeutic management of hyperglycemia in patients with type 2 diabetes mellitus.
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Affiliation(s)
- Shazia Hussain
- Department of Diabetes and Metabolism, Barts and the London School of Medicine and Dentistry, The Royal London Hospital, 7th Floor, John Harrison House, Whitechapel, London, E1 1BB, UK
| | - Tahseen A Chowdhury
- Department of Diabetes and Metabolism, Barts and the London School of Medicine and Dentistry, The Royal London Hospital, 7th Floor, John Harrison House, Whitechapel, London, E1 1BB, UK.
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Adu MD, Malabu UH, Malau-Aduli AEO, Malau-Aduli BS. Enablers and barriers to effective diabetes self-management: A multi-national investigation. PLoS One 2019; 14:e0217771. [PMID: 31166971 PMCID: PMC6550406 DOI: 10.1371/journal.pone.0217771] [Citation(s) in RCA: 144] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/19/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE The study aimed to identify the common gaps in skills and self-efficacy for diabetes self-management and explore other factors which serve as enablers of, and barriers to, achieving optimal diabetes self-management. The information gathered could provide health professionals with valuable insights to achieving better health outcomes with self-management education and support for diabetes patients. METHODS International online survey and telephone interviews were conducted on adults who have type 1 or type 2 diabetes. The survey inquired about their skills and self-efficacy in diabetes self-management, while the interviews assessed other enablers of, and barriers to, diabetes self-management. Surveys were analysed using descriptive and inferential statistics. Interviews were analysed using inductive thematic analysis. RESULTS Survey participants (N = 217) had type 1 diabetes (38.2%) or type 2 diabetes (61.8%), with a mean age of 44.56 SD 11.51 and were from 4 continents (Europe, Australia, Asia, America). Identified gaps in diabetes self-management skills included the ability to: recognize and manage the impact of stress on diabetes, exercise planning to avoid hypoglycemia and interpreting blood glucose pattern levels. Self-efficacy for healthy coping with stress and adjusting medications or food intake to reach ideal blood glucose levels were minimal. Sixteen participants were interviewed. Common enablers of diabetes self-management included: (i) the will to prevent the development of diabetes complications and (ii) the use of technological devices. Issues regarding: (i) frustration due to dynamic and chronic nature of diabetes (ii) financial constraints (iii) unrealistic expectations and (iv) work and environment-related factors limited patients' effective self-management of diabetes. CONCLUSIONS Educational reinforcement using technological devices such as mobile application has been highlighted as an enabler of diabetes self-management and it could be employed as an intervention to alleviate identified gaps in diabetes self-management. Furthermore, improved approaches that address financial burden, work and environment-related factors as well as diabetes distress are essential for enhancing diabetes self-management.
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Affiliation(s)
- Mary D. Adu
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Usman H. Malabu
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Aduli E. O. Malau-Aduli
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
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Bukhsh A, Gan SH, Goh BH, Khan TM. Complementary and alternative medicine practices among type 2 diabetes patients in Pakistan: A qualitative insight. Eur J Integr Med 2018. [DOI: 10.1016/j.eujim.2018.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Riegel B, Moser DK, Buck HG, Dickson VV, Dunbar SB, Lee CS, Lennie TA, Lindenfeld J, Mitchell JE, Treat-Jacobson DJ, Webber DE. Self-Care for the Prevention and Management of Cardiovascular Disease and Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association. J Am Heart Assoc 2017; 6:e006997. [PMID: 28860232 PMCID: PMC5634314 DOI: 10.1161/jaha.117.006997] [Citation(s) in RCA: 278] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Self-care is defined as a naturalistic decision-making process addressing both the prevention and management of chronic illness, with core elements of self-care maintenance, self-care monitoring, and self-care management. In this scientific statement, we describe the importance of self-care in the American Heart Association mission and vision of building healthier lives, free of cardiovascular diseases and stroke. The evidence supporting specific self-care behaviors such as diet and exercise, barriers to self-care, and the effectiveness of self-care in improving outcomes is reviewed, as is the evidence supporting various individual, family-based, and community-based approaches to improving self-care. Although there are many nuances to the relationships between self-care and outcomes, there is strong evidence that self-care is effective in achieving the goals of the treatment plan and cannot be ignored. As such, greater emphasis should be placed on self-care in evidence-based guidelines.
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Schoenberg NE, Ciciurkaite G, Greenwood MK. Community to clinic navigation to improve diabetes outcomes. Prev Med Rep 2016; 5:75-81. [PMID: 27957410 PMCID: PMC5149068 DOI: 10.1016/j.pmedr.2016.11.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 11/11/2016] [Accepted: 11/24/2016] [Indexed: 02/01/2023] Open
Abstract
Rural residents experience rates of Type 2 Diabetes Mellitus (T2DM) that are considerably higher than their urban or suburban counterparts. Two primary modifiable factors, self-management and formal clinical management, have potential to greatly improve diabetes outcomes. “Community to Clinic Navigation to Improve Diabetes Outcomes,” is the first known randomized clinical trial pilot study to test a hybrid model of diabetes self-management education plus clinical navigation among rural residents with T2DM. Forty-one adults with T2DM were recruited from two federally qualified health centers in rural Appalachia from November 2014–January 2015. Community health workers provided navigation, including helping participants understand and implement a diabetes self-management program through six group sessions and, if needed, providing assistance in obtaining clinic visits (contacting providers' offices for appointments, making reminder calls, and facilitating transportation and dependent care). Pre and post-test data were collected on T2DM self-management, physical measures, demographics, psychosocial factors, and feasibility (cost, retention, and satisfaction). Although lacking statistical significance, some outcomes indicate trends in positive directions, including diet, foot care, glucose monitoring, and physical health, including decreased HbA1c and triglyceride levels. Process evaluations revealed high levels of satisfaction and feasibility. Due to the limited intervention dose, modest program expenditures (~$29,950), and a severely affected population most of whom had never received diabetes education, outcomes were not as robust as anticipated. Given high rates of satisfaction and retention, this culturally appropriate small group intervention holds promise for hard to reach rural populations. Modifications should include expanded recruitment venues, sample size, intervention dosage and longer term assessment. Community to clinic navigation combined diabetes self-management and navigation. CCN showed some positive trends in diet, triglycerides, self-care, and diabetes. CCN was feasible (low cost and high retention) and satisfactory. Increasing dose, length, and recruitment venues may improve the CCN intervention.
