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Campbell K, Peddie M, Ashton N, Ma’ia’i K, Russell-Camp T, Mann J, Camp J, Reynolds AN. Experiences and Acceptability of a Weight Loss Intervention for Diabetes (Diabetes Remission Clinical Trial-DiRECT) in Aotearoa New Zealand: A Qualitative Study within a Pilot Randomised Controlled Trial. Nutrients 2024; 16:1853. [PMID: 38931208 PMCID: PMC11206426 DOI: 10.3390/nu16121853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
The Diabetes Remission Clinical Trial (DiRECT) demonstrated that substantial weight loss and remission from type 2 diabetes can be achieved with low-energy total diet replacement and behavioural support. However, the acceptability of the DiRECT intervention in diverse populations with strong cultural emphases on food and shared eating remains unclear. We conducted a qualitative study nested within a pilot randomised controlled trial of DiRECT in one Māori (the Indigenous people of New Zealand) primary care provider in Aotearoa New Zealand. Participants with type 2 diabetes or prediabetes, obesity, and a desire to lose weight were randomised to either dietitian-supported usual care or the dietitian-supported DiRECT intervention for twelve months. The DiRECT intervention included three months of total diet replacement, then food reintroduction and supported weight loss maintenance. At three and twelve months, semi-structured interviews explored the acceptability of DiRECT and participants' experiences of each intervention. Interview transcripts from 25 participants (aged 48 ± 10 years, 76% female, 78% Māori or Pacific) at three months and 15 participants at twelve months were analysed. Participants viewed their pre-enrolment selves as unhealthy people with poor eating habits and desired professional weight loss support. For DiRECT participants, the total diet replacement phase was challenging but well-received, due to rapid improvements in weight and health. Food reintroduction and weight loss maintenance each presented unique challenges requiring effective strategies and adaptability. All participants considered individualised and empathetic dietetic support crucial to success. Sociocultural factors influencing success were experienced in both interventions: family and social networks provided support and motivation; however, eating-related norms were identified as challenges. The DiRECT intervention was considered an acceptable approach to weight loss in participants with type 2 diabetes or prediabetes with strong cultural emphases on food and shared eating. Our findings highlight the importance of individualised and culturally relevant behavioural support for effective weight loss and weight loss maintenance.
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Affiliation(s)
- Kate Campbell
- Department of Medicine, University of Otago, Dunedin 9054, Aotearoa, New Zealand; (K.C.); (T.R.-C.); (J.M.); (J.C.)
- Department of Human Nutrition, University of Otago, Dunedin 9054, Aotearoa, New Zealand;
- Edgar Diabetes and Obesity Research Centre, Dunedin 9054, Aotearoa, New Zealand
| | - Meredith Peddie
- Department of Human Nutrition, University of Otago, Dunedin 9054, Aotearoa, New Zealand;
| | - Natalie Ashton
- Te Kāika Health, Caversham 9012, Aotearoa, New Zealand; (N.A.); (K.M.)
| | - Kim Ma’ia’i
- Te Kāika Health, Caversham 9012, Aotearoa, New Zealand; (N.A.); (K.M.)
| | - Takiwai Russell-Camp
- Department of Medicine, University of Otago, Dunedin 9054, Aotearoa, New Zealand; (K.C.); (T.R.-C.); (J.M.); (J.C.)
| | - Jim Mann
- Department of Medicine, University of Otago, Dunedin 9054, Aotearoa, New Zealand; (K.C.); (T.R.-C.); (J.M.); (J.C.)
- Edgar Diabetes and Obesity Research Centre, Dunedin 9054, Aotearoa, New Zealand
| | - Justine Camp
- Department of Medicine, University of Otago, Dunedin 9054, Aotearoa, New Zealand; (K.C.); (T.R.-C.); (J.M.); (J.C.)
- Edgar Diabetes and Obesity Research Centre, Dunedin 9054, Aotearoa, New Zealand
| | - Andrew N. Reynolds
- Department of Medicine, University of Otago, Dunedin 9054, Aotearoa, New Zealand; (K.C.); (T.R.-C.); (J.M.); (J.C.)
- Edgar Diabetes and Obesity Research Centre, Dunedin 9054, Aotearoa, New Zealand
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Liu K, Choi TST, Zhao L, Teong XT, Hutchison AT, Heilbronn LK. A qualitative exploration of behaviour change and maintenance experience in people with overweight or obesity in a dietary intervention. Nutr Diet 2024; 81:296-305. [PMID: 38057992 DOI: 10.1111/1747-0080.12855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/29/2023] [Accepted: 10/31/2023] [Indexed: 12/08/2023]
Abstract
AIM This qualitative study aimed to explore the experiences of participants who were enrolled in 6-month controlled weight loss interventions with 2-month follow-up to better understand the process of behaviour change and maintenance. METHODS Fifteen participants who completed or dropped out from either a daily energy restriction or intermittent fasting group were recruited using maximum variation purposive sampling. In-depth, semi-structured interviews were conducted at the 2-month follow-up phase. All interviews were transcribed and analysed using thematic analysis, guided by behaviour change models including transtheoretical model, social cognitive theory and integrated model of change. RESULTS Participants following both diets showed similar behaviour change patterns. Their first motivations were mostly external and relied on 'accountability' to adhere to the diet when initiating the dietary changes. Participants highlighted the importance of frequent reviews and monitoring in assisting their adherence. This feedback system promoted the development of self-efficacy and internalised motivation to encourage an 'ownership'. Participants who transitioned successfully from relying on accountability to take 'ownership' of the intervention were more capable of tackling challenges and tailoring their diet to form a new routine for long-term maintenance. CONCLUSION External motivations were key to initiate while internalised motivations were more important to sustain the behaviour change. Health professionals can assist this process through routine monitoring and feedback processes in clinical practice.
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Affiliation(s)
- Kai Liu
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Tammie S T Choi
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Victoria, Australia
| | - Lijun Zhao
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Xiao Tong Teong
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Amy T Hutchison
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Leonie K Heilbronn
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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Pártos K, Major D, Dósa N, Fazekas-Pongor V, Tabak AG, Ungvári Z, Horváth I, Barta I, Pozsgai É, Bodnár T, Fehér G, Lenkey Z, Fekete M, Springó Z. Diagnosis rates, therapeutic characteristics, lifestyle, and cancer screening habits of patients with diabetes mellitus in a highly deprived region in Hungary: a cross-sectional analysis. Front Endocrinol (Lausanne) 2024; 15:1299148. [PMID: 38752177 PMCID: PMC11094325 DOI: 10.3389/fendo.2024.1299148] [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: 09/22/2023] [Accepted: 04/08/2024] [Indexed: 05/18/2024] Open
Abstract
Introduction Low socioeconomic status affects not only diagnosis rates and therapy of patients with diabetes mellitus but also their health behavior. Our primary goal was to examine diagnosis rates and therapy of individuals with diabetes living in Ormánság, one of the most deprived areas in Hungary and Europe. Our secondary goal was to examine the differences in lifestyle factors and cancer screening participation of patients with diagnosed and undiagnosed diabetes compared to healthy participants. Methods Our study is a cross-sectional analysis using data from the "Ormánság Health Program". The "Ormánság Health Program" was launched to improve the health of individuals in a deprived region of Hungary. Participants in the program were coded as diagnosed diabetes based on diagnosis by a physician as a part of the program, self-reported diabetes status, and self-reported prescription of antidiabetic medication. Undiagnosed diabetes was defined as elevated blood glucose levels without self-reported diabetes and antidiabetic prescription. Diagnosis and therapeutic characteristics were presented descriptively. To examine lifestyle factors and screening participation, patients with diagnosed and undiagnosed diabetes were compared to healthy participants using linear regression or multinomial logistic regression models adjusted for sex and age. Results Our study population consisted of 246 individuals, and 17.9% had either diagnosed (n=33) or undiagnosed (n=11) diabetes. Metformin was prescribed in 75.8% (n=25) of diagnosed cases and sodium-glucose cotransporter-2 inhibitors (SGLT-2) in 12.1% (n=4) of diagnosed patients. After adjustment, participants with diagnosed diabetes had more comorbidities (adjusted [aOR]: 3.50, 95% confidence interval [95% CI]: 1.34-9.18, p<0.05), consumed vegetables more often (aOR: 2.49, 95% CI: 1.07-5.78, p<0.05), but desserts less often (aOR: 0.33, 95% CI: 0.15-0.75, p<0.01) than healthy individuals. Patients with undiagnosed diabetes were not different in this regard from healthy participants. No significant differences were observed for cancer screening participation between groups. Conclusions To increase recognition of diabetes, targeted screening tests should be implemented in deprived regions, even among individuals without any comorbidities. Our study also indicates that diagnosis of diabetes is not only important for the timely initiation of therapy, but it can also motivate individuals in deprived areas to lead a healthier lifestyle.
