Self-Care Behaviors and Glycemic Control in Low-Income Adults in México With Type 2 Diabetes Mellitus May Have Implications for Patients of Mexican Heritage Living in the United States

Literacia em Saúde e o Autocuidado e Autocontrolo no Idoso com Diabetes Tipo 2

Introdução. A diabetes como doença crónica, representa um grave problema de saúde pública a nível mundial, pela sua incidência, e pela elevada taxa de morbilidade e mortalidade com fortes repercussões na vida das pessoas. Objetivo. Conhecer efeito de programa de educação para a saúde sobre o conhecimento da diabetes, capacitação para o autocuidado e literacia em saúde no idoso diabético. Método. Estudo quasi-experimental de grupo único, com amostra de 40 participantes diabéticos tipo 2, com 65 ou mais anos de idade, autónomos. Instrumentos: Questionário Sociodemográfico e Clínico; Questionário de Avaliação de Conhecimentos (DKQ-24) (α = 0.83); Escala Atividades de Autocuidado com a Diabetes (α = 0.62); Questionário Literacia Newest Vital Sign (α = 0.76). Realizou-se uma análise estatística descritiva e inferencial. Resultados. Diferenças estatisticamente significativas no conhecimento sobre diabetes entre o 1º e 2º momento de avaliação. Nas atividades de autocuidado com a diabetes encontramos diferenças estatisticamente significativas nas atividades Alimentação, Alimentação Específica e Cuidados com os Pés. A literacia em saúde, na 1ª avaliação, situou-se a um nível de alta probabilidade de literacia limitada e após intervenção evoluiu positivamente, demonstrando um aumento do nível de literacia. Conclusão. Este estudo comprovou a importância dos programas de educação para a saúde como uma ferramenta potente para a capacitação da pessoa diabética. Verificou-se que o nível de conhecimentos sobre a doença na pessoa diabética tipo 2 com mais de 65 anos aumentou de forma significativa, e interferiu positivamente na capacitação do diabético idoso para a gestão das atividades de autocuidado aumentando o nível de literacia em saúde.

Predictors of Adherence to Self-Care Behavior Among Patients with Diabetes at Public Hospitals in West Ethiopia

BACKGROUND

Diabetes is a typical chronic disease that needs integrated and multifaceted approaches. Self-care practices are fundamental to achieve good blood glucose control and prevent long-term complications. Therefore, the aim of the study was to determine the level and predictors of adherence to self-care behavior among patients with diabetes on follow-up at public hospitals of western Ethiopia.

PATIENTS AND METHODS

The cross-sectional study design was employed on a sample of 423 diabetic patients on follow-up at public hospitals of western Ethiopia. A systematic random sampling method was employed. The data were entered into Epi data version 3.1 and exported into Statistical Package for the Social Sciences window version 24 for analysis. All variables significant at p-value <0.05 in the bivariable were entered in multivariate regression analysis. Backward stepwise goodness of fit was used to ascertain the suitable variables in multiple linear regression analysis. Finally, multivariate linear regression analysis with adjusted B, CI at 95%, and the significance level was set at p <0.05. All predictive variables were reported in terms of adjusted R2.

RESULTS

The overall mean and standard deviation of adherence to self-care behavior was 23.09 ±6.55. Among the study participants, 42.70% had good self-care behavior. Self-efficacy (B=0.106, p<0.001), home blood glucose test (B=0.075, p<0.001), exercise per week (0.035, P<0.002), meal planning (B=0.039, P<0.001), dietary restriction (B=0.077, P<0.001), duration of diabetes<4 years (B=0.030, P<0.013), non-pharmacological intervention (B=0.055, P<0.011), and good appetite (B=0.039, P<0.045) were significant variables associated with adherence to self-care behaviors.