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Affiliation(s)
- Nancy E Schoenberg
- 125 Medical Behavioral Science Office Building, University of Kentucky, Lexington, KY 40536-0086, USA
| | - Gabriele Ciciurkaite
- Department of Sociology, Social Work and Anthropology, Utah State University, 0730 Old Main Hill, Logan, UT 84322-0730, USA
| | - Mary Kate Greenwood
- University of Kentucky College of Medicine, UK Medical Center MN 150, Lexington, KY 40536-0298, USA
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Peimani M, Rambod C, Omidvar M, Larijani B, Ghodssi-Ghassemabadi R, Tootee A, Esfahani EN. Effectiveness of short message service-based intervention (SMS) on self-care in type 2 diabetes: A feasibility study. Prim Care Diabetes 2016; 10:251-258. [PMID: 26653014 DOI: 10.1016/j.pcd.2015.11.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 10/04/2015] [Accepted: 11/01/2015] [Indexed: 11/19/2022]
Abstract
AIM The objective of the current study is to assess the effectiveness of Mobile Short Message Service (SMS) intervention on education of basic self-care skills in patients with type 2 diabetes. Moreover, we aimed to determine whether delivering individually-tailored educational messages can be more effective than general educational messages. METHODS A total of 150 patients with diabetes type 2 were randomized into three groups: tailored SMS group, non-tailored SMS group, and the control group. Biochemical parameters including HbA1c, FBS, lipid profile were evaluated for the three groups at baseline and after 12 weeks. Moreover, self-care Inventory (SCI), Diabetes Management Self-Efficacy Scale (DMSES) and Diabetes Self-Care Barriers assessment scale for Older Adults (DSCB-OA) were completed. In the tailored SMS group, each person received 75% of their messages based on the top two barriers to adherence that they had experienced and reported in their scale. In the non-tailored SMS group, random messages were sent to every patient. RESULTS After 12 weeks, although HgA1c levels did not significantly change, significant decline was observed in FBS and mean BMI in both intervention groups. Mean SCI-R scores significantly increased and mean DSCB and DMSES scores significantly decreased in both tailored and non-tailored SMS groups. In the control group, mean SCI-R scores decreased and mean DSCB and DMSES scores significantly increased (P<0.001). CONCLUSION Sending short text messages as a method of education in conjunction with conventional diabetes treatment can improve glycemic control and positively influence other aspects of diabetes self-care. According to our findings, sending SMS regularly in particular times appears to be as effective as sending individually tailored messages.
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Affiliation(s)
- Maryam Peimani
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Camelia Rambod
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Omidvar
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Robabeh Ghodssi-Ghassemabadi
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Tootee
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ensieh Nasli Esfahani
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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McCaskill GM, Bolland KA, Burgio KL, Leeper J. Development and validation of a diabetes self-management instrument for older African-Americans. SOCIAL WORK IN HEALTH CARE 2016; 55:381-394. [PMID: 27045578 DOI: 10.1080/00981389.2015.1129012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The objective of this study was to develop and validate a new diabetes self-management instrument for older African-Americans 65 years of age and older. The Self-Care Utility Geriatric African-American Rating (SUGAAR) was developed using the American Diabetes Association's standards for the management of type 2 diabetes in older adults and cognitive interviews with older African-Americans. The instrument underwent extensive review by a panel of experts, two rounds of cognitive interviews, and a pilot test before it was administered in an interview format to 125 community-dwelling older African-Americans. The instrument demonstrated content validity and significant, but modest, convergent validity with items from an established diabetes self-management instrument. Social workers and health care professionals can use the SUGARR to assess diabetes self-management and to identify areas for education and support for older African-Americans with type 2 diabetes.
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Affiliation(s)
- Gina M McCaskill
- a Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC) , Department of Veterans Affairs , Birmingham , Alabama , USA
- b Comprehensive Center for Healthy Aging, School of Medicine , The University of Alabama at Birmingham , Birmingham , Alabama , USA
| | - Kathleen A Bolland
- c School of Social Work , The University of Alabama , Tuscaloosa , Alabama , USA
| | - Kathryn L Burgio
- a Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC) , Department of Veterans Affairs , Birmingham , Alabama , USA
- b Comprehensive Center for Healthy Aging, School of Medicine , The University of Alabama at Birmingham , Birmingham , Alabama , USA
| | - James Leeper
- d Department of Community and Rural Medicine , The University of Alabama , Tuscaloosa , Alabama , USA
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Jones LC, Clay OJ, Ovalle F, Cherrington A, Crowe M. Correlates of Depressive Symptoms in Older Adults with Diabetes. J Diabetes Res 2016; 2016:8702730. [PMID: 26682235 PMCID: PMC4670668 DOI: 10.1155/2016/8702730] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 05/01/2015] [Accepted: 05/02/2015] [Indexed: 02/06/2023] Open
Abstract
Investigators examined correlates of depressive symptoms within a sample of older adults with diabetes. Participants completed a structured telephone interview with measures including depressive symptoms, health conditions, cognitive function, and diabetes distress. Correlations and hierarchical linear regression models were utilized to examine bivariate and covariate-adjusted correlates of depressive symptoms. The sample included 246 community-dwelling adults with diabetes (≥ 65 years old). In bivariate analyses, African Americans, individuals with specific health issues (neuropathy, stroke, respiratory issues, arthritis, and cardiac issues), and those with higher levels of diabetes distress reported more depressive symptoms. Older age, higher education, more income, and better cognitive function were inversely associated with depressive symptoms. In the final covariate-adjusted regression model, stroke (B = .22, p < .001), cognitive function (B = -.14, p < .01), and higher levels of diabetes-related distress (B = .49, p < .001) each were uniquely associated with more depressive symptoms. Diabetes distress partially mediated the associations between cardiac issues and depressive symptoms and between cognitive function and depressive symptoms. Findings suggest that interventions targeted at helping older adults manage their diabetes-related distress and reducing the likelihood of experiencing additional health complications may reduce depressive symptoms within this population.
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Affiliation(s)
- LaRita C. Jones
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Olivio J. Clay
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
- *Olivio J. Clay:
| | - Fernando Ovalle
- Diabetes & Endocrine Clinical Research Unit, Division of Endocrinology, Diabetes and Metabolism, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Andrea Cherrington
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Michael Crowe
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
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Razzano LA, Cook JA, Yost C, Jonikas JA, Swarbrick MA, Carter TM, Santos A. Factors associated with co-occurring medical conditions among adults with serious mental disorders. Schizophr Res 2015; 161:458-64. [PMID: 25487698 DOI: 10.1016/j.schres.2014.11.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 11/13/2014] [Accepted: 11/17/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND This study examined the prevalence and treatment of 17 co-occurring physical health conditions among adults with serious mental health disorders, and factors associated with prevalence of the 5 most common medical co-morbidities. METHODS Data were collected from 457 adults attending publicly funded mental health programs who participated in community health screenings held in 4 U.S. states. Face-to-face interviews included standardized items from the National Health Interview Survey and the National Health and Nutrition Examination Survey. Ordinary least squares regression analysis examined associations between prevalence of the 5 most common co-morbid conditions and respondents' demographic, clinical, attitudinal, and health insurance statuses. RESULTS Compared to the U.S. population, prevalence was significantly higher for 14 out of 17 medical conditions assessed. The 5 most common were hyperlipidemia (45%), hypertension (44%), asthma (28%), arthritis (22%), and diabetes (21%). Controlling for age, study site, and Medicaid status, racial/ethnic minorities were almost twice as likely as Caucasians to be diagnosed with hypertension and diabetes; women were almost twice as likely as men to be diagnosed with diabetes; and people with schizophrenia were around half as likely as those with other disorders to be diagnosed with hypertension and arthritis. Age was positively related to all conditions except asthma. Treatment prevalence was below 70% for approximately half of ongoing conditions. CONCLUSIONS These results suggest a high level of medical vulnerability and need for coordination of health and mental health services in this population. Associations with age, minority status, and gender point to the need for targeted health care strategies.