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Affiliation(s)
- Kata Pártos
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - David Major
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Norbert Dósa
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Vince Fazekas-Pongor
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Adam G. Tabak
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Zoltán Ungvári
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
- The Peggy and Charles Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Ildikó Horváth
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Ildikó Barta
- Ormansag Health Center, Ormánság Egészség Központ (OEKP), “AZ ORMANSÁG EGÉSZSÉGÉÉRT” Nonprofit Kft., Sellye, Hungary
| | - Éva Pozsgai
- Department of Public Health Medicine, University of Pécs Medical School, Pécs, Hungary
- Department of Primary Health Care, University of Pécs Medical School, Pécs, Hungary
| | - Tamás Bodnár
- Ormansag Health Center, Ormánság Egészség Központ (OEKP), “AZ ORMANSÁG EGÉSZSÉGÉÉRT” Nonprofit Kft., Sellye, Hungary
- Department of Anesthesia, Luzerner Kantonsspital, Sursee, Switzerland
| | - Gergely Fehér
- Centre for Occupational Medicine, Medical School, University of Pécs, Pecs, Hungary
- Department of Primary Health Care, Medical School, University of Pécs, Pecs, Hungary
| | - Zsófia Lenkey
- Ormansag Health Center, Ormánság Egészség Központ (OEKP), “AZ ORMANSÁG EGÉSZSÉGÉÉRT” Nonprofit Kft., Sellye, Hungary
- Heart Institute, Medical School, University of Pécs, Pécs, Hungary
| | - Mónika Fekete
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Zsolt Springó
- Department of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Ormansag Health Center, Ormánság Egészség Központ (OEKP), “AZ ORMANSÁG EGÉSZSÉGÉÉRT” Nonprofit Kft., Sellye, Hungary
- Clinical Medicine Doctoral School, Department of Public Health Medicine, University of Pécs Medical School, Pécs, Hungary
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Sun YX, Tang T, Zou JY, Yue QQ, Hu LF, Peng T, Meng XR, Feng GH, Huang LL, Zeng Y. Interventions to Improve Endoscopic Screening Adherence of Cancer in High-Risk Populations: A Scoping Review. Patient Prefer Adherence 2024; 18:709-720. [PMID: 38524198 PMCID: PMC10961025 DOI: 10.2147/ppa.s443607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 03/07/2024] [Indexed: 03/26/2024] Open
Abstract
Background Colorectal, and gastric cancers have the second, and fourth mortality rates worldwide, respectively. Endoscopic screening is a crucial diagnostic tool for colorectal, and gastric cancers. Effective interventions can improve adherence to endoscopic screening in high-risk populations, which is important for cancer prevention and mortality reduction. This study aimed to identify interventions that could improve adherence to endoscopic screening for cancer in high-risk populations. Methods Combination keywords including colorectal cancer, gastric cancer, screening adherence, and interventions were used to search for articles in PubMed, Web of Science, Cochrane Library, and MEDLINE Complete. The review methodology was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-SCR). Results A total of 12 articles were included in this review: 9 randomized controlled trials(RCT) and 3 quasi-experimental studies(QEDs). Among the extracted studies, 11 were about colorectal cancer, and 1 was about gastric cancer. Most studies used lecture-based or Information Technology-based health education interventions. Narrative interventions have proven to be novel and effective approaches for promoting adherence to endoscopic screening. Health education interventions included cancer epidemiology, cancer risk factors, warning symptoms, and screening methods. Conclusion All interventions involved were effective in increasing individual knowledge of cancer-related endoscopic screening, willingness to undergo screening, and screening behaviors. These findings provide a reference for designing endoscopy-related cancer screening interventions.
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Affiliation(s)
- Ying-Xue Sun
- Department of International and Humanistic Nursing, School of Nursing, Hengyang Medical School, University of South China, Hengyang, People’s Republic of China
| | - Tian Tang
- Department of International and Humanistic Nursing, School of Nursing, Hengyang Medical School, University of South China, Hengyang, People’s Republic of China
| | - Jin-Yu Zou
- Department of International and Humanistic Nursing, School of Nursing, Hengyang Medical School, University of South China, Hengyang, People’s Republic of China
| | - Qian-Qian Yue
- Department of International and Humanistic Nursing, School of Nursing, Hengyang Medical School, University of South China, Hengyang, People’s Republic of China
| | - Li-Feng Hu
- Department of International and Humanistic Nursing, School of Nursing, Hengyang Medical School, University of South China, Hengyang, People’s Republic of China
| | - Tong Peng
- Department of International and Humanistic Nursing, School of Nursing, Hengyang Medical School, University of South China, Hengyang, People’s Republic of China
| | - Xin-Ru Meng
- Department of International and Humanistic Nursing, School of Nursing, Hengyang Medical School, University of South China, Hengyang, People’s Republic of China
| | - Ge-Hui Feng
- Department of International and Humanistic Nursing, School of Nursing, Hengyang Medical School, University of South China, Hengyang, People’s Republic of China
| | - Li-Li Huang
- Department of International and Humanistic Nursing, School of Nursing, Hengyang Medical School, University of South China, Hengyang, People’s Republic of China
| | - Ying Zeng
- Department of International and Humanistic Nursing, School of Nursing, Hengyang Medical School, University of South China, Hengyang, People’s Republic of China
- Hunan Province Key Laboratory of Tumor Cellular & Molecular Pathology, Cancer Research Institute, Hengyang Medical School, University of South China, Hengyang, People’s Republic of China
- Hunan Engineering Research Center for Early Diagnosis and Treatment of Liver Cancer, Cancer Research Institute, Hengyang Medical School, University of South China, Hengyang, People's Republic of China
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Gonzalez Bravo C, Sabree SA, Dukes K, Adeagbo MJ, Edwards S, Wainwright K, Schaeffer SE, Villa A, Wilks AD, Carvour ML. Diabetes care in the pandemic era in the Midwestern USA: a semi-structured interview study of the patient perspective. BMJ Open 2024; 14:e081417. [PMID: 38458805 DOI: 10.1136/bmjopen-2023-081417] [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] [Indexed: 03/10/2024] Open
Abstract
OBJECTIVES To understand patients' experiences with diabetes care during the COVID-19 pandemic, with an emphasis on rural, medically underserved, and/or minoritised racial and ethnic groups in the Midwestern USA. DESIGN Community-engaged, semi-structured interviews were conducted by medical student researchers trained in qualitative interviewing. Transcripts were prepared and coded in the language in which the interview was conducted (English or Spanish). Thematic analysis was conducted, and data saturation was achieved. SETTING The study was conducted in communities in Eastern and Western Iowa. PARTICIPANTS Adults with diabetes (n=20) who were fluent in conversational English or Spanish were interviewed. One-third of participants were residents of areas designated as federal primary healthcare professional shortage areas and/or medically underserved areas, and more than half were recruited from medical clinics that offer care at no cost. RESULTS Themes across both English and Spanish transcripts included: (1) perspectives of diabetes, care providers and care management; (2) challenges and barriers affecting diabetes care; and (3) participant feedback and recommendations. Participants reported major constraints related to provider availability, costs of care, access to nutrition counselling and mental health concerns associated with diabetes care during the pandemic. Participants also reported a lack of shared decision-making regarding some aspects of care, including amputation. Finally, participants recognised systems-level challenges that affected both patients and providers and expressed a preference for proactive collaboration with healthcare teams. CONCLUSIONS These findings support enhanced engagement of rural, medically underserved and minoritised groups as stakeholders in diabetes care, diabetes research and diabetes provider education.