CONCLUSION

The overall level of adherence to self-care behavior was low. Therefore, we recommended that it is better if the national health policymaker focused on dietary management modality that engages patients' behavior change to develop self-care practices and closely monitoring of glucose level. Also, we recommended an additional longitudinal study incorporating a qualitative study that focused on behavioral changes.

Development of a diabetes self-management + mHealth program: tailoring the intervention for a pilot study in a low-income setting in Mexico

Background

Type 2 diabetes (T2D) is a public health pandemic disproportionately affecting low- and middle-income countries. The purpose of this formative research was to adapt evidence-based diabetes self-management education programs to the context of Seguro Popular clinics in Mexico. A theory-based mHealth (pictorial text messaging) component was developed.

Method

Our formative research and development of the program protocol consisted of six phases: (1) interviews and focus groups with stakeholders on the challenges to T2D management, curriculum content needs, and the use of mHealth as a supplement to a DSME program; (2) review of the theoretical underpinning, curriculum, and interactive strategies of four evidence-based DSME programs and modification to meet the needs of adults with T2D and systems of care in Mexico City; (3) development of theory-based illustrated text messages; (4) evaluation of text messaging acceptability and access in adults with T2D via focus groups; (5) development of program manual; and (6) development of a training program for health care providers.

Results

The ¡Sí, Yo Puedo Vivir Sano Con Diabetes! included 7 group-based weekly lessons; simple, interactive content; weekly empowerment messages; video novellas; group activities; and goal setting. Adaptations to the cultural context of Mexico included content/activities on diabetes etiology (addressing cultural misconceptions), nutrition (indigenous foods and plate method), self-blood glucose monitoring, and diabetes-related stress/coping. We used the Health Action Process Approach to guide the text message development, which posits that adoption, initiation, and maintenance of health behaviors require the development of intentions, plans, coping, and self-efficacy. Our final text message bank consisted of 181 messages. There were approximately 20–30 messages for each process of behavior change (e.g., action planning, maintenance self-efficacy) and 30 messages for each content topic (e.g., eating healthy, physical activity). There were 96 messages that were illustrated. Training materials were also developed.

Discussion

We used a systematic approach, collaboration with stakeholders, and a well-established behavior change theory to develop an evidence-based intervention to an international context and system of care. Collectively, this process has the potential to enhance the feasibility, acceptability, and efficacy of the program.

The Space Between: Transformative Learning and Type 2 Diabetes Self-Management

INTRODUCTION

Immigrant populations experience higher type 2 diabetes mellitus (T2DM) prevalence rates and worse health outcomes secondary to T2DM than native-born populations. But as the largest immigrant population in the United States, the experience of T2DM diagnosis and self-management among Spanish-speaking, limited English-language proficient Latinx immigrants remains largely unexamined. This study used semistructured interviews to explore these phenomena among a cohort of 30 recent Latinx immigrants.

METHOD

All aspects of data collection were conducted in Spanish. Quantitative and qualitative data were collected. Data analysis included descriptive statistical procedures. Qualitative data analysis was conducted using a grounded theory approach.

RESULTS

Patterns in the data analysis of 30 interviews identified accepting T2DM as a common transitional process that required significant changes in individuals' self-perspective and ways of being. Accepting T2DM was identified by the participants as a precursor to treatment initiation. And while for most participants this transition period was brief, for some it took months to years. Distinct transitional stages were identified, categorized, and considered within the context of several theoretical orientations and were observed to align with those in transformative learning.

CONCLUSION

Understanding differing responses and processing of a T2DM diagnosis could be leveraged to better support patients' acceptance and transition into treatment.

Challenges to diabetes self-management for adults with type 2 diabetes in low-resource settings in Mexico City: a qualitative descriptive study

Background

The prevalence of type 2 diabetes (T2D) in Mexico is one of the highest in the world, with high morbidity and mortality, and difficulty meeting glycemic targets. The purpose of this study was to identify the challenges for T2D self-management as perceived by both adults with T2D and health care providers in primary health clinics from Seguro Popular in Mexico City.