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Affiliation(s)
- Lisa A Razzano
- Center on Mental Health Services Research and Policy, Department of Psychiatry, University of Illinois at Chicago, 1601 West Taylor Street, M/C 912, Chicago, IL 60612, United States.
| | - Judith A Cook
- Center on Mental Health Services Research and Policy, Department of Psychiatry, University of Illinois at Chicago, 1601 West Taylor Street, M/C 912, Chicago, IL 60612, United States
| | - Chantelle Yost
- Center on Mental Health Services Research and Policy, Department of Psychiatry, University of Illinois at Chicago, 1601 West Taylor Street, M/C 912, Chicago, IL 60612, United States
| | - Jessica A Jonikas
- Center on Mental Health Services Research and Policy, Department of Psychiatry, University of Illinois at Chicago, 1601 West Taylor Street, M/C 912, Chicago, IL 60612, United States
| | - Margaret A Swarbrick
- Collaborative Support Programs of New Jersey, Rutgers, The State University of New Jersey, Department of Psychiatric Rehabilitation and Counseling Professions, 8 Spring Street, Freehold, NJ 07728, United States
| | - Tina M Carter
- Center on Mental Health Services Research and Policy, Department of Psychiatry, University of Illinois at Chicago, 1601 West Taylor Street, M/C 912, Chicago, IL 60612, United States
| | - Alberto Santos
- Georgia Regents University, Department of Psychiatry and Health Behavior, 1120, 15th Street, Augusta, GA 30912, United States
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Abstract
The prevalence of diabetes is highest in older adults, a population that is increasing. Diabetes self-care is complex with important recommendations for nutrition, physical activity, checking glucose levels, and taking medication. Older adults with diabetes have unique issues that impact self-care. As people age, their health status, support systems, physical and mental abilities, and nutritional requirements change. Furthermore, comorbidities, complications, and polypharmacy complicate diabetes self-care. Depression is also more common among the elderly and may lead to deterioration in self-care behaviors. Because of concerns about cognitive deficits and multiple comorbidities, adults older than 65 years are often excluded from research trials. Thus, little clinical evidence is available and the most appropriate treatment approaches and how to best support older patients' self-care efforts are unclear. This review summarizes the current literature, research findings, and expert and consensus recommendations with their rationales.
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Affiliation(s)
- Katie Weinger
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
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Beverly EA, Wray LA, Chiu CJ, LaCoe CL. Older Adults' Perceived Challenges With Health Care Providers Treating Their Type 2 Diabetes and Comorbid Conditions. Clin Diabetes 2014; 32:12-7. [PMID: 26246673 PMCID: PMC4521426 DOI: 10.2337/diaclin.32.1.12] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Type 2 diabetes and comorbidity represent serious health problems to the aging population. This qualitative study aimed to describe older adults' perceived challenges with providers treating their type 2 diabetes and other chronic conditions. Older adults perceived a general unwillingness from their providers to treat their multiple health conditions and address their individual preferences for care. Older adults may require more in-depth communication with their providers in addition to individualized treatment plans that address their preferences for comorbidity management.
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Eton DT, Elraiyah TA, Yost KJ, Ridgeway JL, Johnson A, Egginton JS, Mullan RJ, Murad MH, Erwin PJ, Montori VM. A systematic review of patient-reported measures of burden of treatment in three chronic diseases. PATIENT-RELATED OUTCOME MEASURES 2013; 4:7-20. [PMID: 23833553 PMCID: PMC3699294 DOI: 10.2147/prom.s44694] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background Burden of treatment refers to the workload of health care and its impact on patient functioning and well-being. There are a number of patient-reported measures that assess burden of treatment in single diseases or in specific treatment contexts. A review of such measures could help identify content for a general measure of treatment burden that could be used with patients dealing with multiple chronic conditions. We reviewed the content and psychometric properties of patient-reported measures that assess aspects of treatment burden in three chronic diseases, ie, diabetes, chronic kidney disease, and heart failure. Methods We searched Ovid MEDLINE, Ovid EMBASE, Ovid PsycINFO, and EBSCO CINAHL through November 2011. Abstracts were independently reviewed by two people, with disagreements adjudicated by a third person. Retrieved articles were reviewed to confirm relevance, with patient-reported measures scrutinized to determine consistency with the definition of burden of treatment. Descriptive information and psychometric properties were extracted. Results A total of 5686 abstracts were identified from the database searches. After abstract review, 359 full-text articles were retrieved, of which 76 met our inclusion criteria. An additional 22 articles were identified from the references of included articles. From the 98 studies, 57 patient-reported measures of treatment burden (full measures or components within measures) were identified. Most were multi-item scales (89%) and assessed treatment burden in diabetes (82%). Only 15 measures were developed using direct patient input and had demonstrable evidence of reliability, scale structure, and multiple forms of validity; six of these demonstrated evidence of sensitivity to change. We identified 12 content domains common across measures and disease types. Conclusion Available measures of treatment burden in single diseases can inform derivation of a patient-centered measure of the construct in patients with multiple chronic conditions. Patients should take part in developing the measure to ensure salience and relevance.
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Affiliation(s)
- David T Eton
- Division of Heath Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
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Beverly EA, Fitzgerald S, Sitnikov L, Ganda OP, Caballero AE, Weinger K. Do older adults aged 60-75 years benefit from diabetes behavioral interventions? Diabetes Care 2013; 36:1501-6. [PMID: 23315603 PMCID: PMC3661804 DOI: 10.2337/dc12-2110] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE In this secondary analysis, we examined whether older adults with diabetes (aged 60-75 years) could benefit from self-management interventions compared with younger adults. Seventy-one community-dwelling older adults and 151 younger adults were randomized to attend a structured behavioral group, an attention control group, or one-to-one education. RESEARCH DESIGN AND METHODS We measured A1C, self-care (3-day pedometer readings, blood glucose checks, and frequency of self-care), and psychosocial factors (quality of life, diabetes distress, frustration with self-care, depression, self-efficacy, and coping styles) at baseline and 3, 6, and 12 months postintervention. RESULTS Both older (age 67 ± 5 years, A1C 8.7 ± 0.8%, duration 20 ± 12 years, 30% type 1 diabetes, 83% white, 41% female) and younger (age 47 ± 9 years, A1C 9.2 ± 1.2%, 18 ± 12 years with diabetes, 59% type 1 diabetes, 82% white, 55% female) adults had improved A1C equally over time. Importantly, older and younger adults in the group conditions improved more and maintained improvements at 12 months (older structured behavioral group change in A1C -0.72 ± 1.4%, older control group -0.65 ± 0.9%, younger behavioral group -0.55 ± 1.2%, younger control group -0.43 ± 1.7%). Furthermore, frequency of self-care, glucose checks, depressive symptoms, quality of life, distress, frustration with self-care, self-efficacy, and emotional coping improved in older and younger participants at follow-up. CONCLUSIONS The findings suggest that, compared with younger adults, older adults receive equal glycemic benefit from participating in self-management interventions. Moreover, older adults showed the greatest glycemic improvement in the two group conditions. Clinicians can safely recommend group diabetes interventions to community-dwelling older adults with poor glycemic control.
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Abstract
Diabetes and its many manifestations articulate well with the four-field approach in anthropology, providing an almost seamless example of the relationship between human biology, behavior, society, and culture in both the past and the present tense. In general, publications on diabetes and culture echo Enlightenment philosophies on change and progress that posit the increasing prevalence of diabetes as a “crisis in human relations” ( Bendix 1967 , p. 302) for which culture plays a significant role. The undermining of racial approaches due to what now appears to be diabetes-without-borders has also directed anthropological research into the contingent temporal frameworks of history. The recent attention to society and the social production of the disease may portend the end of culture in research on diabetes and culture.
