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Golding J, Hope SV, Chakera AJ, Puttanna A. The evolving continuum of dysglycaemia: Non-diabetic hyperglycaemia in older adults. Diabet Med 2023; 40:e15177. [PMID: 37452769 DOI: 10.1111/dme.15177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/06/2023] [Accepted: 07/12/2023] [Indexed: 07/18/2023]
Abstract
Identifying non-diabetic hyperglycaemia (NDH) and intervening to halt the progression to type 2 diabetes has become an essential component of cardiovascular and cerebrovascular risk reduction. Diabetes prevention programs have been instigated to address the increasing prevalence of NDH and type 2 diabetes by targeting lifestyle modifications. Evidence suggests that the risk of progression from NDH to type 2 diabetes declines with age, and that a diagnosis of type 2 diabetes in older adults is not associated with the same risk of adverse consequences as it is in younger age groups. The current definition of NDH is not adjusted based on a person's age. Therefore, there is debate about the emphasis that should be placed upon a diagnosis of NDH in older adults. This article will explore the evidence and current clinical practice surrounding dysglycaemia through the spectrum of different age ranges, and the potential implications this has for older adults.
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Affiliation(s)
- J Golding
- Department of Diabetes and Endocrinology, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
- Department of Medicine, Brighton and Sussex Medical School, Brighton, UK
| | - S V Hope
- College of Medicine and Health, University of Exeter, Exeter, UK
- Department of Healthcare for Older People, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - A J Chakera
- Department of Diabetes and Endocrinology, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
- Department of Medicine, Brighton and Sussex Medical School, Brighton, UK
| | - A Puttanna
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Tadege M, Misganaw A, Truneh Z, Tegegne AS. Predictors for the Longevity of People with Diabetes in Buno Bedele and Illubabor Zones, South-west Ethiopia. Diabetes Metab Syndr Obes 2023; 16:1449-1457. [PMID: 37223494 PMCID: PMC10202116 DOI: 10.2147/dmso.s403556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 05/15/2023] [Indexed: 05/25/2023] Open
Abstract
Introduction Currently, diabetes is a global health problem and it affects many people, especially in the developing continents. As patients' living conditions improve and the science of medicine advances, the longevity of such patients has increased greatly. Therefore, the purpose of this study was to identify predictors for the association of the longevity of people with diabetes in Buno Bedele and Illubabor Zones, South-west Ethiopia. Methods The study applied a retrospective cohort study design approach. In particular, long rank tests for longevity experience and Cox semi-parametric regression were implemented to compare and investigate the predictors associated with the longevity of patients with diabetes. Results Among all the patients who participated in this study, 56.9% were females and the rest were males. From the Cox regression result, age (AHR = 1.0550, 95% CI: (1.0250, 1.0860), p-value = 0.001), female patients (AHR = 0.2200, 95% CI: (0.0390, 0.5290)), rural patients (AHR = 0.2200, 95% CI: (0.1000, 0.4890), p-value = 0.001), the existence of fasting blood glucose complication (AHR = 1.2040, 95% CI: (1.0930, 1.4460), p-value = 0.001), the existence of blood pressure (AHR = 1.2480, 95% CI: (1.1390, 1.5999), p-value = 0.0180), treatment type, Sulfonylureas (AHR = 4.9970, 95% CI: (1.4140, 17.6550), p-value = 0.0120), treatment type, Sulfonylurea and Metformin (AHR = 5.7200, 95% CI: (1.7780, 18.3990), p-value = 0.0030) were significantly affected the longevity of people with diabetes. Conclusion The findings of the current study showed that the patient's age, sex of patients, residence area, the existence of complications, existence of pressure, and treatment type were major risk factors related to the longevity of people with diabetes. Hence, health-related education should be given to patients who come to take treatment to have better longevity for people with diabetes. More attention should be given to aged patients, male and urban patients, patients under complication treatment, and patients under treatment with single-treatment medication.
