"Worried all the time'': distress and the circumstances of everyday life among immigrant Australians with type 2 diabetes

Major sight-threatening eye disorders and mental disorders

The purpose of this study was to: (a) investigate the comorbidities of major sight-threatening eye disorders with mental disorders, (b) investigate the associations and prevalence of reported comorbidities and (c) identify potential influencing factors. A systematic review of the PubMed, Embase, Web of Science and Cochrane Library databases was conducted from inception to 30 December 2023. Studies that presented only laboratory results or used non-representative sampling methods were excluded. Meta-analyses were performed using the inverse variance method with a random-effects model. A total of 67 studies were included in the analysis. The most prevalent comorbidities were diabetic retinopathy (DR) and depression (pooled prevalence of 30%) and DR and anxiety (pooled prevalence of 29%). Significant associations were found between glaucoma and depression (odds ratio [OR] = 1.42, 95% confidence interval [CI] = 1.21-1.66), glaucoma and anxiety (OR = 2.11, 95% CI = 1.22-3.66), glaucoma and schizophrenia (OR = 1.38, 95% CI = 1.28-1.50), age-related macular degeneration (AMD) and depression (OR = 1.36, 95% CI = 1.18-1.57), and DR and depression (OR = 1.03, 95% CI = 1.01-1.06). Income was identified as a significant contributing factor to the prevalence of comorbidity between glaucoma and depression. Major sight-threatening eye disorders were significantly associated with mental disorders, particularly depression and anxiety. The burden of comorbidity between major sight-threatening eye disorders and mental disorders is not optimistic and may be influenced by income disparities. Healthcare providers are encouraged to assess and manage potential comorbidities to optimize patient outcomes.

Understanding Experiences of Diabetes Distress: A Systematic Review and Thematic Synthesis

Background: Diabetes distress is a common emotional issue for those living with diabetes, which has the potential to negatively impact well-being, management behaviors, and HbA1c levels. These implications have led to diabetes distress becoming an important consideration in diabetes healthcare and management. Nonetheless, discussions remain ongoing on how to best conceptualize this experience. Recent research has attempted to enhance conceptualization by considering the underlying emotional mechanisms that may underpin the highly contextualized experience of diabetes distress. Qualitative insights can further add to these understandings; however, the research in this remit is yet to be systematically reviewed. This review therefore sought to add to the growing body of literature attempting to better conceptualize diabetes distress and the underlying mechanisms that may contribute to this experience. A secondary aim was to leverage this understanding to consider ways to improve patient-healthcare interactions. Methods: A qualitative systematic review and thematic synthesis was undertaken. Eligible studies were identified through PsycINFO, MEDLINE, CINAHL, and EMBASE databases from November 2020 to May 2021. Study quality was assessed using the McMaster Critical Review Form. Results: Nineteen papers were included in the review. The analysis resulted in seven descriptive themes which contributed to three analytical themes: (1) threatened autonomy, (2) sense of helplessness, and (3) negative sense of self. These results highlight that a major area underpinning experiences of diabetes distress is not feeling in control. Conclusions: Consideration should be given to how psychological factors, such as locus of control and learned helplessness, may constitute underlying mechanisms impacting emotional regulation in those experiencing diabetes distress. Clinicians should consider including and leading discussions around distress during appointments, as well as using approaches that promote patient autonomy and empowerment.

Social isolation in people with type 2 diabetes: A concept analysis

Objective

To identify the defining attributes, antecedents, consequences and empirical referents to form an operational definition of social isolation in people with type 2 diabetes.

Design

The Walker and Avant approach.

Data source

An electronic search of the literature using China National Knowledge Infrastructure (CNKI), Wanfang database, PubMed, Web of Science, CINAHL, and PsycINFO informed the analysis. The search included both quantitative and qualitative studies related to social isolation in people with type 2 diabetes published in Chinese and English.

Results

Of the 2918 articles identified, 21 ultimately met the inclusion criteria. The analysis identified the defining attributes of social isolation in people with type 2 diabetes as objective and subjective. Antecedents included five aspects: personal characteristics, disease-related physiological factors, and psychological, behavioral, and social factors. Consequences were identified as physiological, psychological, behavioral aspects and quality of life.

Conclusions

The operational definition of social isolation in people with type 2 diabetes is that due to personal characteristics, disease-related physiological factors, and psychological, behavioral, and social factors, people with type 2 diabetes will have limited social networks and social support, reduced social contact and social involvement, and/or negative feelings of disconnection from the outside world, which lead to adverse physiological, psychological, and behavioral outcomes and poor quality of life. Clinicians can further develop tools to measure social isolation in people with type 2 diabetes and analyze the path of the antecedents to social isolation to investigate the interplay between them in order to develop target interventions.

Help-seeking during 1-year follow-up in Chinese patients diagnosed with type 2 diabetes mellitus comorbid major depressive disorder

Introduction

Previous research has revealed a bidirectional relationship between type 2 diabetes mellitus (T2DM) and major depressive disorder (MDD). A very limited proportion of patients with T2DM comorbid MDD received adequate psychiatric intervention. This study investigated the help-seeking behaviors of patients with T2DM comorbid with MDD during one-year follow-up.

Methods

At a medical center in China, a cohort of outpatients with T2DM were assessed and diagnosed for comorbid depression at baseline and after one year. The Mini International Neuropsychiatric Interview was used to diagnose MDD, while The Patient Health Questionnaire-9 (PHQ-9) and The Hamilton Depression Scale 17-item (HAMD-17) were used for depression assessment. Mental health help-seeking behaviors of patients during follow-up period were also evaluated.