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Affiliation(s)
- Steve Ferzacca
- Department of Anthropology, University of Lethbridge, Lethbridge, Alberta T1K3M4, Canada
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Brouwer AM, Mosack KE. “I Am a Blood Sugar Checker”: Intervening Effects of Self-as-doer Identity on the Relationship between Self-efficacy and Diabetes Self-care Behaviors. SELF AND IDENTITY 2012. [DOI: 10.1080/15298868.2011.603901] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Abstract
Qualitative research methodology is more recognized and valued in diabetes behavioral research in recent years. Qualitative methods help clinicians answer questions that quantitative research may not be able to answer, such as exploring patients' motivations, perceptions, and expectations. This paper reviews recent (2005-present) rigorous qualitative studies of children, adolescents, and adult patients with type 1 and type 2 diabetes with the aim of answering the following research question: How has qualitative research contributed to our understanding of behavioral diabetes care? We focus on studies exploring patients', health care providers', and families' interpersonal experiences of diabetes as well as patients' psychosocial experiences of diagnosis and treatment, self-care, complications, and cultural factors. After reviewing the research in each area, we conclude by discussing how qualitative research contributes to our increased understanding of behavioral diabetes.
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Abstract
Approximately half of adults with diabetes have at least one comorbid condition. However, diabetes care guidelines focus on diabetes-specific care, and their recommendations may not be appropriate for many patients with diabetes and comorbidity. We describe Piette and Kerr's typology of comorbid conditions, which categorizes conditions based on if they are clinically dominant (eclipse diabetes management), symptomatic versus asymptomatic, and concordant (similar pathophysiologic processes as diabetes) versus discordant. We integrate this typology with clinical evidence and shared decision-making methods to create an algorithmic approach to prioritizing care in patients with diabetes and comorbidity. Initial steps are determining the patient's goals of care and preferences for treatment, whether there is a clinically dominant condition or inadequately treated symptomatic condition, and the risk of cardiovascular disease. With these data in hand, the clinician and patient prioritize diabetes treatments during a shared decision-making process. These steps should be repeated, especially when the patient's clinical status changes. This patient-centered process emphasizes overall quality of life and functioning rather than a narrow focus on diabetes.
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Affiliation(s)
- Neda Laiteerapong
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Illinois 60637, USA.
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Rahim-Williams B. Beliefs, behaviors, and modifications of type 2 diabetes self-management among African American women. J Natl Med Assoc 2011; 103:203-15. [PMID: 21671524 DOI: 10.1016/s0027-9684(15)30300-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Among African Americans, behaviors and beliefs about management of disease constitute an important component of self-management of type 2 diabetes (diabetes mellitus). The purpose of this study was to explore and identify health beliefs and health behaviors affecting diabetes self-management among African American women with type 2 diabetes. Twenty-five African American women aged 46 to 87 years, participated in the study. Community-based women in Pinellas County, Florida, completed semistructured, in-depth interviews, a self-management questionnaire, and a demographic profile. Participant observation occurred at a cross-section of 5 diabetes self-management education classes. Participants were asked about nutritional changes, physical activity, medication use, blood glucose monitoring, physician-patient interaction, support systems, and patient education/knowledge. Findings indicated that a majority of participants used regular exercise, medications, and dietary modifications as a core components model of diabetes self-management. Successful self-management was affected by diabetes beliefs, types of behaviors initiated, and available support systems and resources. Difficulties experienced that affected behavioral outcomes included access to care, costs of medications, pain, testing supplies, and nutritional changes. Findings suggest that modifications to the recommended regimen support or impede participants' efficient self-management of clinically recommended behaviors. Thus, for African American women managing type 2 diabetes, the regimen may necessitate modification models of diabetes self-management, day-to-day behavioral lifestyle adjustments to the biomedically recommended self-management regimen.
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Affiliation(s)
- Bridgett Rahim-Williams
- Department of Behavioral Science and Community Health, College of Public, University of Florida, PO Box 100175, Gainesville, FL 32610-0175, USA.
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Beverly EA, Wray LA, Chiu CJ, Weinger K. Perceived challenges and priorities in co-morbidity management of older patients with Type 2 diabetes. Diabet Med 2011; 28:781-4. [PMID: 21395674 PMCID: PMC4839190 DOI: 10.1111/j.1464-5491.2011.03282.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS To explore older patients' perceived impact of chronic co-morbid conditions on Type 2 diabetes self-management. METHODS We used purposive sampling to select 32 mentally alert community-dwelling adults, aged 60 years or older, diagnosed with Type 2 diabetes and at least one other chronic health condition to participate in focus groups. We summarized the discussions following each focus group and identified codes to describe the overarching themes. RESULTS We conducted eight 90-min focus groups, each consisting of two to six patients. Three themes emerged. (i) Diabetes complications as a motivator: managing co-morbid conditions made health an important focal point in the lives of older patients. Most patients acknowledged the positive effect complications had on their diabetes self-management by motivating them to pay greater attention to their diabetes to diminish the progression of these complications. (ii) Prioritizing health conditions: patients reported prioritizing health conditions and selectively attending to the management of those conditions based on perceived severity or importance. Further, many patients perceived some conditions as more serious than others and admitted to prioritizing another health condition over their diabetes. (iii) Emotional impact of co-morbidity management: patients described feeling frustrated, confused, and overwhelmed in response to conflicting treatment recommendations, particularly for diet, physical activity and medication regimens. CONCLUSIONS Complications and co-morbidities may have differential impacts on the diabetes self-management of older patients. Addressing the perceived impact of co-morbidity on diabetes self-management may improve patients' outcomes; however, the most effective method of utilizing this information in clinical practice needs to be examined.
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Affiliation(s)
- E A Beverly
- The Pennsylvania State University, University Park, PA, USA.
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Chen HY, Ruppert K, Charron-Prochownik D, Noullet WV, Zgibor JC. Effects of depression and antidepressant use on goal setting and barrier identification among patients with type 2 diabetes. DIABETES EDUCATOR 2011; 37:370-80. [PMID: 21460104 DOI: 10.1177/0145721711400662] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this study was to examine the effects of depression and antidepressant use on goal setting and barrier identification in patients with type 2 diabetes. METHODS In a large diabetes education network, 778 patients with type 2 diabetes were enrolled in the American Association of Diabetes Educators (AADE) Outcomes System as part of their routine diabetes education between 2005 and 2008. Self-reported depression, 7 self-identified behavior change goals, and 13 barriers to diabetes self-care were collected from the Diabetes Self-Management Assessment Report Tool (D-SMART(®)); antidepressant use was documented from the Diabetes Educator Tool (D-ET(®)). Multiple linear regression was used to evaluate the effects of depression or antidepressant use on the number of goals or the number of barriers while controlling for relevant covariates. RESULTS Among 778 patients (507 nondepressed, 181 depressed with antidepressant use, 90 depressed without antidepressant use), median age was 58, 60.9% were female, and 85.9% were Caucasian. Patients with and without depression had a similar number of self-identified behavior change goals, whereas patients with depression had 1 additional barrier to diabetes self-care compared with those without depression. In the depressed subgroup, antidepressant use had no association with the number of goals that the subjects set or the number of barriers they identified. CONCLUSIONS Among patients with type 2 diabetes, depression was associated with a slightly greater number of barriers, which may support the importance of depression screening and depression treatment in patients with diabetes.