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Affiliation(s)
- Melaku Tadege
- Department of Statistics, Injibara University, Injibara, Amhara, Ethiopia
| | - Azmeraw Misganaw
- Department of Statistics, Mettu University, Mettu, Oromia, Ethiopia
| | - Zemenay Truneh
- Department of Statistics, Injibara University, Injibara, Amhara, Ethiopia
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Shakya P, Bajracharya M, Skovlund E, Shrestha A, Karmacharya BM, Kulseng BE, Sen A, Steinsbekk A, Shrestha A. How Did People with Prediabetes Who Attended the Diabetes Prevention Education Program (DiPEP) Experience Making Lifestyle Changes? A Qualitative Study in Nepal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5054. [PMID: 36981962 PMCID: PMC10048900 DOI: 10.3390/ijerph20065054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 06/18/2023]
Abstract
Diabetes can be prevented through lifestyle modification in the prediabetic phase. A group-based lifestyle intervention called 'Diabetes Prevention Education Program' (DiPEP) was tested recently in Nepal. The present study aimed to explore experiences of making lifestyle changes among people with prediabetes participating in the DiPEP. This qualitative study, with semi-structured interviews of 20 participants, was conducted 4-7 months following DiPEP intervention. Data analysis was performed by thematic analysis. The results included four themes, understanding that diabetes could be prevented, lifestyle changes made, hurdles to overcome, and experiencing benefits leading to sustained change. Some participants said they felt relieved to know that they had a chance to prevent diabetes. The participants talked mostly about making changes in diet (reducing carbohydrate intake) and physical activity (starting exercises). Obstacles mentioned included a lack of motivation and a lack of family support to implement changes. Experiencing benefits such as weight loss and reduced blood sugar levels were reported to lead them to maintain the changes they had made. Understanding that diabetes could be prevented was a key motivator for implementing changes. The benefits and hurdles experienced by the participants of the present study can be taken into consideration while designing lifestyle intervention programs in similar settings.
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Affiliation(s)
- Pushpanjali Shakya
- Department of Public Health and Nursing, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Monish Bajracharya
- Department of Business and IT, University of South-Eastern Norway, 3800 Bø, Norway
| | - Eva Skovlund
- Department of Public Health and Nursing, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Abha Shrestha
- Department of Community Medicine, Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel 45200, Nepal
| | - Biraj Man Karmacharya
- Department of Public Health and Nursing, Norwegian University of Science and Technology, 7491 Trondheim, Norway
- Department of Public Health and Community Programs, Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel 45200, Nepal
| | - Bård Eirik Kulseng
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Abhijit Sen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, 7491 Trondheim, Norway
- Centre for Oral Health Services and Research (TkMidt), 7030 Trondheim, Norway
| | - Aslak Steinsbekk
- Department of Public Health and Nursing, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Archana Shrestha
- Department of Public Health and Community Programs, Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel 45200, Nepal
- Institute for Implementation Science and Health, Kathmandu 44600, Nepal
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT 06520-0834, USA
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Arslan Ates E, Türkyilmaz A, Alavanda C, Yıldırım Ö, Güney Aİ. Multigene Panel Testing in Turkish Hereditary Cancer Syndrome Patients. Medeni Med J 2022; 37:150-158. [PMID: 35734982 PMCID: PMC9234359 DOI: 10.4274/mmj.galenos.2022.22556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Coppell KJ, Abel S, Whitehead LC, Tangiora A, Spedding T, Tipene-Leach D. A diagnosis of prediabetes when combined with lifestyle advice and support is considered helpful rather than a negative label by a demographically diverse group: A qualitative study. Prim Care Diabetes 2022; 16:301-306. [PMID: 34953750 DOI: 10.1016/j.pcd.2021.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/16/2021] [Accepted: 10/02/2021] [Indexed: 12/14/2022]
Abstract
AIMS The aim of this study was to explore the experience and perceptions of a diagnosis of prediabetes among a demographically diverse sample of New Zealanders who had, and had not, regressed to normoglycaemia following participation in a primary care nurse-delivered intervention for 6 months. The sample included Indigenous Māori who have high rates of diabetes and associated co-morbidities. METHODS A purposefully selected sample of 58 people with prediabetes and BMI >25 kg/m2, stratified by male/female, Māori/non-Māori, and those who had/had not regressed to normoglycaemia, after completing 6-months of a prediabetes intervention were interviewed. Interviews were audio-recorded and transcribed. Data were analysed by thematic analysis. RESULTS Most participants recalled being shocked when told they had prediabetes, but they did not perceive the diagnosis to be a label in a negative sense, and some, described the diagnosis as helpful. Participants appreciated knowing that prediabetes could be reversed, and the opportunity to be able to take supported action and make lifestyle changes through the nurse-delivered prediabetes lifestyle intervention. Participants' clear preference was to take control and make dietary changes, not to take Metformin. CONCLUSIONS Prediabetes was not considered a negative label, but an opportunity, when coupled with a primary care nurse-delivered dietary intervention.