Results

Out of the 203 patients with T2DM at baseline, 114 (56.2%) completed the follow-up. The prevalence of MDD in participants with T2DM was 12.8% at baseline and 22.8% at follow-up. Patients who completed the follow-up had a lower baseline PHQ-9 score (test statistic -2.068, p=0.039), HAMD-17 score (test statistic -2.285, p=0.022) than those who did not complete the follow-up. A total of 26 patients had comorbid MDD during the follow-up period, among which 8 patients (30.8%) voluntarily visited psychiatric clinics, while others did not seek assistance. The level of HbA1c at follow-up was higher in patients who sought help than in those who did not (8.1 ± 1.8% vs. 7.0 ± 0.7%), although the difference was not statistically significant.

Conclusion

Voluntary psychiatric help-seeking for Chinese patients with comorbid T2DM and MDD is uncommon. It is crucial to increase awareness of depression among patients and healthcare professionals alike.

Flourishing with chronic illness(es) and everyday stress: Experiences from Soweto, South Africa

The pursuit of flourishing, or living a good life, is a common human endeavor with different meanings across individuals and contexts. What is needed is a further exploration of the relationship between flourishing and health, particularly chronic illness, which affects individuals across the life course and is affected by experiences of stress derived from social and structural vulnerability. Drawing on data from the Soweto Syndemics study, including a locally derived stress scale and in-depth interviews, we explore the connections between flourishing and health for those living with multiple chronic illnesses in Soweto, South Africa within a syndemic of communicable and non-communicable disease. Rather than drawing on Western-centric notions of flourishing (which place emphasis on an individual's capabilities or capacities to thrive), we draw on previous ethnographic work on flourishing in Soweto, South Africa, which described how ukuphumelela, or "becoming victorious," as a social or communal affair. This conceptualization reflects local values and priorities for people's lives and the ways in which their lives are deeply intertwined with each other. We contribute to a more robust understanding of flourishing in context, of how chronic illness is experienced, and of how the role of a patient is transcended in spaces where individuals are part of a social or faith community. As people living with chronic illness(es) actively pursue the good life, health care systems must consider these pursuits as valid parts of the human experience that also challenge narrow definitions of health.

What is important for people with type 2 diabetes? A focus group study to identify relevant aspects for Patient-Reported Outcome Measures in diabetes care

Background

Patient-Reported Outcome Measures (PROMs) aim to evaluate the quality of care based on the perspectives of patients rather than clinical indicators. Qualitative research is needed to identify these perspectives in people with type 2 diabetes.

Objective

To identify, for the first time in Israel, aspects valuable for people with type 2 diabetes that can be relevant for PROMs in diabetes care.

Methods

A qualitative study included three focus groups totalling 19 people with type 2 diabetes. Inclusion criteria were: (1)type 2 diabetes, (2)diabetes duration of at least six months, and (3)adults aged 45–80 years. Purposive sampling enabled recruitment of heterogeneous participants. Also, two experts’ panels with healthcare providers involved in diabetes care (n = 23) were conducted to provide triangulation of information (more testimony about what is valuable for people with type 2 diabetes). Discussions were recorded, transcribed and thematically analysed.

Results

Four domains were deemed valuable for people with type 2 diabetes: (1)challenges of living with diabetes, including reduced physical function, healthy lifestyle struggles, sexual dysfunction, and financial burden, (2)mental health issues, including depression, distress, anxiety, frustration, and loneliness, (3)self-management ability, including management of lifestyle modifications and treatment, knowledge about the disease and treatment, and (4)patient-clinician relationships, including the devotion of clinicians, trust in clinicians and treatment, shared decision-making, and multidisciplinary care under one roof. Experts favour using PROMs in diabetes routine care and even acknowledged their necessity to improve the treatment process. However, only some of the domains raised by people with type 2 diabetes were identified by the experts.

Conclusions

There are content gaps between perspectives of people with type 2 diabetes and their healthcare providers. PROMs are essential in addressing issues largely not addressed in routine diabetes care. We recommend that researchers and healthcare providers, who intend to utilize PROMs for diabetes care, consider the aforementioned domains.

Emotional distress, anxiety and depression in South Asians with long-term conditions: a qualitative systematic review

Background

People with physical–mental comorbidity have a poorer quality of life, worse clinical outcomes, and increased mortality compared with people with physical conditions alone. People of South Asian (SA) origin are the largest minority group in the UK and are more likely to have long-term conditions (LTCs) such as diabetes and heart disease. People of SA origin are less likely to recognise symptoms that may represent mental health problems.

Aim

To explore how people of SA origin with LTCs understand, experience, and seek help for emotional distress, depression, and anxiety.

Design and setting

Systematic review of qualitative studies exploring emotional distress in people of SA origin with diabetes or coronary heart disease, within primary and community care settings worldwide.

Method

Comprehensive searches of eight electronic databases from inception to 1 September 2021 were undertaken. Data extracted included study characteristics, and understanding, experience, and help-seeking behaviour for emotional distress. Thematic synthesis was undertaken. The Critical Appraisal Skills Programme (CASP) checklist for qualitative studies was used to assess quality of articles, and Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) used to determine the overall strength of evidence.

Results

Twenty-one studies from 3165 unique citations were included. Three main themes were identified. Understanding of emotional distress: non-medical terminology used, such as ‘tension’, and a complex relationship between emotional and physical illness. Experiences of emotional distress: multiple forms of inequality, distress at diagnosis of their LTC, cultural factors, and sex differences. Help-seeking behaviour: self-management, support from family, friends, and faith, and inadequate clinical support.

Conclusion

This review provides a greater understanding of the conceptualisation of emotional distress in the context of LTCs by people of SA origin, to support improvement in its recognition and management.