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Affiliation(s)
- Hsiang-Yu Chen
- The Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania (Ms Chen, Dr Ruppert, Mr Noullet, Dr Zgibor)
| | - Kristine Ruppert
- The Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania (Ms Chen, Dr Ruppert, Mr Noullet, Dr Zgibor)
| | | | - William V Noullet
- The Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania (Ms Chen, Dr Ruppert, Mr Noullet, Dr Zgibor)
| | - Janice C Zgibor
- The Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania (Ms Chen, Dr Ruppert, Mr Noullet, Dr Zgibor)
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Bengle R, Sinnett S, Johnson T, Johnson MA, Brown A, Lee JS. Food insecurity is associated with cost-related medication non-adherence in community-dwelling, low-income older adults in Georgia. ACTA ACUST UNITED AC 2010; 29:170-91. [PMID: 20473811 DOI: 10.1080/01639361003772400] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Low-income older adults are at increased risk of cutting back on basic needs, including food and medication. This study examined the relationship between food insecurity and cost-related medication non-adherence (CRN) in low-income Georgian older adults. The study sample includes new Older Americans Act Nutrition Program participants and waitlisted people assessed by a self-administered mail survey (N = 1000, mean age 75.0 + so - 9.1 years, 68.4% women, 25.8% African American). About 49.7% of participants were food insecure, while 44.4% reported practicing CRN. Those who were food insecure and/or who practiced CRN were more likely to be African American, low-income, younger, less educated, and to report poorer self-reported health status. Food insecure participants were 2.9 (95% CI 2.2, 4.0) times more likely to practice CRN behaviors than their counterparts after controlling for potential confounders. Improving food security is important inorder to promote adherence to recommended prescription regimens.
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Affiliation(s)
- Rebecca Bengle
- Department of Foods and Nutrition, University of Georgia, 280 Dawson Hall, Athens, GA 30602, USA
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Bair MJ, Brizendine EJ, Ackermann RT, Shen C, Kroenke K, Marrero DG. Prevalence of pain and association with quality of life, depression and glycaemic control in patients with diabetes. Diabet Med 2010; 27:578-84. [PMID: 20536955 DOI: 10.1111/j.1464-5491.2010.02971.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
AIMS To determine the prevalence of pain and its association with glycaemic control, mental health and physical functioning in patients with diabetes. METHODS Cross-sectional data from a multi-site, prospective cohort study of 11 689 participants with diabetes. We analysed the associations of pain severity and interference with glycated haemoglobin (HbA(1c)) measurements and Medical Outcomes Study SF-Mental and Physical Component Summary-12 (MCS-12 and PCS-12) scores. RESULTS Of participants, 57.8% reported moderate to extreme pain and, compared with those without pain, were somewhat older (60.8 vs. 59.9 years, P < 0.001), more obese (body mass index of 32.1 vs. 29.8 kg/m(2), P < 0.001), more likely to report being depressed or anxious (41.3 vs. 16.2%, P < 0.001) and more likely to report fair or poor health (48.5 vs. 23.1%, P < 0.001). Bivariate comparisons demonstrated that patients with extreme pain had higher HbA(1c) than those without pain (8.3 vs. 8.0%, P = 0.001). In multivariable analyses, pain was not associated with HbA(1c) (P = 0.304) but was strongly associated with worse MCS-12 (P < 0.001), PCS-12 (P < 0.001) and depression (P < 0.001). Depression was 1.3 (95% CI: 1.12, 1.96) times more likely in patients with moderate pain and 2.0 (95% CI: 1.56, 2.46) times more likely in patients with extreme pain. CONCLUSIONS Moderate to extreme pain was present in 57.8% of diabetic patients. Pain was strongly associated with poorer mental health and physical functioning, but not worse glycaemic control. Recognizing the high prevalence of pain and its strong association with poorer health-related quality of life may be important to improve the comprehensive management of diabetes.
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Affiliation(s)
- M J Bair
- Roudebush VA Center of Excellence on Implementing Evidence-Based Practice, Indianapolis, IN 46202, USA.
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Gordon EJ, Prohaska TR, Gallant M, Siminoff LA. Self-care strategies and barriers among kidney transplant recipients: a qualitative study. Chronic Illn 2009; 5:75-91. [PMID: 19474231 PMCID: PMC3540789 DOI: 10.1177/1742395309103558] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES We investigated kidney transplant recipients' self-reported levels of exercise and fluid intake. We also examined attitudes about, barriers to undertaking, and strategies used to initiate and maintain adequate self-care for fluid intake, exercise and dietary practices. METHODS A qualitative approach was used and supplemented by quantitative data to examine self-care among kidney transplant recipients (n = 82), including a semi-structured interview and survey of physical activity. RESULTS One-third of patients (33%) reported drinking the recommended 3 L of fluid each day. However, the majority (60%) reported not receiving this or any specific fluid intake recommendation. Twenty percent reported engaging in moderate to regular physical activity while 78% were sedentary. However, many reported that clinicians did not specify the amount of exercise (39%) or did not discuss exercise (15%). Attitudes towards fluid intake, exercise and maintaining a low-salt diet were mostly positive; patients expressed relatively more negative attitudes towards maintaining a low-cholesterol diet. Major barriers to fluid intake were not feeling thirsty, difficulty breaking the habit of limiting fluid intake formed while on dialysis, feeling full and limited access to fluids. Patients devised creative strategies to initiate and maintain appropriate hydration, physical activity and dietary levels, including intentionally drinking when not thirsty, modifying the environment, tracking intake and relying on social supports. CONCLUSIONS Few kidney recipients practiced optimal self-care for fluid intake or physical activity. Most patients encountered barriers to self-care that should be ameliorated to assist patients with managing their transplant. Understanding barriers and strategies is essential for developing educational interventions.
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Affiliation(s)
- Elisa J Gordon
- Institute for Healthcare Studies, Feinberg School of Medicine, Department of Surgery, Division of Organ Transplantation, Northwestern University, Chicago, IL 60611, USA.
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Daily temporal self-care responses to osteoarthritis symptoms by older African Americans and whites. J Cross Cult Gerontol 2009; 23:319-37. [PMID: 18841454 DOI: 10.1007/s10823-008-9082-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Osteoarthritis (OA) is the most prevalent form of arthritis and is among the most prevalent chronic conditions in the USA. Because there is no known cure for OA, treatment is directed towards the alleviation of pain, improving function, and limiting disability. The major burden of care falls on the individual, who tailors personal systems of care to alleviate troublesome symptoms. To date, little has been known about the temporal variations in self-care that older patients with OA develop, nor has it been known to what extent self-care patterns vary with ethnicity and disease severity. This patient-centered descriptive study was designed to demonstrate the self-care strategies used by older African Americans and whites to alleviate the symptoms of OA on a typical day and during specific segments of a typical day over the past 30 days. A sample of 551 older adults participated in in-depth interviews, and the authors clustered their responses into six categories. Findings showed that the frequency of particular behaviors varied by time of day, disease severity, and race. Overall, patterns of self-care behaviors were similar between African Americans and whites, but African Americans used them in different proportions than whites. This study contributes to our knowledge of the dynamic and changing nature of self-care actions even within a single day. By defining how self-care is used in one illness by two different ethnic groups, we may be able to design appropriate educational programs that are more culturally specific to better meet the needs of patients with OA.
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Abstract
The population is aging in the United States as well as worldwide. The prevalence of diabetes increases with increasing age. To provide optimal care to older adults with diabetes, unique psychosocial barriers need to be considered by medical providers. Unlike in younger adults, cognitive dysfunction/dementia and depressive mood disorders are common coexisting conditions in older adults with diabetes. This article reviews recent literature on epidemiology and clinical implications of cognitive and psychosocial dysfunctions in older patients with diabetes. This article focuses on cognitive dysfunctions, dementia, depression, and other psychosocial stresses, and their implications in the care of older adults with diabetes.
