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Airikkala E, Laaksonen M, Halkoaho A, Kaunonen M. Perception of inherited risk in type 2 diabetes: a systematic review. Front Public Health 2023; 11:1293874. [PMID: 38155883 PMCID: PMC10752975 DOI: 10.3389/fpubh.2023.1293874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/30/2023] [Indexed: 12/30/2023] Open
Abstract
Introduction A family history is impacting the individual's risk perception. The objective of this systematic review was to describe inherited risk perceptions of type 2 diabetes from the citizen's viewpoint. The aim was to summarize and increase understanding so that the increased knowledge could be used effectively in type 2 diabetes risk communication in health care. Methods We conducted a systematic review using CINAHL, Medline, and Scopus databases for hereditary, risk, perception, and diabetes related concepts, within the date range of 1.1.2017 to 2.8.2022. Eligible articles were English, peer-reviewed, and addressed the research question: how is hereditary risk of type 2 diabetes perceived? Returns were viewed independently by two authors, and evaluated using the appraisal criteria of the Joanna Briggs Institute. A thematic analysis was used for the synthesis of the data, yielding three themes describing perceptions of inherited risk in type 2 diabetes. Results A total of 32 articles were included, of which 23 were quantitative, 5 qualitative, and 4 were mixed-methods studies. The extracted themes were (1) Identifying heredity as a risk factor, (2) Diversity of hereditary risk, and (3) Perception of the magnitude of personal risk. Discussion The perception towards hereditary risk can vary from a desire to actively make a lifestyle change, to the view that diabetes is inevitable regardless of lifestyle. A positive family history increases the risk perception of type 2 diabetes, but the perceived magnitude of the risk may vary from person to person. The findings have the potential to be applied in healthcare's risk communication.
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Affiliation(s)
- Elisa Airikkala
- Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland
- School of Social Services and Health Care, Tampere University of Applied Sciences, Tampere, Finland
| | - Mari Laaksonen
- Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland
- School of Social Services and Health Care, Tampere University of Applied Sciences, Tampere, Finland
| | - Arja Halkoaho
- Applied Research Center, Tampere University of Applied Sciences, Tampere, Finland
| | - Marja Kaunonen
- Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland
- Wellbeing Services County of Pirkanmaa, Tampere, Finland
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Law JH, Sultan N, Finer S, Fudge N. Advancing the communication of genetic risk for cardiometabolic diseases: a critical interpretive synthesis. BMC Med 2023; 21:432. [PMID: 37953248 PMCID: PMC10641935 DOI: 10.1186/s12916-023-03150-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/02/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Genetics play an important role in risk for cardiometabolic diseases-including type 2 diabetes, cardiovascular disease and obesity. Existing research has explored the clinical utility of genetic risk tools such as polygenic risk scores-and whether interventions communicating genetic risk information using these tools can impact on individuals' cognitive appraisals of disease risk and/or preventative health behaviours. Previous systematic reviews suggest mixed results. To expand current understanding and address knowledge gaps, we undertook an interpretive, reflexive method of evidence synthesis-questioning the theoretical basis behind current interventions that communicate genetic risk information and exploring how the effects of genetic risk tools can be fully harnessed for cardiometabolic diseases. METHODS We obtained 189 records from a combination of database, website and grey literature searches-supplemented with reference chaining and expert subject knowledge within the review team. Using pre-defined critical interpretive synthesis methods, quantitative and qualitative evidence was synthesised and critiqued alongside theoretical understanding from surrounding fields of behavioural and social sciences. FINDINGS Existing interventions communicating genetic risk information focus predominantly on the "self", targeting individual-level cognitive appraisals, such as perceived risk and perceived behavioural control. This approach risks neglecting the role of contextual factors and upstream determinants that can reinforce individuals' interpretations of risk. It also assumes target populations to embody an "ascetic subject of compliance"-the idea of a patient who strives to comply diligently with professional medical advice, logically and rationally adopting any recommended lifestyle changes. We developed a synthesising argument-"beyond the ascetic subject of compliance"-grounded in three major limitations of this perspective: (1) difficulty applying existing theories/models to diverse populations, (2) the role of familial variables and (3) the need for a life course perspective. CONCLUSIONS Interventions communicating genetic risk information should account for wider influences that can affect individuals' responses to risk at different levels-including through interactions with their family systems, socio-cultural environments and wider health provision. PROTOCOL REGISTRATION PROSPERO CRD42021289269.
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Affiliation(s)
- Jing Hui Law
- Centre for Primary Care, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
| | - Najia Sultan
- Centre for Primary Care, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sarah Finer
- Centre for Primary Care, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Barts Health NHS Trust, London, UK
| | - Nina Fudge
- Centre for Primary Care, Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Caro-Bautista J, Villa-Estrada F, Gómez-González A, Lupiáñez-Pérez I, Morilla-Herrera JC, Kaknani-Uttumchandani S, García-Mayor S, Morales-Asencio JM. Effectiveness of a Diabetes Education Program based on Tailored interventions and Theory of Planned Behaviour: Cluster randomized controlled trial protocol. J Adv Nurs 2020; 77:427-438. [PMID: 33009844 DOI: 10.1111/jan.14580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/26/2020] [Accepted: 08/21/2020] [Indexed: 11/29/2022]
Abstract
AIM To measure the Effectiveness of a Diabetes Education Program for people with T2DM, based on Tailored interventions and the Theory of Planned Behaviour. DESIGN Cluster randomized controlled clinical trial. METHODS This multicentre study will be carried out at 30 primary healthcare centres, where 436 persons with Type 2 Diabetes Mellitus (T2DM), aged between 18-75 years, will be recruited. The experimental educational program to be applied is modelled using components obtained from a systematic review and prior qualitative analysis. In addition, a taxonomy of nursing practice is used to standardize the program, based on the Theory of Planned Behaviour as a conceptual model. The intervention will be carried out by community nurses, using ADAPP-Ti® , an application developed with FileMaker Pro v.18. The control group will receive usual care and data will be collected at 6, 12, and 18 months, for both groups. The primary outcome considered will be glycosylated haemoglobin and cardiovascular factors, while the secondary ones will be tobacco consumption, body mass index, barriers to self-care, health-related quality of life, and lifestyle modification. The protocol was approved by the Ethics Committee of the Province of Malaga (Spain) in November 2014. DISCUSSION The degree of metabolic control in T2DM is not always associated with healthy lifestyles and significant levels of medication are often prescribed to achieve clinical objectives. An intervention focused on needs, based on the best available evidence and a solid conceptual framework, might successfully consolidate appropriate self-care behaviour in this population. IMPACT The study will result in the publication of an educational program featuring well-defined interventions and activities that will enable clinicians to tailor health care to the individual's needs and to combat treatment inertia in attending this population.