Investigating patients´ views on screening for depression in cardiac practice: A qualitative interview study

OBJECTIVE

Recommendations on screening for depression in patients with coronary heart disease (CHD) are highly debated. While recent research has prioritized efficacy studies, little is known about what is potentially required for screening to be efficacious. Expanding our knowledge of how patients with CHD view screening is likely to pose a first step towards addressing this gap. We aimed to investigate patients ́ views on routine screening for depression in cardiac practice.

METHODS

This exploratory, qualitative study was conducted among 12 patients with CHD, who completed semi-structured interviews. We used a purposive sampling strategy to include patients within a range of ages, gender and self-reported depression. Thematic analysis was carried out.

RESULTS

We identified four main themes: Acceptance, utility, barriers and expectations. Patients in this sample appeared to be in favor of standardized routine screening for depression in cardiac practice, if the rationale was disclosed. Patients reported that standardized screening addresses holistic care demands, promotes validation of individual symptom burden and legitimizes the display of psychological distress in cardiac practice. Yet, skepticism towards the validity of screening instruments and perceived stigmatization could pose a main barrier to screening efficacy. Patients expected to receive feedback on results and consecutive recommendations.

CONCLUSION

We found that depression screening is endorsed by patients with CHD in this study sample. Standardized routine screening procedures could serve as a useful tool to combat stigmatization, and encourage patients to display symptoms of depression towards cardiologists. The efficacy of depression screening could potentially be enhanced by tailoring the screening process towards patients´ needs.

Making Sense of Chagas Disease among Mexican Immigrants in California

Mexican immigrants are affected by Chagas disease (CD) in California. It is through the representation of Chagas as a rare disease that participants make sense of the disease. A positive diagnosis has meant the disruption of patients' sense of normality and self-image, as well as their memories of homeland both reproducing and challenging hegemonic and stigmatized ideas of the disease associated with rurality and poverty. Access to treatment and medical care was the major coping mechanism. Health programs on CD should consider the emotional and social impact of the disease on people's self-perceptions to develop better medical care and prevention.

The effect of anxiety and depression on progression of glaucoma

Glaucoma is considered a chronic disease that requires lifelong management. Chronic diseases are known to be highly associated with psychological disturbances such as depression and anxiety. There have also been many studies on association between anxiety or depression and glaucoma. The majority of these studies explained that the glaucoma diagnosis causes anxiety or depression. However, It is also necessary to evaluate whether the psychological disturbance itself affect glaucoma. Therefore, we investigated the association of anxiety and depression with glaucoma progression, and elucidate mechanisms underlying that. We included 251 eyes with open angle glaucoma who were followed up for at least 2 years in this retrospective case-control study. The Beck Anxiety Inventory (BAI) and Beck Depressive Inventory-II (BDI-II) were used to assess anxiety and depression in glaucoma patients. Patients were classified into groups (high-anxiety group; HA-G, low-anxiety group; LA-G, high-depression group; HD-G, low-depression group; LD-G) according to their score on the BAI or BDI-II (separately). In logistic regression analysis, disc hemorrhage, peak intraocular pressure (IOP) and RNFL thickness loss rate were significantly associated with high anxiety (p = 0.017, p = 0.046, p = 0.026). RNFL thinning rate and disc hemorrhage were significant factors associated with anxiety in multivariate models (p = 0.015, p = 0.019). Multivariate linear regression analysis showed a significant positive correlation between the rate of RNFL thickness loss and BAI score (B = 0.058; 95% confidential interval = 0.020-0.097; p = 0.003), and RNFL loss and IOP fluctuation (B = 0.092; 95% confidential interval = 0.030-0.154; p = 0.004). For the depression scale, visual field mean deviation and heart rate variability were significantly associated with high depression in multivariate logistic regression analysis (p = 0.003, p = 0.006). We suggest that anxiety increase the risk of glaucoma progression and they are also associated with IOP profile and disc hemorrhage.

Psychological and Cognitive Barriers to Diabetes-Related Foot Complication Treatment: Clinicians' Perspectives

This study investigated clinicians' perspectives about cognitive functioning and mental health in individuals with diabetes-related foot complications (DRFCs), and how these impact the clinicians' treatment of the patients' conditions. Psychological and cognitive impairments may be more pronounced in individuals with DRFCs compared with the general diabetes mellitus population. Understanding these factors will identify potential barriers to DRFC treatment adherence and effective disease self-management. Fourteen multidisciplinary clinicians (Mean_age = 37.86 years; standard deviation = 9.26; range = 27-51) were recruited from a metropolitan hospital diabetic foot unit. Semistructured interviews were conducted with each clinician, followed by the completion of a brief quantitative questionnaire. Interview data were analyzed thematically. Six themes that encompassed factors affecting DRFC treatment were identified: (1) psychological and cognitive characteristics; (2) the person in the environment; (3) illness and self-identity; (4) burden of chronic disease; (5) engaging with treatment; and (6) the clinician and health system response. Quantitative questionnaire results coincided with qualitative findings, with endorsement of global psychological and cognitive impairment in individuals with DRFC, which considerably affected their ability to engage in treatment. From the perspectives of clinicians working with patients with DRFCs, psychological, cognitive, and social factors have a considerable influence on DRFC treatment and self-management. Further investigation of these factors and their interrelationships is necessary to enhance treatment adherence in individuals with DRFCs.