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Affiliation(s)
- Isao Iwata
- Harvard Medical School, Joslin Geriatric Diabetes Programs, Beth Israel Deaconess Medical Center, 110 Francis Street, LMOB 1B, Boston, MA 02215, USA
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Pun SPY, Coates V, Benzie IFF. Barriers to the self-care of type 2 diabetes from both patients’ and providers’ perspectives: literature review. ACTA ACUST UNITED AC 2009. [DOI: 10.1111/j.1365-2702.2008.01000.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Striving for control: cognitive, self-care, and faith strategies employed by vulnerable black and white older adults with multiple chronic conditions. J Cross Cult Gerontol 2008; 23:377-99. [PMID: 18987966 DOI: 10.1007/s10823-008-9086-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2007] [Accepted: 10/10/2008] [Indexed: 10/21/2022]
Abstract
The average older adult reaches age 65 with at least two chronic, co-occurring illnesses, or multiple morbidities (MM). We currently lack critical information about the specific strategies older adults use to attempt to control these MM. To increase our understanding of how older adults attempt to manage these MM and retain control of their health, in-depth interviews were conducted with 41 Black and White middle aged and older men and women with MM. We were particularly interested in representing the experience of those groups more vulnerable to adverse health outcomes due to greater disease prevalence and low income. During in-depth interviews, we asked open-ended questions on life and health history and open-ended and semi-structured questions about self-care for multiple morbidities. Participants expressed a strong desire to remain in control of their health; to do so they employed a wide range of strategies including cognitive structuring techniques (being health vigilant, normalizing, resignation/relinquishing control, and social comparison), self-care activities (emphasizing diet, exercise, medication taking, modifying existing activities, going to the doctor), and faith orientations (prayer as a constructive support strategy, gaining strength from God, church as a central part of life). With the exception of faith orientations, there were no race/ethnicity differences in the strategies participants use. Future studies should expand on this knowledge by exploring the contextual, cultural, and psychological backdrop and characteristics that shape the use of these coping strategies.
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Gatt S, Sammut R. An exploratory study of predictors of self-care behaviour in persons with type 2 diabetes. Int J Nurs Stud 2008; 45:1525-33. [DOI: 10.1016/j.ijnurstu.2008.02.006] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2007] [Revised: 02/13/2008] [Accepted: 02/20/2008] [Indexed: 11/26/2022]
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Amoako E, Skelly AH, Rossen EK. Outcomes of an intervention to reduce uncertainty among African American women with diabetes. West J Nurs Res 2008; 30:928-42. [PMID: 18596303 DOI: 10.1177/0193945908320465] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Poor adjustment to diabetes in older African American women may result from uncertainty, stemming from a lack of information about self-care activities, a complexity of self-care activities, comorbid conditions, and a lack of resources. This study evaluated a telephone intervention to reduce uncertainty (through problem-solving strategies, information, cognitive reframing, and improved patient-provider communication)--namely, to measure its effects on diabetes self-care and psychosocial adjustment. Sixty-eight older African American women were randomly assigned to an experimental group and a control group. The experimental group received the intervention for 4 weeks, and the control group received usual care. Psychosocial adjustment and self-care were measured in all participants at baseline and 6 weeks postbaseline. The experimental group reported increased participation in exercise (self-care component; p < .001) and improvement in psychosocial adjustment (p < .001). Thus, reducing the uncertainty related to diabetes self-care improves self-care exercise, as well as psychosocial adjustment.
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Affiliation(s)
- Emelia Amoako
- School of Nursing, The University of North Carolina at Greensboro, Greensboro, NC 27402-6170, USA.
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Piette JD, Kerr E, Richardson C, Heisler M. Veterans Affairs research on health information technologies for diabetes self-management support. J Diabetes Sci Technol 2008; 2:15-23. [PMID: 19885173 PMCID: PMC2769696 DOI: 10.1177/193229680800200104] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Like many patients with diabetes, Department of Veterans Affairs (VA) patients frequently fall short of self-management goals and experience multiple barriers to self-care. Health information technologies (HITs) may provide the tools that patients need to manage their illness under the direction of their primary care team. METHODS We describe several ongoing projects focused on HIT resources for self-management in VA. VA researchers are developing HITs that seek to bolster a variety of potential avenues for self-management support, including patients' relationships with other patients, connections with their informal care networks, and communication with their health care teams. RESULTS Veterans Affairs HIT research projects are developing services that can address the needs of patients with multiple challenges to disease self-care, including multimorbidity, health literacy deficits, and limited treatment access. These services include patient-to-patient interactive voice response (IVR) calling systems, IVR assessments with feedback to informal caregivers, novel information supports for clinical pharmacists based on medication refill data, and enhanced pedometers. CONCLUSION Large health care systems such as the VA can play a critical role in developing HITs for diabetes self-care. To be truly effective, these efforts should include a continuum of studies: observational research to identify barriers to self-management, developmental studies (e.g., usability testing), efficacy trials, and implementation studies to evaluate utility in real-world settings. VA HIT researchers partner with operations to promote the dissemination of efficacious services, and such relationships will be critical to move HIT innovations into practice.
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Affiliation(s)
- John D Piette
- Department of Veterans Affairs Center for Practice Management and Outcomes Research, Michigan Diabetes Research and Training Center, and University of Michigan, Ann Arbor, Michigan 48113-0710, USA.
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Kerr EA, Heisler M, Krein SL, Kabeto M, Langa KM, Weir D, Piette JD. Beyond comorbidity counts: how do comorbidity type and severity influence diabetes patients' treatment priorities and self-management? J Gen Intern Med 2007; 22:1635-40. [PMID: 17647065 PMCID: PMC2219819 DOI: 10.1007/s11606-007-0313-2] [Citation(s) in RCA: 226] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Revised: 05/17/2007] [Accepted: 07/12/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND The majority of older adults have 2 or more chronic conditions and among patients with diabetes, 40% have at least three. OBJECTIVE We sought to understand how the number, type, and severity of comorbidities influence diabetes patients' self-management and treatment priorities. DESIGN Cross-sectional observation study. PATIENTS A total of 1,901 diabetes patients who responded to the 2003 Health and Retirement Study (HRS) diabetes survey. MEASUREMENTS We constructed multivariate models to assess the association between presence of comorbidities and each of 2 self-reported outcomes, diabetes prioritization and self-management ability, controlling for patient demographics. Comorbidity was characterized first by a count of all comorbid conditions, then by the presence of specific comorbidity subtypes (microvascular, macrovascular, and non-diabetes related), and finally by severity of 1 serious comorbidity: heart failure (HF). RESULTS 40% of respondents had at least 1 microvascular comorbidity, 79% at least 1 macrovascular comorbidity, and 61% at least 1 non-diabetes-related comorbidity. Patients with a greater overall number of comorbidities placed lower priority on diabetes and had worse diabetes self-management ability scores. However, only macrovascular and non-diabetes-related comorbidities, but not microvascular comorbidities, were associated with lower diabetes prioritization, whereas higher numbers of microvascular, macrovascular, and non-diabetes-related conditions were all associated with lower diabetes self-management ability scores. Severe, but not mild, HF was associated with lower diabetes prioritization and self-management scores. CONCLUSIONS The type and severity of comorbid conditions, and not just the comorbidity count, influence diabetes patients' self-management. Patients with severely symptomatic comorbidities and those with conditions they consider to be unrelated to diabetes may need additional support in making decisions about care priorities and self-management activities.