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Affiliation(s)
- Kirsten J Coppell
- Department of Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand.
| | - Sally Abel
- Kaupapa Consulting Ltd., 52 Vigor Brown St, Napier 4110, New Zealand
| | - Lisa C Whitehead
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027, Australia
| | | | - Terrie Spedding
- Health Hawke's Bay, 100 McLeod Street, Hastings 4120, New Zealand
| | - David Tipene-Leach
- Eastern Institute of Technology, 501 Gloucester Street, Taradale, Napier 4112, Hawke's Bay, New Zealand
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Sims R, Michaleff ZA, Glasziou P, Thomas R. Consequences of a Diagnostic Label: A Systematic Scoping Review and Thematic Framework. Front Public Health 2022; 9:725877. [PMID: 35004561 PMCID: PMC8727520 DOI: 10.3389/fpubh.2021.725877] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 11/29/2021] [Indexed: 12/03/2022] Open
Abstract
Objectives: To develop a thematic framework for the range of consequences arising from a diagnostic label from an individual, family/caregiver, healthcare professional, and community perspective. Design: Systematic scoping review of qualitative studies. Search Strategy: We searched PubMed, Embase, PsycINFO, Cochrane, and CINAHL for primary studies and syntheses of primary studies that explore the consequences of labelling non-cancer diagnoses. Reference lists of included studies were screened, and forward citation searches undertaken. Study Selection: We included peer reviewed publications describing the perceived consequences for individuals labelled with a non-cancer diagnostic label from four perspectives: that of the individual, their family/caregiver, healthcare professional and/or community members. We excluded studies using hypothetical scenarios. Data Extraction and Synthesis: Data extraction used a three-staged process: one third was used to develop a preliminary framework, the next third for framework validation, and the final third coded if thematic saturation was not achieved. Author themes and supporting quotes were extracted, and analysed from the perspective of individual, family/caregiver, healthcare professional, or community member. Results: After deduplication, searches identified 7,379 unique articles. Following screening, 146 articles, consisting of 128 primary studies and 18 reviews, were included. The developed framework consisted of five overarching themes relevant to the four perspectives: psychosocial impact (e.g., positive/negative psychological impact, social- and self-identity, stigma), support (e.g., increased, decreased, relationship changes, professional interactions), future planning (e.g., action and uncertainty), behaviour (e.g., beneficial or detrimental modifications), and treatment expectations (e.g., positive/negative experiences). Perspectives of individuals were most frequently reported. Conclusions: This review developed and validated a framework of five domains of consequences following diagnostic labelling. Further research is required to test the external validity and acceptability of the framework for individuals and their family/caregiver, healthcare professionals, and community.
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Affiliation(s)
- Rebecca Sims
- Institute for Evidence-Based Healthcare (IEBH), Health Science and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Zoe A Michaleff
- Institute for Evidence-Based Healthcare (IEBH), Health Science and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare (IEBH), Health Science and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Rae Thomas
- Institute for Evidence-Based Healthcare (IEBH), Health Science and Medicine, Bond University, Gold Coast, QLD, Australia
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Burch P, Holm S. Pre-diabetes in the elderly and the see-saw model of paternalism. JOURNAL OF MEDICAL ETHICS 2021; 47:719-721. [PMID: 33148775 PMCID: PMC8562306 DOI: 10.1136/medethics-2020-106573] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/29/2020] [Accepted: 10/02/2020] [Indexed: 06/11/2023]
Abstract
Pre-diabetes is a risk factor for the development of diabetes, not a disease in its own right. The prevalence increases with age and reaches nearly 50% of those aged over 75 years in the USA. While lifestyle modification and treatment are likely to benefit those with many years of life ahead of them, they are unlikely to benefit patients with a limited life expectancy. Despite this, some very elderly patients in the UK and elsewhere are being labelled as pre-diabetic. While ideal practice would be to carefully consider the impact of any potentially abnormal blood test before it is taken, this is not always possible in routine practice. In this paper, we discuss a pragmatic, ethical approach for clinicians managing pre-diabetic blood tests in very elderly patients. We argue that a 'see-saw' model of paternalism should be used in deciding which patients to inform that they can be labelled as pre-diabetic. Those patients that may benefit from the label should be informed, and those that will not, should not. Where the benefits/drawbacks are unclear, the result and its potential significance should be discussed in depth with the individual patient. We do not advocate withholding information from any patient. Instead we suggest clinicians use individual patient circumstances to contextualise the relevance of pre-diabetes to the patient and consider the benefits and drawbacks before informing them. This approach has the potential to be used for other pre-conditions and risk factors in addition to pre-diabetes.