How does chronic multimorbidity affect daily routines? An experience sampling study of community-dwelling adults in Hong Kong

Limited by conventional data collection methods, it is unclear how community-dwelling multimorbid people's daily routines are affected by their co-occurring illnesses. This study investigated the differences in everyday life schedules between multimorbid and nonmultimorbid people. Three hundred community-dwelling adults, representative of the Hong Kong Chinese population, provided real-time self-reports of daily routines over a 7-day study period. Stratified by baseline multimorbidity status, we implemented generalized linear mixed models (binomial) for each of the four outcomes: meal, chores, conversation, and work/school, with time intervals as independent variable and potential confounders adjusted. The odds of engaging in these activities were compared between multimorbid and nonmultimorbid participants by time intervals. Significant differences were identified. Unlike nonmultimorbid participants, late evening (22:00-24:00) was estimated to be the most frequently observed meal time among multimorbid participants (adjusted odds ratio [AOR] = 8.21, 95% confidence interval [CI] = 2.59-26.01 vs. 14:00-16:00), who also did chores significantly earlier in the morning (AOR = 1.97, 95% CI = 1.09-3.58 in 8:00-10:00 vs. 14:00-16:00). Conversations were significantly less likely among multimorbid participants throughout the day. Last, multimorbid participants seemed to have less typical working/schooling hours. Further studies are warranted to investigate how these disruptions may lead to lower levels of quality of life and poorer mental health.

The Lived Experience of Older Adults With Type 2 Diabetes Mellitus and Diabetes-Related Distress

An older, more diverse population and longer lifespans are major contributors to the anticipated tripling of diabetes prevalence by 2050. Diabetes-related distress affects up to 40% of people with diabetes and may be a higher risk for older adults due to greater prevalence of comorbidities. The objective of the current phenomenological study was to describe how diabetes-related distress might be uniquely experienced by older adults (age ≥65) with type 2 diabetes mellitus (T2DM). Interpretive phenomenology guided the research design and analysis. Everyday life experiences of living with T2DM and elevated diabetes distress were investigated with interpretive interviews. The most prevalent lived experiences were strained relationships with health care providers, guilt, fear, loneliness, and forgetfulness. These experiences created challenges in managing diabetes and increased diabetes-related distress. Improving knowledge regarding the lived experience of older adults with diabetes-related distress may allow health care providers to tailor treatment to this population, thus improving outcomes. [Journal of Gerontological Nursing, 46(3), 37-44.].

Challenges faced in daily life by persons with type 2 diabetes: A meta-synthesis

Objectives

To derive improved understanding of the implicit meanings of challenges in daily life from the perspective of persons with type 2 diabetes.

Methods

A meta-synthesis was conducted with an interpretive and constructivist approach. Four databases were searched for articles published between 2007 and 2011, producing 37 articles for analysis. Van Deurzen’s life world theory was applied as an analytic grid.

Results

Challenges in daily life with type 2 diabetes could be understood as living in a tension between opposing forces, implying a struggle with inevitable paradoxes: living in the present and for the future, trusting oneself while relying on others, and being normal while feeling changed and different.

Discussion

This synthesis adds knowledge to previous understanding of living with type 2 diabetes, revealing the complexity of daily life when struggling with a lifelong illness. Person-centred care could be used to understand what challenges diabetes may cause in family and working life and the ambivalent feelings the illness can lead to. Future research is needed to implement and evaluate a person-centred care in practice. Since new qualitative research is continuously added to this topic, metasyntheses should be undertaken regularly.

Symptom Experience of Older Adults With Type 2 Diabetes and Diabetes-Related Distress

BACKGROUND

An older, more diverse population and longer life spans are major contributors to the anticipated tripling of Type 2 diabetes prevalence by 2050. Diabetes-related distress affects up to 40% of people diagnosed with Type 2 diabetes and may be a greater risk for older adults due to greater prevalence of comorbidities.

OBJECTIVE

The objective of this phenomenological study was to describe how diabetes-related distress in older adults (≥65 years) with Type 2 diabetes might be uniquely experienced.

METHODS

Participants were recruited using convenience sampling and snowball sampling. Interpretive phenomenology guided the research design and analysis. With interpretive interviews, we investigated the everyday health, symptoms, and life experiences of living with Type 2 diabetes and elevated diabetes distress.

RESULTS

Among the older adults in this study, the most prevalent symptoms were fatigue, hypoglycemia, diarrhea, pain, loss of balance, and falling. These diabetes-related symptoms led to substantial loss of independence, decreased quality of life, and constrained social lives due to restricted activities.

DISCUSSION

Diabetes-related distress presents with some unique symptoms and responses in older adults. Improving knowledge regarding the symptom experience of older adults with diabetes-related distress may allow healthcare providers to tailor treatment and thus improve outcomes for older adults struggling with diabetes.

The impact of living with long-term conditions in young adulthood on mental health and identity: What can help?

BACKGROUND

It has been suggested that the mental health impacts of living with long-term conditions are greater in young adulthood compared to older adulthood, due to greater disruption to identity and routine life events.

OBJECTIVES

To explore the impact of living with long-term conditions in young adulthood on mental health and identity, and what helps living well with these conditions.

METHODS

Fifteen in-depth interviews with young adults with various conditions were conducted and analysed thematically.

RESULTS

Themes related to the impacts on mental health and identity include the following: negative mood and depression; anxiety and fear for the future; and identity as 'ill'/abnormal compared to former self and 'normal' others. Themes related to suggestions for addressing negative impacts include the following: promotion of positive thinking; support reaching acceptance with altered identity and limitations (through stages of denial, anger, depression, then acceptance); and more professional mental health support.

DISCUSSION

In order to promote mental health and a positive sense of self/identity, young adults with long-term conditions should be offered advice and support on positive thinking; the long and difficult process of reconstructing identity; and reaching acceptance. This is particularly important for young adults for whom the identity reconstruction process is more complex and psychologically damaging than for older adults, as this life stage is associated with health/vitality and illness represents a shift from a perceived normal trajectory to one that appears and feels abnormal.

The Experiences of Older Italian Migrants With Type 2 Diabetes: A Qualitative Study

PURPOSE

Older Italian migrants in Australia are a vulnerable group, with high rates of type 2 diabetes and low levels of English language proficiency. The project explored the experience of living with diabetes and factors that facilitated or inhibited access to diabetes services.