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Affiliation(s)
- Carolina Gonzalez Bravo
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Shakoora A Sabree
- Medical Scientist Training Program, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Kimberly Dukes
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
- University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Morolake J Adeagbo
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, Iowa, USA
| | - Sarai Edwards
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, Iowa, USA
| | - Kasey Wainwright
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Sienna E Schaeffer
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Aneli Villa
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Aloha D Wilks
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Martha L Carvour
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
- University of Iowa College of Public Health, Iowa City, Iowa, USA
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Zeh P, Young A, Gholap N, Randeva H, Robbins T, Johal K, Patel S, O'Hare JP. Diabetes specialist intervention in general practices in areas of deprivation and ethnic diversity: A qualitative evaluation (QUAL-ECLIPSE). Prim Care Diabetes 2024; 18:37-43. [PMID: 37926590 DOI: 10.1016/j.pcd.2023.10.012] [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: 08/09/2023] [Revised: 10/21/2023] [Accepted: 10/29/2023] [Indexed: 11/07/2023]
Abstract
AIM To assess patients' and healthcare professionals' perspectives of a specialist-led Diabetes Risk-based Assessment Clinic (DIRAC) for people with diabetes at high risk of complications (PWDHRC) in areas of deprivation in Coventry, UK. METHODS A qualitative evaluation of a pilot trial, comprising a specialist team intervention (DIRAC), was undertaken in seven GP practices through observations of weekly virtual or occasional face-to-face patient consultations and monthly interventionists' meetings. Semi-structured interviews were carried out post-intervention, with PWDHRC, primary care clinicians and diabetes specialists (interventionists). Thematic analyses of observations and interviews were undertaken. KEY FINDINGS Over 12 months, 28 DIRAC clinics comprising 154 patient consultations and five interventionists' meetings, were observed. 19 interviews were undertaken, PWDHRC experienced 'culturally-sensitive care from a specialist-led clinic intervention encompassing integrated care. This model of care was recommended at GP practice level, all participants (PWDHRC, primary care clinicians and diabetes specialist interventionists) felt upskilled to deal with complex diabetes care. The EMIS and ECLIPSE technologies utilised during the intervention were perceived to positively contribute to diabetes management of PWDHRC despite reservations around cost and database. CONCLUSION The specialist-led DIRACs were largely appreciated by study participants. These qualitative data support the trial progressing to a full-service evaluation.
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Affiliation(s)
- Peter Zeh
- Centre for Healthcare Research, Faculty of Health & Life Sciences, Coventry University, Coventry CV1 5RW, UK; Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM) Centre, University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK.
| | - Annie Young
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Nitin Gholap
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM) Centre, University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK
| | - Harpal Randeva
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM) Centre, University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK
| | - Timothy Robbins
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM) Centre, University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK
| | - Kam Johal
- Henley Green Medical Centre, Coventry CV2 1AB, UK
| | - Shweta Patel
- University Hospitals of Leicester NHS Trust, LE5 4PW Leicester, UK
| | - J Paul O'Hare
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM) Centre, University Hospitals Coventry & Warwickshire NHS Trust, Coventry CV2 2DX, UK
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Guo L, Zhang M, Namassevayam G, Wei M, Zhang G, He Y, Guo Y, Liu Y. Effectiveness of health management among individuals at high risk of stroke: An intervention study based on the health ecology model and self-determination theory (HEM-SDT). Heliyon 2023; 9:e21301. [PMID: 37964830 PMCID: PMC10641168 DOI: 10.1016/j.heliyon.2023.e21301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/11/2023] [Accepted: 10/19/2023] [Indexed: 11/16/2023] Open
Abstract
Background Stroke is the second leading cause of death in adults worldwide. However, up to 80% of strokes can be prevented by modifying risk factors. Objective The study aims to assess the effectiveness of the Health Ecology Model and Self-Determination Theory (HEM-SDT) based health management intervention among individuals at high risk of stroke. Methods A randomized controlled trial was conducted in Zhengzhou from May 1st, 2020, to December 31st, 2020. A total of 229 participants were recruited for the study, with 116 individuals at high risk of stroke being randomly assigned to the HEM-SDT health management group, while 113 participants were enrolled in the control group, following their current routine practices. The Generalized Estimating Equation model (GEE) was used to analyze the differences in health knowledge, belief and, behavior between the two groups at the beginning of the intervention, and at 6-month intervals after the intervention. The chi-square test was utilized to assess the control rate of risk factors. Results After 6 months of intervention, there were significant improvements in health knowledge, behavior, and belief among the participants. The study found significant differences in the interaction effects between time and group for health knowledge (Mean, SD = 25.62 ± 3.88, 95%CI: 7.944-9.604, P<0.001), health belief (Mean, SD = 87.18 ± 14.21, 95%CI: 23.999-29.887, P<0.001), and health behavior (Mean, SD = 173.28 ± 24.22, 95%CI: 22.332-36.904, P<0.001). Additionally, the rates of hypertension, hyperglycemia, dyslipidemia, high or medium risk condition of stroke, obesity, hyperhomocysteinemia, smoking, alcohol consumption, and lack of exercise also showed statistical significance (P<0.05) after the intervention. Conclusion The HEM-SDT health management model improves the health knowledge, behavior, and beliefs in people at high risk of stroke and remarkably it shows improvement in modifiable risk factors. It can be recommended for systematic health management in people at high-risk of stroke.
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Affiliation(s)
- Lina Guo
- Department of Neurology, National Advanced Stroke Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Mengyv Zhang
- Department of Neurology, National Advanced Stroke Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Genoosha Namassevayam
- Department of Neurology, National Advanced Stroke Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Department of Supplementary Health Sciences, Faculty of Health-Care Sciences, Eastern University, Sri Lanka
| | - Miao Wei
- Department of Neurology, National Advanced Stroke Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Gege Zhang
- Department of Neurology, National Advanced Stroke Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yv He
- Department of Neurology, National Advanced Stroke Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Reproductive Medicine Center, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Yuanli Guo
- Department of Neurology, National Advanced Stroke Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yanjin Liu
- Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
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Cox JS, Searle A, Thornton G, Hamilton-Shield JP, Hinton EC. Integrating COM-B and the person-based approach to develop an ACT based therapy programme to raise self-determination in adolescents with obesity. BMC Health Serv Res 2023; 23:1158. [PMID: 37884913 PMCID: PMC10601199 DOI: 10.1186/s12913-023-09930-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/16/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND This paper details the development of the Adolescent Intrinsic Motivation 'AIM2Change' intervention to support weight-management in young people previously unable to make changes whilst attending a tier 3 weight management service for children and young people. AIM2Change is an acceptance and commitment therapy based intervention that will be delivered one-to-one online over a seven-week period. METHODS To develop this intervention, we have triangulated results from a qualitative research study, patient and public involvement groups (PPI) and a COM-B (capability, opportunity, motivation, behaviour) analysis, in a method informed by the person-based approach. RESULTS The integrated development approach yielded a broad range of perspectives and facilitated the creation of a tailored intervention to meet the needs of the patient group whist remaining pragmatic and deliverable. CONCLUSIONS The next steps for this intervention will be in-depth co-development of the therapy sessions with service users, before implementing a proof of concept trial.