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Affiliation(s)
- Patrick Burch
- Centre for Primary Care, The University of Manchester, Manchester, UK
| | - Soren Holm
- Centre for Social Ethics and Policy, School of Law, University of Manchester, Manchester, UK
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van Herpt TTW, Ligthart S, Leening MJG, van Hoek M, Lieverse AG, Ikram MA, Sijbrands EJG, Dehghan A, Kavousi M. Lifetime risk to progress from pre-diabetes to type 2 diabetes among women and men: comparison between American Diabetes Association and World Health Organization diagnostic criteria. BMJ Open Diabetes Res Care 2020; 8:8/2/e001529. [PMID: 33214188 PMCID: PMC7678236 DOI: 10.1136/bmjdrc-2020-001529] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 10/16/2020] [Accepted: 10/29/2020] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Pre-diabetes, a status conferring high risk of overt diabetes, is defined differently by the American Diabetes Association (ADA) and the WHO. We investigated the impact of applying definitions of pre-diabetes on lifetime risk of diabetes in women and men from the general population. RESEARCH DESIGN AND METHODS We used data from 8844 women without diabetes and men aged ≥45 years from the prospective population-based Rotterdam Study in the Netherlands. In both gender groups, we calculated pre-diabetes prevalence according to ADA and WHO criteria and estimated the 10-year and lifetime risk to progress to overt diabetes with adjustment for competing risk of death. RESULTS Out of 8844 individuals, pre-diabetes was identified in 3492 individuals (prevalence 40%, 95% CI 38% to 41%) according to ADA and 1382 individuals (prevalence 16%, 95% CI 15% to 16%) according to WHO criteria. In both women and men and each age category, ADA prevalence estimates doubled WHO-defined pre-diabetes. For women and men aged 45 years having ADA-defined pre-diabetes, the 10-year risk of diabetes was 14.2% (95% CI 6.0% to 22.5%) and 9.2% (95% CI 3.4% to 15.0%) compared with 23.2% (95% CI 6.8% to 39.6%) and 24.6% (95% CI 8.4% to 40.8%) in women and men with WHO-defined pre-diabetes. At age 45 years, the remaining lifetime risk to progress to overt diabetes was 57.5% (95% CI 51.8% to 63.2%) vs 80.2% (95% CI 74.1% to 86.3%) in women and 46.1% (95% CI 40.8% to 51.4%) vs 68.4% (95% CI 58.3% to 78.5%) in men with pre-diabetes according to ADA and WHO definitions, respectively. CONCLUSION Prevalence of pre-diabetes differed considerably in both women and men when applying ADA and WHO pre-diabetes definitions. Women with pre-diabetes had higher lifetime risk to progress to diabetes. The lifetime risk of diabetes was lower in women and men with ADA-defined pre-diabetes as compared with WHO. Improvement of pre-diabetes definition considering appropriate sex-specific and age-specific glycemic thresholds may lead to better identification of individuals at high risk of diabetes.