Methods

This was a qualitative descriptive study conducted in three Seguro Popular primary care clinics in Mexico City using convenience sampling. Semi-structured interviews were conducted with participants and data were analyzed using a content analysis approach.

Results

The sample included 20 adults with T2D [52.5 years old (SD = 9.9), diagnosed with T2D for 12.3 years (SD = 6.3), mean A1C of 9.8% (SD = 2.4), 80% female, 90% with financial insecurity] and 19 providers [primarily female (78.9%), mean age of 41.6 years old (SD = 11.4), 12.3 mean years in practice (SD = 8.50)]. Personal challenges included cultural beliefs, lack of resources, challenges to lifestyle modification, lack of family support/competing demands, and mental health issues. System level challenges included lack of resources, perceived quality of care, and patient engagement barriers.

Conclusions

Evidence-based diabetes self-management programs need to become more accessible, taking into consideration the social determinants of health and building upon current initiatives to improve early diagnosis and treatment of T2D. Cultural beliefs, personal control, and low health literacy influence diabetes self-management in adults with T2D with limited resources. Mental health and financial challenges of adults with T2D will require multidisciplinary team-based care. Future research on best practices to implement and scale-up evidence-based patient-centered T2D prevention and DSME programs for the poor and underserved is warranted in Mexico and world-wide.

Effects of Guided Reflection on Diabetes Self-Care: A Randomized Controlled Trial

The purpose of this study was to evaluate the effects of guided reflection on self-care behaviors, confidence scores, and diabetes knowledge among adults with diabetes. A randomized controlled trial with a pre/posttest design was used to generate data from a convenience sample of 62 adults with diabetes recruited from a single site. After viewing a 30-minute video on how to manage diabetes, participants were randomized to a control group (CG) (usual care) or an intervention group (IG). The IG further engaged in a reflection educational session. For 8 weeks, the IG isolated diabetes-related events weekly, critically analyzed them using Gibbs's reflective questions, and recorded their analysis in a journal. They also shared their perspective relative to using the journal in an audiotaped interview. Main measures included baseline and 8-week clinical outcomes (self-care maintenance, monitoring, management, and confidence scores and diabetes knowledge scores) and intervention acceptability. Compared to the CG, the IG had no statistically significant difference in self-care measures over time, although scores trended in the anticipated direction. Importantly, both groups had statistically significant improvement in self-care scores. Furthermore, there was statistically significant improvement in diabetes knowledge among IG participants. Informatively, IG critically analyzed 147 diabetes-related events concentrating on blood glucose, diet, exercise, monitoring, medication, sleep pattern, and health care visits. Participants found the guided reflection activity highly acceptable. Combined educational and reflection interventions are effective approaches for improving self-care outcomes and diabetes knowledge among adults with diabetes. Research concentrating on purposeful patient reflection is warranted in a larger sample paying careful attention to study limitations.

Living With Type 2 Diabetes in San Jose Tecoh, Yucatan, Mexico: A Phenomenological Study

INTRODUCTION

Understanding the psychosocial aspects that accompany and influence type 2 diabetes mellitus (T2DM) has become increasingly important for culturally appropriate health care in Mexico. The purpose of this study was to understand the lived experience of individuals' with T2DM in Merida, Yucatan.

METHOD

A phenomenological method guided data collection and analysis. Patients in San Jose Tecoh, diagnosed with T2DM for at least 5 years, were interviewed.

RESULTS

Eight (six female, two male) patients described their lived experience. Individuals discussed knowledge of the disease (e.g., care, beliefs about origin, consequences, type, symptoms) and changes arising from diagnosis (e.g., emotional, dietary, physiological, lifestyle and self-care, economic).

DISCUSSION

The Mayan-Yucatecan cultural perceptions of factors that influence physical health are unique to this region. Nurses can facilitate improvement in T2DM health outcomes through providing information and encouraging self-care. Our results emphasize the importance of considering T2DM in terms of differences between and within culture.