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Affiliation(s)
- Jennifer S. Cox
- National Institute for Health Research Bristol Biomedical Research Centre Diet and Physical Activity Theme, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, BS8 1TU UK
| | - Aidan Searle
- National Institute for Health Research Bristol Biomedical Research Centre Diet and Physical Activity Theme, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, BS8 1TU UK
| | - Gail Thornton
- Ms Gail Thornton, Patient & Public Involvement Representative, Bristol, UK
| | - Julian P. Hamilton-Shield
- National Institute for Health Research Bristol Biomedical Research Centre Diet and Physical Activity Theme, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, BS8 1TU UK
| | - Elanor C. Hinton
- National Institute for Health Research Bristol Biomedical Research Centre Diet and Physical Activity Theme, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, BS8 1TU UK
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9
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Martiskainen T, Lamidi ML, Venojärvi M, Tikkanen H, Laatikainen T. Factors affecting the effectiveness of the physical activity counselling intervention implemented in primary health care in adults with type 2 diabetes. BMC Endocr Disord 2023; 23:166. [PMID: 37550678 PMCID: PMC10405502 DOI: 10.1186/s12902-023-01428-w] [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: 11/17/2022] [Accepted: 08/01/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) has become a major public health threat; physical inactivity and obesity are both independent risk factors. Increasing daily physical activity (PA) significantly benefits treatment. Individual PA counselling is helpful for people with T2D, especially those with previous inactivity or with diabetes complications. This study evaluated factors contributing to effectiveness of PA counselling in primary health care (PHC) patients with T2D in a real-world setting and using data elicited from electronic health records (EHRs). METHODS All patients with T2D were offered the opportunity to participate in a PA program organized as part of basic PHC services in the Siun sote region in North Karelia, Finland, from October 2016 to December 2018. The study population consists of patients aged 19 to 87 years (n = 546). During the intervention information on possible other factors in addition to age and sex influencing the intervention effect such as amount of counselling sessions, changes in PA and patients´ motivation was gathered. Changes in the participants' PA activity was generated by following the predefined rules from patient records and by assessing the descriptive documentation of activity patterns. The patients' motivation level was assessed using a Likert scale. RESULTS Over 60% of participants who attended PA counselling more than three times increased their PA compared with 1% of participants with one counselling session. Of the whole intervention group, the participants experiencing the largest weight loss were those with an increased level of PA (-1.36 kg vs. -0.63 kg among those with no change in PA). Age, sex, and baseline motivation did not affect the change the PA nor the main intervention outcomes. CONCLUSIONS Patients' compliance with the intervention was reflected in the number of PA counselling sessions attended which in turn was seen as increased levels of PA as well as better treatment outcomes. In the implementation of lifestyle counselling interventions attention should be paid on sufficient amount and frequency of counselling sessions. The individually tailored PA counselling provided in PHC has similar effects regardless of sex and age.
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Affiliation(s)
- Tuula Martiskainen
- Joint municipal authority for North Karelia social and health services (Siun sote), Tikkamäentie 16, Joensuu, 70210, Finland.
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, PO BOX 1627, Kuopio, 70211, Finland.
| | - Marja-Leena Lamidi
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, PO BOX 1627, Kuopio, 70211, Finland
| | - Mika Venojärvi
- Institute of Biomedicine/Sports and Exercise Medicine, University of Eastern Finland, PO BOX 1627, Kuopio, 70211, Finland
| | - Heikki Tikkanen
- Institute of Biomedicine/Sports and Exercise Medicine, University of Eastern Finland, PO BOX 1627, Kuopio, 70211, Finland
| | - Tiina Laatikainen
- Joint municipal authority for North Karelia social and health services (Siun sote), Tikkamäentie 16, Joensuu, 70210, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, PO BOX 1627, Kuopio, 70211, Finland
- Department of Public Health and Social Welfare, Finnish Institute for Health and Welfare, PO BOX 30, Helsinki, 00271, Finland
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Cavallo M, Morgana G, Dozzani I, Gatti A, Vandoni M, Pippi R, Pucci G, Vaudo G, Fanelli CG. Unraveling Barriers to a Healthy Lifestyle: Understanding Barriers to Diet and Physical Activity in Patients with Chronic Non-Communicable Diseases. Nutrients 2023; 15:3473. [PMID: 37571410 PMCID: PMC10421422 DOI: 10.3390/nu15153473] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
Although the important contribution of nutrition and physical activity to people's health is known, it is equally well known that there are many barriers to adherence to healthy habits (i.e., of an organizational, economic, and/or psychological nature) experienced by the general population, as well as by people with non-communicable diseases. Knowledge of these barriers seems essential to the implementation of the activities and strategies needed to overcome them. Here, we aim to highlight the most frequent barriers to nutrition and exercise improvement that patients with chronic-degenerative diseases experience. Drawing from the Pubmed database, our analysis includes quantitative or mixed descriptive studies published within the last 10 years, involving adult participants with non-communicable diseases. Barriers of an organizational nature, as well as those of an environmental, economic, or psychological nature, are reported. The study of patients' barriers enables healthcare and non-health professionals, stakeholders, and policymakers to propose truly effective solutions that can help both the general population and those with chronic pathologies to adhere to a healthy lifestyle.
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Affiliation(s)
- Massimiliano Cavallo
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100 Terni, Italy; (M.C.); (G.P.); (G.V.)
| | - Giovanni Morgana
- Post-Graduate School of Sports Medicine, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy;
| | - Ivan Dozzani
- Post-Graduate School of Clinical Nutrition and Dietetics, Department of Medicine and Surgery, University of Perugia, Piazzale Gambuli 1, 06132 Perugia, Italy;
| | - Alessandro Gatti
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, 27100 Pavia, Italy; (A.G.); (M.V.)
| | - Matteo Vandoni
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, 27100 Pavia, Italy; (A.G.); (M.V.)
| | - Roberto Pippi
- Healthy Lifestyle Institute, C.U.R.I.A.Mo. (Centro Universitario Ricerca Interdipartimentale Attività Motoria), Department of Medicine and Surgery, University of Perugia, 06126 Perugia, Italy;
| | - Giacomo Pucci
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100 Terni, Italy; (M.C.); (G.P.); (G.V.)
| | - Gaetano Vaudo
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine, Terni University Hospital, Piazzale Tristano Di Joannuccio, 1, T05100 Terni, Italy; (M.C.); (G.P.); (G.V.)