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Affiliation(s)
- Jorge Caro-Bautista
- Málaga-Valle del Guadalhorce Primary Healthcare District, Andalusian Public Health System, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
| | - Francisca Villa-Estrada
- Málaga-Valle del Guadalhorce Primary Healthcare District, Andalusian Public Health System, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
| | - Alberto Gómez-González
- Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Department of Nursing and Podiatry, Faculty of Health Sciences, University of Málaga, Málaga, Spain
| | - Inmaculada Lupiáñez-Pérez
- Málaga-Valle del Guadalhorce Primary Healthcare District, Andalusian Public Health System, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Department of Nursing and Podiatry, Faculty of Health Sciences, University of Málaga, Málaga, Spain
| | - Juan Carlos Morilla-Herrera
- Málaga-Valle del Guadalhorce Primary Healthcare District, Andalusian Public Health System, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Department of Nursing and Podiatry, Faculty of Health Sciences, University of Málaga, Málaga, Spain
| | - Shakira Kaknani-Uttumchandani
- Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Department of Nursing and Podiatry, Faculty of Health Sciences, University of Málaga, Málaga, Spain
| | - Silvia García-Mayor
- Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Department of Nursing and Podiatry, Faculty of Health Sciences, University of Málaga, Málaga, Spain
| | - José Miguel Morales-Asencio
- Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Department of Nursing and Podiatry, Faculty of Health Sciences, University of Málaga, Málaga, Spain
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Helms Andersen T, Grabowski D. Implementing a research-based innovation to generate intra-familial involvement in type 2 diabetes self-management for use in diverse municipal settings: a qualitative study of barriers and facilitators. BMC Health Serv Res 2020; 20:198. [PMID: 32164726 PMCID: PMC7068919 DOI: 10.1186/s12913-020-5036-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 02/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Involving family members in disease management is vital to people with type 2 diabetes. New innovations that support family members' involvement can help both the person with type 2 diabetes and the relatives to create the supportive environment they need. The objective of the present study is to examine what facilitates and obstructs implementation of an innovation that supports intra-familial involvement in life with type 2 diabetes. METHODS Of the 48 healthcare professionals trained in facilitating the innovation in municipal patient education courses, single, semi-structured interviews were conducted with 13 of them. The interviews were focused specifically on the implementation process. All interviews were transcribed verbatim and analyzed using radical hermeneutics. RESULTS The analysis revealed three distinct themes affecting implementation of the innovation. 1) Focusing on creating family involvement in patient education for people with type 2 diabetes was relevant and important to the healthcare professionals. 2) The dynamics of group-based patient education sessions changed when family members were involved, which affects healthcare professionals' group facilitation methods. 3) Implementing new methods in patient education requires great commitment and support from the organization and management. CONCLUSION Implementation of an innovation to involve families and close relatives in patient education in Danish municipalities is feasible, but highly dependent on the commitment of healthcare professionals and managers as well as their openness to new ways of facilitating group processes.
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Affiliation(s)
- Tue Helms Andersen
- Steno diabetes Center Copenhagen, Neils Steensens Vej 2, 2820, Gentofte, Denmark.
| | - Dan Grabowski
- Steno diabetes Center Copenhagen, Neils Steensens Vej 2, 2820, Gentofte, Denmark
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Mutual Involvement in Families Living with Type 2 Diabetes: Using the Family Toolbox to Address Challenges Related to Knowledge, Communication, Support, Role Confusion, Everyday Practices and Mutual Worries. SOCIAL SCIENCES-BASEL 2019. [DOI: 10.3390/socsci8090257] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Family involvement plays a key role in diabetes management. Challenges related to type 2 diabetes (T2D) often affect the whole family, and relatives are at increased risk of developing diabetes themselves. Creating family involvement in families living with T2D is a complex matter. This article studies potential effects of working with dialogue tools specifically developed to create family involvement. The data consist of 18 semi-structured family interviews. The data were analyzed using radical hermeneutics and theories on family identity and healthcare authenticity. The analysis revealed five themes: (1) Working with the tools created better and broader intra-familial involvement; (2) the tools enabled new roles and self-understandings for all family members; (3) the tools facilitated mutual insights into each other’s thoughts and worries; (4) after working with the tools, it was easier to discover potential challenges and possible behavior change; and (5) gaining new knowledge and the motivation to seek more knowledge was easier after working with the tools. Working with the tools changed how the families perceive themselves and the ways in which they can affect their own T2D-related health behavior together. This has direct implications for healthcare practitioners working with people with T2D.
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