Socio-demographic and clinical determinants of self-care in adults with type 2 diabetes: a multicentre observational study

AIMS

To describe self-care as defined by the Middle Range Theory of Self-Care of Chronic Illness and to identify clinical and socio-demographic determinants in a T2DM population.

METHODS

A multicentre observational cross-sectional study was conducted involving 540 adults with a confirmed diagnosis of T2DM from six outpatient diabetes services in Italy. Socio-demographic and clinical data were collected from medical records. The Self-Care of Diabetes Inventory (SCODI) was used to measure self-care maintenance, monitoring, management, and confidence dimensions. For each separate scale, scores were standardized 0-100 with higher SCODI scores indicating better self-care; a score ≥ 70 is adequate. Multiple quantile regression models were performed to identify determinants of each self-care dimension.

RESULTS

Self-care maintenance (median = 81.3) and self-care confidence (median = 79.5) were adequate in most of the subjects. Self-care monitoring was adequate in only half of the sample (median = 70.6). Self-care management was poor (median = 59.4). Lower self-care maintenance was associated with lower self-care confidence (p < 0.001). Lower self-care monitoring was associated with being male (p < 0.001), having lower self-care confidence (p < 001), and having diabetes for < 10 years (p < 0.001). Lower self-care management was associated with being male (p = 0.002), being older (p = 0.005), having a low income (p = 0.030), being employed (p = 0.008), having missed diabetes education in the last year (p = 0.002), and lower self-care confidence (p < 0.0001). Lower self-care confidence was associated with having diabetes for < 10 years (p = 0.008), and having at least one comorbid condition (p = 0.006).

CONCLUSIONS

Determinants of self-care maintenance, monitoring, management and confidence include both clinical and socio-demographic variables. Modifiable determinants such as self-care confidence and diabetes self-care management education could be used to tailor interventions to improve diabetes self-care.

Type 2 Diabetes Self-management Among Spanish-Speaking Hispanic Immigrants

This article describes the quantitative findings of a mixed-methods study that examined the relationship among knowledge, self-efficacy, health promoting behaviors, and type 2 diabetes self-management among recent Spanish-speaking, limited English proficient immigrants to the US. This population is at risk for both a higher incidence of disease and increased barriers to successful disease management compared to the general US population. Distinguishing aspects of this study compared to the available literature are the comprehensive nature of the data collected, the theoretical component, and the analysis and modeling approach. Social cognitive theory provides the framework for the study design and analysis. An innovative community-based recruiting strategy was used, a broad range of physiological measures related to health were observed, and instruments related to knowledge, self-efficacy, and healthy lifestyle behaviors were administered orally in Spanish to 30 participants. A broad range of statistical analysis methods was applied to the data, including a set of three structural equation models. The study results are consistent with the importance of education, health knowledge, and healthy lifestyle practices for type 2 diabetes self-management. With the usual cautions associated with applying structural equation modeling to modest sample sizes, multiple elements of the posited theoretical model were consistent with the data collected. The results of the investigation of this under-studied population indicate that, on average, participants were not effectively managing their disease. The results suggest that clinical interventions focused on improving knowledge, nutrition, and physical activity, reducing stress, and leveraging the importance of interpersonal relations could be effective intervention strategies to improve self-management among this population.

Self-care, quality of life and clinical outcomes of type 2 diabetes patients: an observational cross-sectional study

AIMS

To describe self-care of T2DM patients and to evaluate outcomes associated with self-care in T2DM patients.

METHODS

A multicentre cross-sectional study was conducted on a sample of 302 randomly selected T2DM patients. Clinical and socio-demographic data were collected by medical records. The Summary of Diabetes Self-care Activities was used to measure self-care about diet, blood testing, exercise and foot care. The EQ-5D was used to measure perceived quality of life. Multiple regression models were used to evaluate the associations between self-care and body mass index (BMI), glycated haemoglobin (HbA1c), presence of diabetes complications and quality of life (QoL).