| | - Carmine Giuseppe Fanelli
- Healthy Lifestyle Institute, C.U.R.I.A.Mo. (Centro Universitario Ricerca Interdipartimentale Attività Motoria), Department of Medicine and Surgery, University of Perugia, 06126 Perugia, Italy;
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Burgermaster M, Desai PM, Heitkemper EM, Juul F, Mitchell EG, Turchioe M, Albers DJ, Levine ME, Larson D, Mamykina L. Who needs what (features) when? Personalizing engagement with data-driven self-management to improve health equity. J Biomed Inform 2023; 144:104419. [PMID: 37301528 DOI: 10.1016/j.jbi.2023.104419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To examine the feasibility of promoting engagement with data-driven self-management of health among individuals from minoritized medically underserved communities by tailoring the design of self-management interventions to individuals' type of motivation and regulation in accordance with the Self-Determination Theory. METHODS Fifty-three individuals with type 2 diabetes from an impoverished minority community were randomly assigned to four different versions of an mHealth app for data-driven self-management with the focus on nutrition, Platano; each version was tailored to a specific type of motivation and regulation within the SDT self-determination continuum. These versions included financial rewards (external regulation), feedback from expert registered dietitians (RDF, introjected regulation), self-assessment of attainment of one's nutritional goals (SA, identified regulation), and personalized meal-time nutrition decision support with post-meal blood glucose forecasts (FORC, integrated regulation). We used qualitative interviews to examine interaction between participants' experiences with the app and their motivation type (internal-external). RESULTS As hypothesized, we found a clear interaction between the type of motivation and Platano features that users responded to and benefited from. For example, those with more internal motivation reported more positive experience with SA and FORC than those with more external motivation. However, we also found that Platano features that aimed to specifically address the needs of individuals with external regulation did not create the desired experience. We attribute this to a mismatch in emphasis on informational versus emotional support, particularly evident in RDF. In addition, we found that for participants recruited from an economically disadvantaged community, internal factors, such as motivation and regulation, interacted with external factors, most notably with limited health literacy and limited access to resources. CONCLUSIONS The study suggests feasibility of using SDT to tailor design of mHealth interventions for promoting data-driven self-management to individuals' motivation and regulation. However, further research is needed to better align design solutions with different levels of self-determination continuum, to incorporate stronger emphasis on emotional support for individuals with external regulation, and to address unique needs and challenges of underserved communities, with particular attention to limited health literacy and access to resources.
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Affiliation(s)
- Marissa Burgermaster
- Department of Nutritional Sciences, The University Of Texas At Austin, Department Of Population Health, Dell Medical School, Austin, TX, United States
| | - Pooja M Desai
- Department Of Biomedical Informatics, Columbia University, United States
| | | | - Filippa Juul
- School Of Global Public Health, New York University, United States
| | | | | | | | | | - Dagny Larson
- Department Of Nutritional Sciences, University of Texas In Austin, United States
| | - Lena Mamykina
- Department Of Biomedical Informatics, Columbia University, United States.
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Cross R, Greaves C, Withall J, Kritz M, Stathi A. A qualitative longitudinal study of motivation in the REtirement in ACTion (REACT) physical activity intervention for older adults with mobility limitations. Int J Behav Nutr Phys Act 2023; 20:50. [PMID: 37101268 PMCID: PMC10131311 DOI: 10.1186/s12966-023-01434-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/10/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Physical activity (PA) is beneficial for older adults' health, however they remain the least active age group in the UK. This qualitative longitudinal study aims to understand motivations in older adults receiving the REACT physical activity intervention, through the lens of self-determination theory. METHODS Participants were older adults randomised to the intervention arm of the Retirement in ACTion (REACT) Study, a group-based physical activity and behaviour maintenance intervention to prevent decline of physical functioning in older adults (≥ 65 years). Stratified purposive sampling by physical functioning (Short Physical Performance Battery scores) and 3-month attendance was employed. Fifty-one semi-structured interviews were conducted at 6, 12 and 24-months with twenty-nine older adults (Mean age (baseline) = 77.9 years, SD 6.86, 69% female) and at 24-months with twelve session leaders and two service managers. Interviews were audio recorded, transcribed verbatim and analysed using Framework Analysis. RESULTS Perceptions of autonomy, competence and relatedness were associated with adherence to the REACT programme and maintenance of an active lifestyle. Motivational processes and participants' support needs, changed during the 12-month REACT intervention and across the 12-months post-intervention. Group interactions were an important source of motivation during the first six months but increased competence and mobility drove motivation at the later stages (12 months) and post-intervention (24 months). CONCLUSIONS Motivational support needs vary in different stages of a 12-month group-based programme (adoption and adherence) and post-intervention (long-term maintenance). Strategies to accommodate those needs include, (a) making exercise social and enjoyable, (b) understanding participants' capabilities and tailoring the programme accordingly, (c) capitalising on group support to motivate participants to try other activities and prepare sustainable active living plans. TRIAL REGISTRATION The REACT study was a pragmatic multi-centre, two-arm, single-blind, parallel-group, RCT (ISRCTN registration number 45627165).
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Affiliation(s)
- Rosina Cross
- Department for Health, University of Bath, Claverton Down, BA2 7AY, Bath, UK.
- College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, EX1 2LU, Exeter, UK.
| | - Colin Greaves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, B15 2TT, Birmingham, UK
| | - Janet Withall
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, B15 2TT, Birmingham, UK
| | - Marlene Kritz
- Curtin School of Population Health, Curtin University, Kent St, WA, 6102, Bentley, Australia
| | - Afroditi Stathi
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, B15 2TT, Birmingham, UK
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Ma L, Chen J, Sun Y, Feng Y, Yuan L, Ran X. The perceptions of living with diabetic foot ulcers: A systematic review and meta-synthesis of qualitative studies. J Tissue Viability 2023; 32:39-50. [PMID: 36470779 DOI: 10.1016/j.jtv.2022.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/30/2022] [Accepted: 11/27/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Diabetic foot ulcers are associated with decreased quality of life in patients with diabetes and impose a heavy burden on patients, their families, and the health care system. For health providers, a deeper understanding of the perceptions of patients is significant. They can provide better management and direction to patients with diabetic foot ulcers, thus improving their quality of life. OBJECTIVES To synthesize the findings of qualitative studies to explore the perceptions of individuals living with diabetic foot ulcers. DESIGN A systematic review and meta-synthesis of qualitative studies. METHODS Published qualitative research articles were identified in PubMed, CINAHL, Embase, ISI Web of Science, Ovid, and Scopus from inception to January 2022, and bibliographical reports were reviewed. In addition, combing with the search for unpublished studies in the Google Scholar ProQuest Dissertations and Theses Database, we conducted a meta-synthesis. RESULTS Fourteen articles were eligible for inclusion, and the total number of included individuals was 226, with ages ranging from 28 to 84 years. The perceptions of individuals with diabetic foot ulcers synthesized four overarching themes and their subthemes: perceptions of diabetic foot ulcers (Realization, Reasons), living with diabetic foot ulcers (Change in life, Physical burdens, Emotional burdens, Economic burdens), coping with diabetic foot ulcers (Hospital attendance, Attitude toward amputation, Treatment, Management), and expectations (Expectation of health-personnel, Future expectation). CONCLUSIONS Individuals with diabetic foot ulcers suffer greatly in their physical, psychological, and social aspects. Comprehensive and individualized patient-centered care and appropriate families and social support for patients with diabetic foot ulcers should be provided.