METHOD

Focus groups were conducted in Italian with 13 participants with type 2 diabetes, aged 68 to 85 years.

RESULTS

Findings indicate five main themes, including (a) the value of health, (b) the impact of diabetes, (c) making changes, (d) managing diabetes, and (e) access to information and services.

CONCLUSION

The social context of food, presented the greatest impediment to successful diabetes self-management for this group of older Italian migrants. Participants identified a need for greater community engagement and education.

IMPLICATIONS FOR PRACTICE

A need for greater access to interpreters and information in Italian was identified. Counselling services may be necessary for this group.

Living with Diabetes: Experiences of Inner and Outer Sources of Beliefs in Women with Low Socioeconomic Status

The purpose of this study was to examine the life experiences of nineteen Thai women of low socioeconomic status who were living with type 2 diabetes. A qualitative research design was conducted, and the women were identified by the snowball technique. Data was collected through semi-structured interviews, and processes of induction and abstraction were used for data analysis. The theme "keeping equilibrium of one's mind" involved two sub-themes: experiencing an unpredictable future and being empowered by emerged beliefs. The first sub-theme encompassed worries concerning health and fears of being a burden to one's family. The second sub-theme comprised the experiences of continuing life without being conquered by the disease and believing in the natural law described in Buddhist teachings. These findings revealed that participants could maintain a balance among their concerns through empowerment by inner and outer sources of beliefs, particularly in Buddhist teachings. Despite the vulnerable situations caused by diabetes and low socioeconomic status, the women remained calm, with a consciousness to continue their lives with the disease. The Buddhist views on life, specifically natural law, assisted them to consider life with diabetes as simply a natural course. Buddhism served as a spiritual refuge and helped the women to cope with their psychological burden from diabetes. These findings may reflect the need for health care professionals to provide more holistic care that would assist patients to live with their disease. Buddhist beliefs can be used as a tool to assist Thai patients to empower themselves successfully.

Anxiety and diabetes: Innovative approaches to management in primary care

Type 2 diabetes mellitus is a chief concern for patients, healthcare providers, and health care systems in America, and around the globe. Individuals with type 2 diabetes mellitus exhibit clinical and subclinical symptoms of anxiety more frequently than people without diabetes. Anxiety is traditionally associated with poor metabolic outcomes and increased medical complications among those with type 2 diabetes mellitus. Collaborative care models have been utilized in the multidisciplinary treatment of mental health problems and chronic disease, and have demonstrated success in managing the pathology of depression which often accompanies diabetes. However, no specific treatment model has been published that links the treatment of anxiety to the treatment of type 2 diabetes mellitus. Given the success of collaborative care models in treating depression associated with diabetes, and anxiety unrelated to chronic disease, it is possible that the collaborative care treatment of primary care patients who suffer from both anxiety and diabetes could be met with the same success. The key issue is determining how to implement and sustain these models in practice. This review summarizes the proposed link between anxiety and diabetes, and offers an innovative and evidence-based collaborative care model for anxiety and diabetes in primary care.

Family history and body mass index predict perceived risks of diabetes and heart attack among community-dwelling Caucasian, Filipino, Korean, and Latino Americans--DiLH Survey

AIM

The purpose of the study was to explore the perceived risk for diabetes and heart attack and associated health status of Caucasian, Filipino, Korean, and Latino Americans without diabetes.

METHODS

A cross-sectional survey was conducted with 904 urban adults (mean age 44.3±16.1 years; 64.3% female) in English, Spanish or Korean between August and December 2013.

RESULTS

Perceived risk for developing diabetes was indicated by 46.5% (n=421), and 14.3% (n=129) perceived themselves to be at risk for having a heart attack in their lifetime. Significant predictors of pessimistic diabetes risk perceptions: Filipino (adjusted odds ratio [AOR]=1.7; 95% CI: 1.04-2.86) and Korean (AOR=2.4; 1.33-4.48) ethnicity, family history of diabetes (AOR=1.4; 1.00-1.84), female gender (AOR=1.4; 1.04-1.96), high cholesterol (AOR= 1.6; 1.09-2.37) and higher body mass index (BMI) (AOR=1.1; 1.08-1.15). Predictors of pessimistic heart attack risk perceptions were family history of an early heart attack (AOR=2.9; 1.69-5.02), high blood pressure (AOR=2.4; 1.45-3.84), and higher BMI (AOR=1.1; 1.04-1.12) after controlling for socio-demographic factors. Older age, physical inactivity, smoking, and low HDL levels were not associated with risk perceptions.

CONCLUSION

Multiple risk factors were predictive of greater perceived diabetes risk, whereas, only family history of heart attack, high blood pressure and increases in BMI significantly contributed to perceived risk of heart attack among ethnically diverse at risk middle-aged adults. It is important that healthcare providers address the discordance between an individual's risk perceptions and the presence of actual risk factors.

Life-long battle: Perceptions of type 2 diabetes in Thailand

BACKGROUND

The number of people in Thailand who have Type 2 diabetes has increased dramatically making it one of the country's major health problems. The rising prevalence of diabetes in Thailand is associated with dietary changes, reduced physical activity and health education. Although there is much research about health education programmes, the most effective methods for promoting sustainability and adherence to self-management among diabetics remains unclear.

OBJECTIVES

To examine the perceptions of participants in Thailand regarding Type 2 diabetes and to utilize the findings to formulate a model for patient education.

METHODS

A grounded theory approach was selected and semi-structured face to face interviews and focus group were used to gather data from 33 adults with Type 2 diabetes.

RESULTS

Five explanatory categories emerged from the data: causing lifelong stress and worry, finding their own ways, after a while, still cannot and wanting a normal life.