RESULTS

Self-care was lower about exercise (median = 2.0) and foot care (median = 3.5) than about diet (median = 5.2) and blood testing (median = 4.5). HbA1c was associated with diet (p = 0.025), exercise (p = 0.017) and blood testing (p = 0.034). BMI was associated with exercise (p = 0.0071). Diabetes complications were associated with exercise (p = 0.031) and blood testing (p < 0.009). QoL was associated with exercise (p < 0.0001), blood testing (p = 0.032) and foot care (p = 0.013).

CONCLUSIONS

Self-care influences both clinical outcomes and quality of life of T2DM patients. Although exercise is more frequently associated with positive outcomes, it is particularly poor in T2DM population. Blood testing and foot care should be performed to prevent complications and not only when a health problem is already occurred. Interventions aimed to improve exercise are recommended. Further research is needed to explore barriers to exercise.

Effects of a Family-based Diabetes Intervention on Behavioral and Biological Outcomes for Mexican American Adults

Purpose The purpose of the study was to investigate the effects of a family-based self-management support intervention for adults with type 2 diabetes (T2DM). Methods Using a 2-group, experimental repeated measures design, 157 dyads (participant with T2DM and family member) were randomly assigned to an intervention (education, social support, home visits, and telephone calls) or a wait list control group. Data were collected at baseline, postintervention (3 months), and 6 months postintervention. A series of 2 × 3 repeated measures ANOVAs were used to test the hypotheses with interaction contrasts to assess immediate and sustained intervention effects. Results Significant changes over time were reported in diet self-management, exercise self-management, total self-management, diabetes self-efficacy for general health and total diabetes self-efficacy, physician distress, regimen distress, interpersonal distress, and total distress. There were likewise sustained effects for diet self-management, total self-management, diabetes self-efficacy for general health, total self-efficacy, physician distress, regimen distress, and interpersonal distress. Conclusions Results support and extend prior research documenting the value of culturally relevant family-based interventions to improve diabetes self-management and substantiate the need for intensive, longer, tailored interventions to achieve glycemic control.

Are home visits an effective method for diabetes management? A quantitative systematic review and meta-analysis

AIMS/INTRODUCTION

Previous reviews have revealed uncertainty regarding the effectiveness of home visit interventions for managing diabetes. Therefore, we carried out a quantitative systematic review and meta-analysis to evaluate the effects of home visit interventions among patients with diabetes.

MATERIALS AND METHODS

We searched various electronic databases (PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL, Wanfang and Chinese scientific full-text databases) from their inception until March 2016. We included randomized controlled trials that included patients with diabetes, and evaluated the effects of home visit programs on glycated hemoglobin concentrations. Two reviewers independently used the Cochrane Collaboration methods to assess the included studies' risk of bias and quality.

RESULTS

We included seven randomized controlled trials with 686 participants. Compared with the usual care, the home visit group showed a greater reduction in glycated hemoglobin concentrations (mean difference -0.79% [-9 mmol/mol], 95% confidence interval [CI]: -0.93 to -0.25% [11 to -3 mmol/mol]; P < 0.05; I²  = 0%), systolic blood pressure (mean difference -5.94 mmHg, 95% confidence interval -11.34 to -0.54 mmHg) and diastolic blood pressure (mean difference -6.32 mmHg, 95% confidence interval -12.00 to -0.65 mmHg). Furthermore, home visits improved quality of life, high-density lipoprotein, low-density lipoprotein, total triglycerides and self-management. However, there were no significant differences between the two groups in their bodyweight, total cholesterol, body mass index and self-efficacy.

CONCLUSION

Home visits were associated with improved glycemic control and reduced cardiovascular risk factors, which shows that it is an effective method for diabetes management.