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Affiliation(s)
- Lin Ma
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, Sichuan, China; Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ji Chen
- Mianyang Hospital of Traditional Chinese Medicine, Mianyang, Sichuan, China
| | - Yue Sun
- School of Nursing, Peking University, Beijing, China
| | - Yue Feng
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li Yuan
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, Sichuan, China; Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xingwu Ran
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, Sichuan, China; Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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14
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Sarfo JO, Obeng P, Kyereh HK, Ansah EW, Attafuah PYA. Self-Determination Theory and Quality of Life of Adults with Diabetes: A Scoping Review. J Diabetes Res 2023; 2023:5341656. [PMID: 37091043 PMCID: PMC10115521 DOI: 10.1155/2023/5341656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 03/21/2023] [Accepted: 03/28/2023] [Indexed: 04/25/2023] Open
Abstract
Background Diabetes is one of the leading causes of sickness, death, and decreased quality of life globally. The prevalence of diabetes keeps rising globally due to lifestyle changes and urbanization. Therefore, improved quality of life (QoL) and appropriate diabetes self-management practices, including treatment adherence, are crucial to improving and sustaining the health of diabetic patients. Some studies have adopted the self-determination theory (SDT) to study diabetes interventions, but less is known about its effectiveness in improving QoL, treatment adherence, and diabetes self-management. Aim/Objective. This review assessed the effectiveness of SDT in improving self-management practices, treatment adherence, and QoL among adult diabetic patients. Method We followed the six-stage framework by Arksey and O'Malley in conducting the review. PubMed, JSTOR, Central, and ScienceDirect databases were searched for published articles from January 2011 to October 2021 using keywords and Boolean logic. Furthermore, we screened a reference list of related articles. Also, Google Scholar, Z-library, and web-based searches were carried out to retrieve other relevant evidence that applied SDT in improving QoL, diabetes self-management, and treatment adherence. Findings. Fifteen studies met the inclusion criteria, from which data were extracted as findings. SDT effectively improved QoL, diabetes treatment adherence, and diabetes self-management among diabetic patients. Of these studies, 11 provided data on SDT and diabetes self-management and affirmed the effectiveness of the theory in improving appropriate diabetes self-management practices. Two studies confirmed the effectiveness of SDT in improving treatment adherence. SDT and QoL were assessed in 4 of the studies, which demonstrated the effectiveness of SDT in enhancing the QoL of diabetic patients. Conclusion SDT effectively improved QoL, diabetes treatment adherence, and diabetes self-management. The application of SDT in diabetes management will improve the health and QoL of diabetic patients. Hence, diabetes management interventions could adopt SDT to guide treatment.
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Affiliation(s)
- Jacob Owusu Sarfo
- Department of Health, Physical Education and Recreation, University of Cape Coast, Ghana
| | - Paul Obeng
- Department of Health, Physical Education and Recreation, University of Cape Coast, Ghana
| | - Henneh Kwaku Kyereh
- Department of Health, Physical Education and Recreation, University of Cape Coast, Ghana
| | - Edward Wilson Ansah
- Department of Health, Physical Education and Recreation, University of Cape Coast, Ghana
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Morinishi K, Chikada A, Ogura M, Inagaki N, Nin K. Psychological Factors Motivating Male Japanese Workers With Type 2 Diabetes to Engage in Dietary Modifications: A Qualitative Descriptive Study. SAGE Open Nurs 2023; 9:23779608231194412. [PMID: 37584036 PMCID: PMC10424540 DOI: 10.1177/23779608231194412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/06/2023] [Accepted: 07/22/2023] [Indexed: 08/17/2023] Open
Abstract
Introduction Japanese men with type 2 diabetes mellitus (T2DM) usually encounter work-related difficulties when engaging in dietary modifications. Hence, healthcare providers must understand the psychological factors, such as the needs and goals, that motivate them to engage in dietary modifications. Objective We aimed to describe the psychological factors motivating male Japanese workers with T2DM to engage in dietary modifications. Methods Using a qualitative descriptive design, we conducted semi-structured interviews with 11 male Japanese workers with T2DM and identified categories based on semantic differences using qualitative content analysis. Results The following eight categories emerged: (I want to) demonstrate my skills at work, be able to engage in dietary modifications on my own, avoid unpleasant symptoms caused by eating, avoid burdensome treatment, maintain my healthy life, get positive results in medical examinations, maintain my relationships with others, and enjoy healthy food. Conclusion The factors motivating the participants to engage in dietary modifications were realistic and sincere desires rooted in their ideal lives. Their desire to prioritize work emerged as an important factor. Healthcare providers should identify an individual's ideal daily life, including work aspects, and encourage individuals to set realistic and valuable goals.
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Affiliation(s)
- Kanako Morinishi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ai Chikada
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masahito Ogura
- Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Nobuya Inagaki
- Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuko Nin
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Muacevic A, Adler JR, Aljamri SK, Ghawas AH, Alhussain SS, Althumairi AA, Almuthaffar AA, Alhuwayji KA, Almajed AA, Al-Yateem SS, Alamri AS, Alhussaini NH, Almutairi MA, Alali AO, Alkhateeb AF. Factors Contributing to Noncompliance With Diabetic Medications and Lifestyle Modifications in Patients With Type 2 Diabetes Mellitus in the Eastern Province of Saudi Arabia: A Cross-Sectional Study. Cureus 2022; 14:e31965. [PMID: 36582555 PMCID: PMC9795535 DOI: 10.7759/cureus.31965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is defined as a chronic medical condition in which the blood glucose level remains high. The risk factors of T2DM are high body mass index due to obesity or being overweight, genetics, and certain medical conditions. Lifestyle modification plays a crucial role in T2DM regulation and prevention, and if it is not controlled well by either lifestyle modification or DM regulatory medications, it may lead to medical complications ranging from mild to life-threatening complications. AIM The purpose of this study is to find the contributory factors of noncompliance with oral antidiabetic drugs and lifestyle modifications in patients with T2DM in the eastern province of Saudi Arabia. This will help control one of the most widespread comorbidities that might otherwise be a significant burden on patients' health and financial status as well as on the government. METHODOLOGY A cross-sectional questionnaire study was conducted on T2DM patients in the eastern province of Saudi Arabia through a link distributed on social media, and the contributory factors of noncompliance to diabetes medication and lifestyle modification were evaluated. RESULTS A total of 426 participants were included in the study. Regarding compliance with DM medications, 199 (46.7%) participants were adherent to their medications, 148 (34.7%) were not adherent to their medication, 42 (9.9%) were sometimes adherent, and 37 (8.7%) were mostly adherent to their medication. Regarding lifestyle modification, the level of adherence to a healthy diet and exercise among T2DM patients in the eastern province was low and unsatisfactory. According to the participants, the most reported factors contributing to noncompliance with DM medications and lifestyle modifications were forgetfulness, lack of knowledge about diabetes and the importance of controlling it, side effects of the medications, and difficulty in following a healthy diet. Regarding the influence of sociodemographic variables on the level of adherence in T2DM patients, factors such as age, marital status, occupation, comorbidities, diagnosis period, and previous complaints of DM complications showed significant associations with compliance with DM medication. CONCLUSION The findings of this study revealed that the level of adherence to DM medications among T2DM patients in the eastern province was suboptimal. Although free medicines were available with a high level of healthcare access through government primary healthcare centers (PHCCs), poor adherence was observed. This study highlighted that medication adherence might be affected by age, marital status, occupation, chronic diseases, diagnosis period, and previous complaints of DM complications. Regarding lifestyle modification, this study showed that the level of adherence to a healthy diet and exercise among T2DM patients in the eastern province was low and unsatisfactory. Our recommendation is to measure the presence of dietician clinics, patient relationships with their healthcare providers, and their effect on patient compliance with DM medications. Further research is needed to include other factors that could influence adherence, such as patient-healthcare provider communication. Moreover, it is suggested that PHCCs discuss with noncompliant patients the reasons that prevent them from adhering to their medication and lifestyle modifications as part of their care plan.