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Affiliation(s)
- Eve A Kerr
- VA HSR&D Center of Excellence, VA Ann Arbor Health Care System, Ann Arbor, MI, USA.
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Piette JD. Interactive behavior change technology to support diabetes self-management: where do we stand? Diabetes Care 2007; 30:2425-32. [PMID: 17586735 DOI: 10.2337/dc07-1046] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Chlebowy DO, Garvin BJ. Social support, self-efficacy, and outcome expectations: impact on self-care behaviors and glycemic control in Caucasian and African American adults with type 2 diabetes. THE DIABETES EDUCATOR 2006; 32:777-86. [PMID: 16971711 DOI: 10.1177/0145721706291760] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to examine the relationships of psychosocial variables (social support, self-efficacy, and outcome expectations) to diabetes self-care behaviors and glycemic control in Caucasian and African American adults with type 2 diabetes. METHODS Study participants were scheduled for outpatient visits at 1 of 3 clinical sites in the southeastern United States. All 91 participants completed 4 self-report measures: Social Support Questionnaire (SSQ), Self-efficacy Questionnaire (SEQ), Outcome Expectancy Questionnaire (OEQ), and The Diabetes Activities Questionnaire (TDAQ) at the time of the clinic visit. Long-term glycemic control was assessed by glycosylated hemoglobin analyses at the time of the clinic visit. Pearson product-moment correlations were used to determine whether significant relationships existed between scores on the SSQ, SEQ, OEQ, and TDAQ and glycosylated hemoglobin values. Two-sample t tests were used to detect differences in scores on the self-report measures and glycosylated hemoglobin values between the 2 racial groups. RESULTS In all participants, no significant relationships were found between (1) social support and self-care behaviors and (2) self-efficacy and self-care behaviors. Self-care behaviors were significantly, positively correlated with outcome expectancy scores for the total group and for African Americans. No significant relationships were found between (1) social support and glycemic control, (2) self-efficacy and glycemic control, and (3) outcome expectations and glycemic control. African Americans reported less social support satisfaction than Caucasians did. CONCLUSIONS Psychosocial variables investigated in this study were not related to health outcomes of type 2 diabetes. Caucasians and African Americans were similar in these variables. It is important to investigate the relationships between other variables (eg, age, duration of diabetes, education) and self-care behaviors and glycemic control. Although African Americans experience higher rates of diabetes-related complications than Caucasians do, this may possibly be due to other factors (eg, heredity, financial barriers, inadequate health care). Additional investigations to study the relationships of these variables to diabetes control are warranted.
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Affiliation(s)
| | - Bonnie J Garvin
- The Ohio State University College of Nursing, Columbus (Dr Garvin)
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Abstract
AIM This paper reports the perceived barriers to and effective strategies for self-management of adults with type 2 diabetes in a rural setting. BACKGROUND Worldwide, diabetes is a major public health concern and financial burden. Research shows that, for people with diabetes, adhering to programs of self-care is often problematic. Despite the potential for improved metabolic control and quality of life, little is published on the barriers and effective strategies that people with diabetes successfully use to incorporate plans of care into their lifestyles. METHODS Twenty-four adults diagnosed with type 2 diabetes were recruited from a rural primary care practice to participate in one of three audiotaped focus groups. Content analysis was conducted on the focus group transcripts and validity was strengthened through independent rankings of barriers and strategies by an expert panel and by the nurse researchers. The data were collected 2002. FINDINGS The most frequently reported barriers were lack of knowledge of a specific diet plan, lack of understanding of the plan of care and helplessness and frustration from lack of glycaemic control and continued disease progression despite adherence. Effective strategies identified were developing a collaborative relationship with a provider, maintaining a positive attitude that prompts proactive learning and having a support person who provides encouragement and promotes accountability. CONCLUSIONS These data highlight the importance of barrier and strategy identification in developing and implementing realistic self-management plans and the significance of collaborative alliances between patients and practitioners. Awareness of barriers, identification of strategies to overcome obstacles and the opportunity to problem solve with practitioners assists patients in managing a chronic illness that requires numerous daily decisions.
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Affiliation(s)
- Jean Nagelkerk
- Academic Affairs and Professor of Nursing, Grand Valley State University, Grand Rapids, Michigan 49401, USA.
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Affiliation(s)
- John D Piette
- Center for Practice Management and Outcomes Research, VA Ann Arbor Health Care System, P.O. Box 130170, Ann Arbor, MI 48113-0170, USA.
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Stoller EP, Papp KK, Aikens JE, Erokwu B, Strohl KP. Strategies Resident-Physicians Use to Manage Sleep Loss and Fatigue. MEDICAL EDUCATION ONLINE 2005; 10:4376. [PMID: 28253152 DOI: 10.3402/meo.v10i.4376] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Our purpose is to examine strategies or countermeasures resident-physicians used in dealing with the effects of sleep loss and fatigue during residency training. A total of 149 residents across five sites and six specialty areas were recruited for the study. Focus groups consisted of an average of 7 individuals in the same year of training and residency program, and included 60 interns and 89 senior residents. Trained moderators conducted focus groups using a semi-structured discussion guide. Transcripts were analyzed using the grounded theory tradition. The range of strategies adopted was: Chemical, Dietary, Sleep Management, Behavioral, and Cognitive. Residents exhibited a trial-and-error approach to identifying management strategies. None mentioned searching the scientific literature or consulting local sleep medicine experts. Residents relied on putative countermeasures even when they were aware of their negative effects. Our results document the need to educate resident physicians on self-care strategies during residency training.
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Affiliation(s)
- Eleanor P Stoller
- a Center on Aging and Health Center on Aging and Health at Case Western Reserve University
| | - Klara K Papp
- b School of Medicine, Case Western Reserve University Geriatric Research Education and Clinical Center (GRECC) Cleveland VA Medical Center
| | - James E Aikens
- c Family Medicine and Psychiatry University of Michigan Medical School
| | | | - Kingman P Strohl
- e Department of Medicine, Case Western Reserve University. Louis Stokes Cleveland VA Medical Center
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Sharkey JR. Longitudinal Examination of Homebound Older Adults Who Experience Heightened Food Insufficiency: Effect of Diabetes Status and Implications for Service Provision. THE GERONTOLOGIST 2005; 45:773-82. [PMID: 16326659 DOI: 10.1093/geront/45.6.773] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Healthful eating is important for optimal diabetes self-care. However, the level of food sufficiency may influence the degree of adherence to dietary self-care behaviors through the affordability of nutritionally appropriate food. This study examines whether homebound older adults with diabetes were at greater risk for heightened food insufficiency over 1 year, despite regular receipt of home-delivered meals. DESIGN AND METHODS This was a longitudinal study of a randomly recruited sample of 268 homebound older adults in the Nutrition and Function Study (NAFS) who regularly received home-delivered meals and completed baseline and 1-year in-home assessments. Based on an economic context model, self-reported data were collected on fundamental and proximate factors, food-sufficiency status, and intervening events. Determinants of heightened food insufficiency were examined with multivariate logistic regression models. RESULTS Not only did food-sufficiency status diminish over time in this sample, but it became or remained worse for older adults with diabetes. In addition to diabetes status, heightened food insufficiency was associated with perceived inadequacy of economic resources. IMPLICATIONS Health care providers and nutrition programs should attempt to identify high-risk older adults - those who have diabetes and are at risk of food insufficiency - and develop community linkages and strategies that integrate nutrition with diabetes care plans, thus supporting a multidisciplinary, chronic care model to improve diabetes management and outcomes.