CONCLUSION

A new approach to patient education about Type 2 diabetes in Thailand is needed to give patients a better understanding, provide recommendations that they can apply to their daily lives, and include information about alternative medication. The Buddhist way of thinking and effective strategies enhancing self-efficacy should be applied to patient education to promote sustainability and adherence to self-management.

Social status and living with a chronic illness: an exploration of assessment and meaning attributed to work and employment

BACKGROUND

Traditional measures of social status are predicated on position in the labour market. There has been less attention directed to the meanings of social position for people with a long-term condition whose relationship to employment is precarious. Previous research has demonstrated that the MacArthur scale is capable of capturing contextualised aspects of social status, which makes it a useful tool for exploring changes in meaning.

AIMS

The paper explores the meanings and experiences of social status of people living with a long-term condition with particular reference to employment status.

METHODS

A sample of 300 participants was drawn from diabetes and chronic heart disease registers of General Practices in North West England. A cross-sectional survey with nested qualitative interviews was used in collecting and analysing the data.

FINDINGS

Having financial independence and participating in valued activities are more important for people with chronic illness than power and status mediated through the labour market. Income and the lack and loss of employment were given a central role in respondents' narratives reflecting the absence of acceptable alternative routes through which social status for those with a long-term condition can realistically be rebuilt outside of participation in the labour market.

CONCLUSION

Social participation, where people with chronic illness feel valued and of tangible utility to other people, might offer some opportunities for rebuilding social status outside the labour market. Chronic illness management interventions need to focus on improving people's engagement with such activities.

Experiences of diabetes self-management: a focus group study among Australians with type 2 diabetes

AIMS AND OBJECTIVES

The aim of this study was to explore the experiences and concerns of individuals with type 2 diabetes mellitus, in a predominantly low socio-economic setting.

BACKGROUND

Currently, approximately 1 million Australians have diabetes and rates have more than doubled since 1989. Type 2 diabetes mellitus accounts for approximately 85% of diabetes cases. Risk factors include obesity, older age, low socio-economic status, sedentary lifestyle and ethnicity. Older individuals from low socio-economic backgrounds are particularly at risk of both developing and of mismanaging their condition.

DESIGN

Exploratory qualitative design.

METHODS

Focus groups were used to collect data from 22 individuals, aged 40 to more than 70 years, with type 2 diabetes mellitus, who were attending local health services for their diabetes care. Focus groups ranged in size from four to eight individuals and all were recorded, transcribed and analysed. Data were analysed using a thematic analysis approach.

RESULTS

Participants described their experiences of managing their diabetes as emotionally, physically and socially challenging. Data analysis revealed four main themes including: (1) diabetes the silent disease; (2) a personal journey (3) the work of managing diabetes; and (4) access to resources and services. Throughout, participants highlighted the impact of diabetes on the family, and the importance of family members in providing support and encouragement to assist their self-management efforts.

CONCLUSIONS

Participants in this study were generally satisfied with their diabetes care but identified a need for clear simple instruction immediately post-diagnosis, followed by a need for additional informal information when they had gained some understanding of their condition.

RELEVANCE TO CLINICAL PRACTICE

Findings reveal a number of unmet information and support needs for individuals with type 2 diabetes mellitus. In particular, it is important for healthcare professionals and family members to recognise the significant emotional burden that diabetes imposes, and the type and quantity of information individuals with diabetes prefer. It is also important to consider levels of health literacy in the community when developing diabetes-related information or programmes.

Applying syndemics and chronicity: interpretations from studies of poverty, depression, and diabetes

Medical anthropologists working with global health agendas must develop transdisciplinary frameworks to communicate their work. This article explores two similar but underutilized theoretical frameworks in medical anthropology, and discusses how they facilitate new insights about the relationships between epidemiological patterns and individual-level illness experiences. Two cases from our fieldwork in New Delhi and Chicago are presented to illustrate how syndemics and chronicity theories explain the epidemic problems of co-occurring depression and type 2 diabetes. We use these case studies to illustrate how the holistic agendas of syndemics and chronicity theories allow critical scholars to attend to the macrosocial factors contributing to the rise of noncommunicable diseases while still honoring the diversity of experiences that make individual illness experiences, and actual outcomes, unique. Such an approach not only promotes a more integrative medical anthropology, but also contributes to global health dialogues around diabetes, depression, and their overlap.

Experiences of self-management support from GPs among Australian ethnically diverse diabetes patients: a qualitative study

Ethnically diverse diabetes patients face significant challenges in diabetes self-management ranging from cultural expectations to inequalities in health care provision. This study explored the experiences of ethnically diverse patients with diabetes attending group diabetes education in receiving self-management support from GPs. An approach based on phenomenology was used to analyse participants' experiences in self-management support across three group interviews comprising 28 Australian ethnically diverse diabetes patients: Arabic-speaking group (n = 11), English-speaking group (n = 9) and Vietnamese-speaking group (n = 8). Two themes emerged related to the poor quality of information to support self-management and challenges in negotiating traditional consultation styles. In particular, participants believed they knew more about diabetes self-management than their GPs but felt unable to influence consultation style and communicate their changing needs in self-management support. The health care and information needs of ethnically diverse patients continue to be marginalised within health systems. This small exploratory study highlights the need for further research to illuminate interactions between ethnically diverse diabetes patients and GPs in supporting long-term diabetes self-management.