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Vilafranca Cartagena M, Arreciado Marañón A, Artigues-Barbera E, Tort-Nasarre G. Successful Practices in Performing and Maintaining Physical Activity in Adults with Type 2 Diabetes Mellitus: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14041. [PMID: 36360920 PMCID: PMC9658001 DOI: 10.3390/ijerph192114041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/22/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
Physical activity has proven to be greatly beneficial in patients with DM2. However, few adhere to physical activity recommendations and are motivated to engage in regular physical activity and the numerous interventions conducted to change their habits tend to be unsuccessful in the long term. The objective in this research is to study patients who adhere to physical activity in order to guide patients who have not succeeded in making this change, assisted by the successful tools in the context of community nursing. A qualitative descriptive study was conducted. The sample included 10 patients with type 2 diabetes mellitus who adhered to physical activity in Catalonia, Spain, having been selected using intentional sampling. We recorded semi-structured interviews with the participants and conducted a thematic analysis. Five categories were identified and grouped into two themes: (1) Integrate physical activity as a lifestyle (meaning of DM2 and physical activity, adaptation to change and strategies on a day-to-day basis, physical activity) and (2) Find support to change physical activity (company and personal motivational strategies). In conclusion, a good adherence to physical activity was achieved thanks to motivation maintained over time related to autonomous motivation and the psychological and physiological benefits that physical activity provides patients, external support and encouragement, and the allocation of time to adhere without making great lifestyle changes.
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Affiliation(s)
- Mireia Vilafranca Cartagena
- Department of Nursing, Faculty of Health Science and Welfare, University of Vic-Central University of Catalonia (UVIC-UCC), Av. Universitària 4-6, 08242 Manresa, Spain
- Althaia Foundation, C/Dr Joan Soler 1-3, 08243 Manresa, Spain
| | - Antonia Arreciado Marañón
- Department of Nursing, Faculty of Medicine, Autonomous University of Barcelona, Campus Bellaterra, 08193 Cerdanyola del Vallès, Spain
- Multidisciplinary Research Group in Health and Society (GREMSAS), (2017 SGR 917), 08007 Barcelona, Spain
| | - Eva Artigues-Barbera
- Balafia Primary Care Center, Av. de Rosa Parks. Gerència Territorial Lleida, Catalan Health Institute (ICS), 08007 Barcelona, Spain
- Research Support Unit Lleida, Fundació Institut Universitari per a la Recerca al’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Rambla Ferran 44, 25007 Lleida, Spain
| | - Glòria Tort-Nasarre
- Department of Nursing, Faculty of Nursing and Physiotherapy, University of Lleida, C/Montserrat Roig, 25198 Lleida, Spain
- SAP ANOIA, Gerència Territorial Catalunya Central, Catalan Health Institute (ICS), 08007 Barcelona, Spain
- AFIN Research Group and Outreach Centre, Autonomous University of Barcelona, Campus Bellaterra, 08193 Cerdanyola del Vallès, Spain
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Lin L, Zhu F, Delp EJ, Eicher-Miller HA. Differences in Dietary Intake Exist among U.S. Adults by Diabetic Status Using NHANES 2009–2016. Nutrients 2022; 14:nu14163284. [PMID: 36014790 PMCID: PMC9415376 DOI: 10.3390/nu14163284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022] Open
Abstract
The objective was to determine the most frequently consumed food items, food subcategories, and food categories, and those that contributed most to total energy intake for the group of U.S. adults reporting taking insulin, those with type 2 diabetes (T2D) not taking insulin, and those without diabetes. Laboratory tests and questionnaires of the National Health and Nutrition Examination Survey 2009–2016 classified 774 participants reporting taking insulin, 2758 participants reporting T2D not taking insulin, and 17,796 participants without diabetes. Raw and weighted frequency and energy contributions of each food item, food subcategory, and food category were calculated and ranked. Comparisons among groups by broad food category used the Rao–Scott modified chi-square test. Soft drinks ranked as the 8th and 6th most consumed food subcategory of participants with T2D not taking insulin and those without diabetes, and contributed 5th and 2nd most to energy, respectively. The group reporting taking insulin is likely to consume more protein foods and less soft drink compared to the other two groups. Lists of the most frequently reported foods and foods contributing most to energy may be helpful for nutrition education, prescribing diets, and digital-based dietary assessment for the group reporting taking insulin.
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Affiliation(s)
- Luotao Lin
- Department of Nutrition Science, College of Health and Human Sciences, Purdue University, West Lafayette, IN 47907, USA
| | - Fengqing Zhu
- School of Electrical and Computer Engineering, College of Engineering, Purdue University, West Lafayette, IN 47907, USA
| | - Edward J. Delp
- School of Electrical and Computer Engineering, College of Engineering, Purdue University, West Lafayette, IN 47907, USA
| | - Heather A. Eicher-Miller
- Department of Nutrition Science, College of Health and Human Sciences, Purdue University, West Lafayette, IN 47907, USA
- Correspondence:
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Yang Y, Yu D, Piao W, Huang K, Zhao L. Nutrient-Derived Beneficial for Blood Pressure Dietary Pattern Associated with Hypertension Prevention and Control: Based on China Nutrition and Health Surveillance 2015–2017. Nutrients 2022; 14:nu14153108. [PMID: 35956285 PMCID: PMC9370233 DOI: 10.3390/nu14153108] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 12/05/2022] Open
Abstract
Background: Greater adherence of Dietary Approach to Stop Hypertension (DASH) or the Mediterranean dietary pattern were reported to be beneficial for blood pressure. However, both were established based on Western populations. Our current study aimed to explore a dietary pattern which might be suitable for hypertension prevention and control among Chinese adults nationwide. Methods: A total of 61,747 Chinese adults aged over 18 years from China Nutrition and Health Surveillance 2015–2017 was included in this study. Using reduced-rank regression (RRR) method, a dietary pattern with higher intakes of those nutrients which are inversely associated with the risk of hypertension was identified. DASH-score was also calculated for each participant for further validate the dietary pattern derived by RRR method. Multi-adjustment logistic regression was applied to examine the association between above two dietary patterns and hypertension prevention and control. Results: Dietary pattern named Beneficial for Blood Pressure (BBP) diet was characterized by higher fresh vegetables and fruits, mushrooms/edible fungi, dairy products, seaweeds, fresh eggs, nuts and seeds, legumes and related products, aquatic products, coarse cereals, and less refined grains and alcohol consumption. After multiple adjustment, protective effects showed on both hypertension prevention and control (for prevention: Q5 vs. Q1, OR = 0.842, 95% CI = 0.791–0.896; for control: Q5 vs. Q1, OR = 0.762, 95% CI = 0.629–0.924). For the DASH-diet, significant results were also observed (for prevention: Q5 vs. Q1, OR = 0.912, 95% CI = 0.854–0.973; for control: Q5 vs. Q1, OR = 0.76, 95% CI = 0.616–0.938). Conclusions: BBP-diet derived from Chinese adults has high conformity with the DASH-diet, and it might serve as an adjuvant method for both hypertension prevention and control.