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Affiliation(s)
- Joseph R Sharkey
- Department of Social and Behavioral Health, Texas Healthy Aging Research Network (TxHAN) Center, Texas A&M Health Science Center, College Station, 77840, USA.
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Roberto KA, Gigliotti CM, Husser EK. Older Women's Experiences with Multiple Health Conditions: Daily Challenges and Care Practices. Health Care Women Int 2005; 26:672-92. [PMID: 16234211 DOI: 10.1080/07399330500177147] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Guided by life-course theory and a trajectory model of chronic illness, we examined the health care practices and management strategies used by 17 older women with multiple chronic conditions. Qualitative analyses revealed that the women played an active role in shaping the course of their illness within their everyday lives. Pain and a decline in energy frequently interfered with completion of daily activities. To compensate, many women reduced and slowed down the pace of activities they performed while emphasizing the importance of maintaining independence and autonomy. Appreciative of support from family members, at times the women received more help and advice than they preferred.
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Affiliation(s)
- Karen A Roberto
- Center for Gerontology, Virginia Polytechnic Institute and State University, Blacksburg 24061, Virginia.
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Polzer R, Miles MS. Spirituality and self-management of diabetes in African Americans. J Holist Nurs 2005; 23:230-50; discussion 251-4; quiz 226-7. [PMID: 15883469 DOI: 10.1177/0898010105276179] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Attention to spirituality is especially important for nurses when providing care to African Americans. Spirituality is deeply embedded in their rich cultural heritage. For many African Americans, spirituality is intertwined into all aspects of life, including beliefs about health and illness. Therefore, it is imperative that nurses understand the relationship between African American spirituality, health, and self-management of illness to provide culturally competent care to African Americans. The purpose of this article is to summarize the research literature on African American spirituality, health, and self-management as it relates to Type 2 diabetes, an illness that involves complex self-care management. Recommendations for holistic nursing practice and research related to this literature are also identified.
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Dutton GR, Johnson J, Whitehead D, Bodenlos JS, Brantley PJ. Barriers to physical activity among predominantly low-income African-American patients with type 2 diabetes. Diabetes Care 2005; 28:1209-10. [PMID: 15855592 DOI: 10.2337/diacare.28.5.1209] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Gareth R Dutton
- Centers for Behavioral and Preventive Medicine, Brown University Medical School, 1 Hoppin Street, Coro Building, Suite 500, Providence, RI 02903, USA.
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Abstract
OBJECTIVE Many adults experience chronic pain, yet little is known about the consequences of such pain among individuals with diabetes. The purpose of this study was to examine whether and how chronic pain affects diabetes self-management. RESEARCH DESIGN AND METHODS This is a cross-sectional study of 993 patients with diabetes receiving care through the Department of Veterans Affairs (VA). Data on chronic pain, defined as pain present most of the time for 6 months or more during the past year, and diabetes self-management were collected through a written survey. Multivariable regression techniques were used to examine the association between the presence and severity of chronic pain and difficulty with diabetes self-management, adjusting for sociodemographic and other health characteristics including depression. RESULTS Approximately 60% of respondents reported chronic pain. Patients with chronic pain had poorer diabetes self-management overall (P = 0.002) and more difficulty following a recommended exercise plan (adjusted odds ratio [OR] 3.0 [95% CI 2.1-4.1]) and eating plan (1.6 [1.2-2.1]). Individuals with severe or very severe pain, compared with mild or moderate, reported significantly poorer diabetes self-management (P = 0.003), including greater difficulty with taking diabetes medications (2.0 [1.2-3.4]) and exercise (2.5 [1.3-5.0]). CONCLUSIONS Chronic pain was prevalent in this cohort of patients with diabetes. Even after controlling for general health status and depressive symptoms, chronic pain was a major limiting factor in the performance of self-care behaviors that are important for minimizing diabetes-related complications. Competing demands, such as chronic pain, should be considered when working with patients to develop effective diabetes self-care regimens.
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Affiliation(s)
- Sarah L Krein
- Center for Practice Management and Outcomes Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.
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Savoca MR, Miller CK, Quandt SA. Profiles of people with type 2 diabetes mellitus: the extremes of glycemic control. Soc Sci Med 2004; 58:2655-66. [PMID: 15081213 DOI: 10.1016/j.socscimed.2003.09.031] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
For people with diabetes, hemoglobin A1c (HbA1c) is a measure of blood glucose control and an indication of the risk of developing diabetes complications. However, a given HbA1c value does not provide information about the diabetes self-management practices or philosophies of individuals in poor (HbA1c > 8.0%) or excellent (HbA1c < 6.5%) control. To contrast the experiences and attitudes of people at the extremes of glycemic control, interviews were conducted among 44 individuals (40-65 years old) diagnosed with diabetes for over 1 year. The participants were identified based upon their HbA1c value from a larger sample of people with type 2 diabetes that included African Americans, women, and persons with low income. Narratives were analyzed using a case-based and conceptually clustered matrix approach. The life course concept (life histories and natural transitions in roles and responsibilities across the life span) and the explanatory model of illness (individuals' beliefs about the causes, consequences, and treatment of a disease) provided the framework for the interview guide and the analysis of the narratives. Two self-management philosophy groups emerged from participants with excellent control (Committed [n = 15] and Tentative [ n = 7]) and three groups were identified among the poorly controlled group (Hopeful [n = 8], Hassled [n = 6 ], and Overwhelmed [n = 8]). Perseverance, coping skills, and age at diagnosis were life course concepts that distinguished participants within these groups. From the explanatory model of illness, beliefs about the cause of the disease, physical changes, and accepting the consequence of the disease influenced differences in these self-management philosophies. The profiles of people at the extremes of glycemic control can help those treating people with diabetes or seeking to improve self-management interventions understand differences in self-management philosophies and concentrate on specific issues hindering self-care control.
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Affiliation(s)
- Margaret R Savoca
- Department of Pediatrics, Georgia Prevention Institute, Medical College of Georgia, Augusta, GA 30901, USA
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Schoenberg NE, Amey CH, Stoller EP, Muldoon SB. Lay referral patterns involved in cardiac treatment decision making among middle-aged and older adults. THE GERONTOLOGIST 2003; 43:493-502. [PMID: 12937328 DOI: 10.1093/geront/43.4.493] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE This study examined age and contextually related factors that are influential in lay referral patterns during cardiac treatment decision making. DESIGN AND METHODS A complementary design was used. The Myocardial Infarction (MI) Onset Study identified demographic correlates of who sought medical care for 1,388 MI (heart attack) survivors. Thirty-five in-depth MI illness narratives explicated lay referral patterns. RESULTS Data revealed a linear association between older age and reliance on another person to seek medical attention for cardiac symptoms, with gender also shaping lay referral patterns. Although spouses and children were the most frequently cited decision makers for older respondents, friends and other family members also influenced care-seeking decisions. Qualitative results substantiated and provided explanations for such patterns. IMPLICATIONS Our results highlight the need for researchers to attend to the complex social processes of lay consultation and for health education messages to extend to venues where lay cardiac decisions are made, including the worksite and social gathering places such as religious institutions. Enhanced outreach includes tailoring health messages to elders and their significant others and casting a broader net to include nontraditional significant others.
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Affiliation(s)
- Nancy E Schoenberg
- Department of Behavioral Science, 125 College of Medicine Office Building, University of Kentucky, Lexington, KY 40536-0086, USA.
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