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Affiliation(s)
- Thijs T W van Herpt
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Máxima Medical Center, Eindhoven, The Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Symen Ligthart
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Maarten J G Leening
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Mandy van Hoek
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Aloysius G Lieverse
- Department of Internal Medicine, Máxima Medical Center, Eindhoven, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Eric J G Sijbrands
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Abbas Dehghan
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Johnsen H, Christensen U, Juhl M, Villadsen SF. Organisational barriers to implementing the MAMAACT intervention to improve maternity care for non-Western immigrant women: A qualitative evaluation. Int J Nurs Stud 2020; 111:103742. [PMID: 32992080 DOI: 10.1016/j.ijnurstu.2020.103742] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 07/29/2020] [Accepted: 07/31/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND In Europe, the number of children born by non-Western immigrant women is rising and these women have an increased risk of negative pregnancy and birth outcomes, compared to the host populations. Several individual and system barriers are associated with immigrant women's access to maternity care. Scientific evaluations of interventions to enhance the health of immigrant women in the maternity setting are lacking, and there is a need for further development of the evidence base on how health care system initiatives may mitigate ethnic inequities in reproductive health. In Denmark, the MAMAACT intervention was developed to improve midwives' as well as non-Western immigrant women's response to pregnancy complications and to promote midwives' intercultural communication and cultural competence. The intervention included a training course for midwives as well as a leaflet and a mobile application. This study focuses on the significance of the antenatal care context surrounding the implementation of the MAMAACT intervention (Id. No: SUND-2018-01). OBJECTIVES To explore the main organisational barriers, which impacted the intended mechanisms of the MAMAACT intervention in Danish antenatal care. DESIGN A qualitative study design was used for data collection and analysis. SETTING Midwifery visits at ten antenatal facilities affiliated to five Danish maternity wards formed the setting of the study. PARTICIPANTS AND METHODS Data consisted of nine focus group interviews with midwives (n = 27), twenty-one in-depth interviews with non-Western immigrant women, forty observations of midwifery visits, and informal conversations with midwives at antenatal care facilities (50 h). Data were initially analysed using systematic text condensation. The candidacy framework was applied for further interpretation of data. RESULTS Analysis of data revealed three main categories: 'Permeability of antenatal care services', 'The interpreter as an aid to candidacy´, and 'Local conditions influencing the production of candidacy'. CONCLUSIONS Several organisational barriers impacted the intended mechanisms of the MAMAACT intervention. Major barriers were incomplete antenatal records, insufficient referrals to specialist care, inadequate interpreter assistance, and lack of local time resources for initiating a needs-based dialogue with the women. Immigrant targeted interventions must be understood as events within complex systems, and training midwives in intercultural communication and cultural competence cannot alone improve system responses to pregnancy complications among immigrant women. Changes in the legal, social, and political context of the health care system are needed to support organisational readiness for the MAMAACT intervention.
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Affiliation(s)
- Helle Johnsen
- Midwifery Programme, Department of Midwifery and Therapeutic Sciences, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen N, Denmark; Department of Public Health, Section of Social Medicine, Copenhagen University, Gothersgade 160, 1123 København K., Denmark.
| | - Ulla Christensen
- Department of Public Health, Section of Social Medicine, Copenhagen University, Gothersgade 160, 1123 København K., Denmark.
| | - Mette Juhl
- Midwifery Programme, Department of Midwifery and Therapeutic Sciences, University College Copenhagen, Sigurdsgade 26, 2200 Copenhagen N, Denmark.
| | - Sarah F Villadsen
- Department of Public Health, Section of Social Medicine, Copenhagen University, Gothersgade 160, 1123 København K., Denmark.
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Response to diagnosis of pre-diabetes in socioeconomically deprived areas: a qualitative study. BJGP Open 2019; 3:bjgpopen19X101661. [PMID: 31581115 PMCID: PMC6970589 DOI: 10.3399/bjgpopen19x101661] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 07/15/2019] [Indexed: 01/22/2023] Open
Abstract
Background Diabetes prevention is a key priority for the NHS, with a particular focus on populations at highest risk. The NHS Diabetes Prevention Programme (NHS DPP) has been introduced, offering a course of dietary and lifestyle education to individuals with pre-diabetes. However, concerns about the NHS DPP include: (1) the possible unintended consequences of labelling more people with a ‘pre-condition’; (2) the possibility of worsening health inequalities as people in socioeconomically deprived areas tend to access behaviour-change programmes less readily; (3) the appropriateness of an intervention focused on individuals versus population-wide public health policy interventions. Aim To explore the experience of diagnosis of pre-diabetes, and understand the barriers and facilitators to uptake of the NHS DPP for people living in socioeconomically deprived areas. Design & setting A qualitative study was undertaken. Participants with pre-diabetes were recruited from practices serving socioeconomically deprived areas of Sheffield, UK. Method Semi-structured interviews were conducted and continued until data saturation (23 participants). Thematic analysis of data was undertaken. Results Both healthcare context and an individual’s personal and community context shaped response to diagnosis and likelihood of engaging with the NHS DPP. Patient activation was a useful concept in understanding response. Whether or not people participated in the NHS DPP, being diagnosed with pre-diabetes tended to provoke some degree of dietary change and did not cause significant anxiety for most. However, there were multiple barriers to engaging with the NHS DPP for this patient group. Conclusion Diagnosing pre-diabetes can provoke an individual positive response, but the sociocultural environment often limits an individual’s ability to engage with the NHS DPP or make lifestyle change.
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