'It still leaves me sixty dollars out of pocket': experiences of diabetes medical care among low-income earners in Perth

Diabetes prevalence is increasing in Australia, and there are stark inequities in prevalence and clinical outcomes experienced by Indigenous people and low socioeconomic groups compared with non-Indigenous and socioeconomically advantaged groups. This paper explores the impact of Indigenous status and socioeconomic disadvantage on the experience of diabetes care in the primary health setting. Data were collected through focus groups and interviews. The sample, comprising 38 participants (Indigenous and non-Indigenous), was recruited from disadvantaged areas in Perth, Australia. Data analysis was mainly deductive and based on a conceptual framework for the relationship between socioeconomic position and diabetes health outcomes. Most participants reported accessing general practitioners regularly; however, evidence of access to dietitians and podiatrists was very limited. Perceived need, cost, lack of information on available services and previous negative experiences influenced health care-seeking behaviour. Complexity and lack of coordination characterised the model of care reported by most participants. In contrast, Indigenous participants accessing an Aboriginal community-controlled health organisation reported a more accessible and coordinated experience of care. Our analysis suggests that Indigenous and socioeconomically disadvantaged people tailor their health care-seeking behaviour to the limitations imposed by their income and disadvantaged circumstances. To reduce inequities in care experiences, diabetes services in primary care need to be accessible and responsive to the needs of such groups in the community.

Serious decisions: chronic conditions and choice of provider

People with chronic health conditions combine conventional medical care with different complementary and alternative medicine (CAM) therapies for varying reasons. The data on which we drew to elucidate this derive from a large mixed-methods study utilizing participant observation, in-depth interviews with 69 people with type 2 diabetes mellitus and/or cardiovascular disease (CVD), and interviews with 20 health care providers. Although integrative practices are increasingly common, people make clear choices about and trade-offs between conventional medical care and CAM, often using CAM and prescribed pharmaceuticals in tandem for different conditions and distinct purposes and outcomes. As we illustrate, some people perceived type 2 diabetes and CVD as "too serious" for CAM treatment, but concurrently, many turned to CAM providers in appreciation of the serious attention these providers paid to their health-related concerns.

Ethnic differences and socio-demographic predictors of illness perceptions, self-management, and metabolic control of type 2 diabetes

Objectives

This study investigated ethnic differences in diabetes-specific knowledge, illness perceptions, self-management, and metabolic control among black-African, black-Caribbean,and white-British populations with type 2 diabetes. The study also examined associations between demographic/disease characteristics and diabetes-specific knowledge, illness perceptions, self-management, and metabolic control in each of the three ethnic groups.

Design

Cross-sectional

Setting

Diabetes/retinal screening clinics in Hackney and Brent, London.

Methods

Black-African, black-Caribbean and white-British populations with type 2 diabetes were asked to participate. Questionnaires measuring demographic/disease characteristics, diabetes-specific knowledge, self-management, and illness perceptions were used for data collection. Data for glycated hemoglobin (HbA_1c) and microvascular complications were obtained from medical records. Ethnic differences in diabetes-related measures were estimated using analysis of variance/covariance. Multiple regression techniques were used to determine relationships between demographic/disease characteristics and measured diabetes-related outcomes.

Results

Three hundred and fifty-nine patients participated in the study. White-British participants had high diabetes-specific knowledge compared to their black-African and black-Caribbean counterparts. Black-Africans reported better adherence to self-management recommendations than the other ethnic groups. Compared to the white-British patients, black-African and black-Caribbean participants perceived diabetes as a benign condition that could be cured. Educational status and treatment category were determinants of diabetes-specific knowledge in all three ethnic groups. However, different demographic/disease characteristics predicted adherence to self-management recommendations in each ethnic group.

Conclusion

Clearly, there is disease (diabetes) knowledge-perception variation between different ethnic groups in the UK which may partly influence overall disease outcome. It is plausible to recommend screening, identifying, and dispelling misconceptions about diabetes among ethnic minority patients by health care professionals as well as emphasizing the importance of self-management in managing chronic diseases such as diabetes.

Barriers and facilitators to diabetes self-management: perspectives of older community dwellers and health professionals in China

Little is known about self-management among people with Type 2 diabetes living in mainland China. Understanding the experiences of this target population is needed to provide socioculturally relevant education to effectively promote self-management. The aim of this study was to explore perceived barriers and facilitators to diabetes self-management for both older community dwellers and health professionals in China. Four focus groups, two for older people with diabetes and two for health professionals, were conducted. All participants were purposively sampled from two communities in Shanghai, China. Six barriers were identified: overdependence on but dislike of western medicine, family role expectations, cuisine culture, lack of trustworthy information sources, deficits in communication between clients and health professionals, and restriction of reimbursement regulations. Facilitators included family and peer support, good relationships with health professionals, simple and practical instruction and a favourable community environment. The findings provide valuable information for diabetes self-management intervention development in China, and have implications for programmes tailored to populations in similar sociocultural circumstances.

Making and maintaining lifestyle changes after participating in group based type 2 diabetes self-management educations: a qualitative study

BACKGROUND

Disease management is crucial in type 2 diabetes. Diabetes self-management education aims to provide the knowledge necessary to make and maintain lifestyle changes. However, few studies have investigated the processes after such courses. The aim of this study was to investigate how participants make and maintain lifestyle changes after participating in group-based type 2 diabetes self-management education.

METHODS

Data was collected through qualitative semi-structured interviews with 23 patients who attended educational group programs in Central Norway. The participants were asked how they had used the advice given and what they had changed after the course.

RESULTS

Knowledge was essential for making lifestyle changes following education. Three factors affected whether lifestyle changes were implemented: obtaining new knowledge, taking responsibility, and receiving confirmation of an already healthy lifestyle. Four factors motivated individuals to maintain changes: support from others, experiencing an effect, fear of complications, and the formation of new habits.

CONCLUSION

Knowledge was used to make and maintain changes in diet, medication and physical activity. Knowledge also acted as confirmation of an already adequate lifestyle. Knowledge led to no changes if diabetes appeared "not that scary" or if changes appeared too time consuming. Those involved in diabetes education need to be aware of the challenges in convincing asymptomatic patients about the benefits of adherence to self-management behaviour.

Living with diabetes: lay narratives as idioms of distress among the low-caste Dalit of Nepal

Among the Dalit community in Nepal, people consistently describe their diabetes in relation to stress caused by social inequality and social marginalization. Drawing on the illness narratives of 30 people from this community, I argue that through linking diabetes with stress as a result of caste-based discrimination, respondents use diabetes as an 'idiom of distress.' Respondents report that discrimination based on caste creates and aggravates their dire financial circumstances, resulting in the prolonged stress that causes and interacts with diabetes. Suffering with diabetes, and its ensuing financial struggles and accompanying stress, has for some led to suicidal thoughts and the preference of death to living with diabetes.

Problems of adults with a mitochondrial disease - the patients' perspective: focus on loss

OBJECTIVE

This study aimed to identify problems as experienced by adults with a mitochondrial disease. We chose to describe these problems from the patients' perspective as we thought this would give optimal input for care improvement.

DESIGN

A qualitative design using the grounded theory approach, involving single individual open interviews with 16 adults with a mitochondrial disease.

RESULTS

This study revealed "loss" as the main concept, where one loss often preceded other losses. Respondents mentioned loss of energy as the most basic loss in having a mitochondrial disease, leading to multiple varied losses in all areas of daily life. Looking back, they mentioned psychosocial-spiritual problems and dealing with actual and expected future losses as most prominent and difficult. In our study, we determined seven comprehensive themes: "loss of energy", "loss of independence and autonomy", "loss of social participation", "loss of personal identity", "loss of dreams and future" as well as "lack of health care" and "coping and adjustment".

CONCLUSIONS

In this first study on this theme, we developed a theory about patient's losses related to mitochondrial disease. They experience a variety of problems in the physical, psychological, social and spiritual human domain. Patients experience a lack of health care and professional support as well. They use various strategies to manage their multiple losses and experience circumstances in which it is difficult to manage them effectively. The results can be used as a guide for improving health care, education and research and might result in an improved quality of life.

'You get the quickest and the cheapest stuff you can': Food security issues among low-income earners living with diabetes

BACKGROUND

Diabetes prevalence is increasing worldwide. More than 800,000 Australians live with diabetes, and there are stark inequities in prevalence and clinical outcomes among Indigenous people and low socio-economic groups.

AIMS

This paper focuses on food security issues experienced by low-income earners living with type 2 diabetes in Perth, Western Australia. The results presented here are part of a broader qualitative study exploring the impact of socioeconomic disadvantage on diabetes.

METHOD

Data was collected through focus groups and semistructured interviews conducted from October 2008 to November 2009. The sample, comprising 38 participants ( Indigenous and non-Indigenous), was recruited from areas with high indices of socio-economic disadvantage in Perth. Deductive data analysis identified categories from an existing conceptual framework for the relationship between socio-economic position and diabetes health outcomes, while an inductive approach was adopted to identify new themes.

RESULTS

Participants had a good understanding of their dietary requirements. However, access to healthy food was not always realised, as many participants depended on others for food provision and meal preparation and had little control over their diets. Furthermore, the majority struggled to accommodate the price of healthy food within a limited budget.

CONCLUSION

In this study, low-income earners living with diabetes faced food security issues. Participants reported cost barriers, but also physical barriers relating to functional limitations and lack of transport. This study highlights that the socioeconomic circumstances in which vulnerable populations experience their disease need to be understood and addressed in order to reduce the inequities surrounding diabetes outcomes.

What is the relationship between diabetes and depression? a qualitative meta-synthesis of patient experience of co-morbidity

AIMS

To develop an explanatory framework concerning patient experience of diabetes and depression and the relationship between these disorders; to better understand how interventions and health services should be delivered for this group of patients.

METHODS

The study used meta-synthesis. Published qualitative studies were identified using a structured search, and themes synthesized across studies to develop a new explanatory framework.

RESULTS

Searches of three databases identified 5506 papers, and 22 were included. Diagnosis of diabetes and the impact of symptoms on functioning were associated with varied psychological reactions, not all of which are negative, and the concept of 'depression' only captures aspects of the experience. Similarly, the relationship between diabetes and relationships with professionals and family were variable, with relationships serving as both a buffer of the effects of diabetes and potentially as a cause of further difficulties for patients. Depression and other psychological states were significant barriers to effective coping. Definition of 'self' emerged as a key potential moderator of the relationship between depression and diabetes.

CONCLUSIONS

The variability in psychological reactions to diabetes suggested three key clinical implications, reflecting increasing levels of complexity for practitioners.

Effective communication is crucial to self-management: the experiences of immigrants to Australia living with diabetes

OBJECTIVES

Ageing immigrant populations now pose problems for the management of chronic illness in Australia. This article asks questions about the experiences of immigrants in Australia with type II diabetes mellitus (DM). What impact, if any, have health policies had on the lives of immigrants? How do their experiences of living with DM compare with those of people with DM who were born in Australia?

METHODS

Semi-structured interviews were conducted with 32 participants who had DM (n = 25) or cared for someone with DM (n = 7). Fifteen participants had migrated to Australia and English was not their first language. Participants were asked to describe their experience of managing diabetes.

RESULTS

Immigrants to Australia confront linguistic and cultural barriers that create an extra layer of problems not experienced by Australian-born people. Older people who were born overseas face obstacles to effective engagement with the health system that weaken their ability to take an active part in the management of their conditions.

CONCLUSIONS

Chronic disease policy is failing immigrants to Australia. Health professionals and services must recognize the central role that cultural diversity plays in self-management and the impact that this can have on health outcomes for immigrants with chronic illness.