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Chavda VP, Ajabiya J, Teli D, Bojarska J, Apostolopoulos V. Tirzepatide, a New Era of Dual-Targeted Treatment for Diabetes and Obesity: A Mini-Review. Molecules 2022; 27:molecules27134315. [PMID: 35807558 PMCID: PMC9268041 DOI: 10.3390/molecules27134315] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/28/2022] [Accepted: 07/04/2022] [Indexed: 02/07/2023] Open
Abstract
The prevalence of obesity and diabetes is an increasing global problem, especially in developed countries, and is referred to as the twin epidemics. As such, advanced treatment approaches are needed. Tirzepatide, known as a ‘twincretin’, is a ‘first-in-class’ and the only dual glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP) receptor agonist, that can significantly reduce glycemic levels and improve insulin sensitivity, as well as reducing body weight by more than 20% and improving lipid metabolism. This novel anti-diabetic drug is a synthetic peptide analog of the human GIP hormone with a C20 fatty-diacid portion attached which, via acylation technology, can bind to albumin in order to provide a dose of the drug, by means of subcutaneous injection, once a week, which is appropriate to its a half-life of about five days. Tirzepatide, developed by Eli Lilly, was approved, under the brand name Mounjaro, by the United States Food and Drug Administration in May 2022. This started the ‘twincretin’ era of enormously important and appealing dual therapeutic options for diabetes and obesity, as well as advanced management of closely related cardiometabolic settings, which constitute the leading cause of morbidity, disability, and mortality worldwide. Herein, we present the key characteristics of tirzepatide in terms of synthesis, structure, and activity, bearing in mind its advantages and shortcomings. Furthermore, we briefly trace the evolution of this kind of medical agent and discuss the development of clinical studies.
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Affiliation(s)
- Vivek P. Chavda
- Department of Pharmaceutics and Pharmaceutical Technology, LM College of Pharmacy, Ahmedabad 380009, India
- Correspondence: (V.P.C.); (J.B.); (V.A.)
| | - Jinal Ajabiya
- Department of Pharmaceutics Analysis and Quality Assurance, LM College of Pharmacy, Ahmedabad 380009, India;
| | - Divya Teli
- Department of Pharmaceutical Chemistry, LM College of Pharmacy, Ahmedabad 380009, India;
| | - Joanna Bojarska
- Institute of General and Ecological Chemistry, Faculty of Chemistry, Lodz University of Technology, 116 Żeromskiego Street, 90-924 Lodz, Poland
- Correspondence: (V.P.C.); (J.B.); (V.A.)
| | - Vasso Apostolopoulos
- Institute for Health and Sport, Victoria University, Melbourne, VIC 3030, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), Immunology Program, Melbourne, VIC 3030, Australia
- Correspondence: (V.P.C.); (J.B.); (V.A.)
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Thomson M, Martin A, Long E, Logue J, Simpson SA. A qualitative exploration of weight management during COVID-19. Clin Obes 2022; 12:e12512. [PMID: 35194943 PMCID: PMC9286397 DOI: 10.1111/cob.12512] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 02/01/2022] [Accepted: 02/07/2022] [Indexed: 12/03/2022]
Abstract
COVID-19 has been associated with worse outcomes in people living with obesity and has altered how people can engage with weight management. However, the impact of risk perceptions and changes to daily life on weight loss has not been explored. This study aimed to examine how COVID-19 and perception of risk interacted with weight loss attempts in adults participating in a behavioural weight management programme. Forty-eight participants completed a semi-structured interview exploring the impact of COVID-19 on their weight management experience. Interviews were completed via telephone and analysed using a thematic approach. Reaction to perceived risk varied, but most participants reported the knowledge of increased risk promoted anxiety and avoidance behaviours. Despite this, many reported it as a motivating factor for weight loss. Restrictions both helped (e.g., reduced temptation) and hindered their weight loss (e.g., less support). However, there was consensus that the changes to everyday life meant participants had more time to engage with and take control of their weight loss. To the authors' knowledge, this is the first study to explore the impact of COVID-19 on participation in a weight management programme started during the pandemic in the United Kingdom. Restrictions had varying impacts on participant's weight loss. How risk is perceived and reported to participants is an important factor influencing engagement with weight management. The framing of health information needs to be considered carefully to encourage engagement with weight management to mitigate risk. Additionally, the impact of restrictions and personal well-being are key considerations for weight management programmes.
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Affiliation(s)
- Meigan Thomson
- MRC/CSO Social and Public Health Sciences UnitUniversity of GlasgowGlasgowUK
| | - Anne Martin
- MRC/CSO Social and Public Health Sciences UnitUniversity of GlasgowGlasgowUK
| | - Emily Long
- MRC/CSO Social and Public Health Sciences UnitUniversity of GlasgowGlasgowUK
| | - Jennifer Logue
- Lancaster Medical SchoolUniversity of LancasterLancasterUK
| | - Sharon A. Simpson
- MRC/CSO Social and Public Health Sciences UnitUniversity of GlasgowGlasgowUK
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Ungersboeck M, Tang X, Neeff V, Steele D, Grimm P, Fenech M. Personalised Nutritional Recommendations Based on Individual Post-Prandial Glycaemic Responses Improve Glycaemic Metrics and PROMs in Patients with Type 2 Diabetes: A Real-World Assessment. Nutrients 2022; 14:nu14102123. [PMID: 35631264 PMCID: PMC9145975 DOI: 10.3390/nu14102123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/11/2022] [Accepted: 05/16/2022] [Indexed: 02/01/2023] Open
Abstract
The recommended first-line therapy in type 2 diabetes (T2D) is lifestyle modification. In many patients, such interventions fail, and disease progresses inexorably to medication requirement. A potential reason for the failure of standard nutritional interventions is the use of generic dietary advice, with no personalisation to account for differences in the effect of food on blood glucose between different individuals. Another is the lack of instant feedback on the impact of dietary modification on glycaemic control, which supports sustained behaviour change. The use of continuous glucose monitoring (CGM) may help address both these shortcomings. We conducted an observational study to explore how personalised nutritional information impacts glycaemic control and patient-reported outcome measures (PROMs) of well-being. Free-living people with T2D eating their normal diet were provided with personalised nutritional recommendations by state-registered nutritionists based on the CGM-enabled analysis of individual post-prandial glycaemic responses (PPGRs). Participants demonstrated considerable inter-individual differences in PPGRs, reductions in post-prandial incremental area under the curve (iAUC) and daytime AUC, and improvements in energy levels, ability to concentrate, and other PROMs. These results suggest a role for personalised nutritional recommendations based on individual-level understanding of PPGRs in the non-pharmaceutical management of T2D.
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Nielsen SG, Danielsen JH, Grønbæk HN, Molsted S, Jacobsen SS, Vilsbøll T, Varming AR. Transforming Motivation for Exercise in a Safe and Kind Environment-A Qualitative Study of Experiences among Individuals with Type 2 Diabetes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106091. [PMID: 35627628 PMCID: PMC9141646 DOI: 10.3390/ijerph19106091] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 05/13/2022] [Accepted: 05/14/2022] [Indexed: 02/05/2023]
Abstract
Exercise is a cornerstone in diabetes care; however, adherence is low and sustaining physical activity remains a challenge. Patient-centered diabetes self-management education and support are recommended; however, sparse literature exists on how to design exercise interventions that improve self-management in individuals with complications of type 2 diabetes mellitus (T2D). We aimed to gain insights into needs, barriers, and motivation based on experiences with exercise participation among individuals with T2D and complications to adjust and develop new types of tailored, supervised exercise classes in specialized care at three hospitals in Denmark. In keeping with a constructivist research paradigm, a qualitative hermeneutic approach using focus group interviews was applied to explore perspectives among different participants in terms of disease severity. Seven interviews with 30 participants (aged 49–88) representing seven different exercise classes, were conducted over three years. Reflective thematic analysis was used. Four themes were generated: People like us, Getting started with exercise, Game changers, and Moving forward. An overarching theme ‘The transformation of motivation when exercising in a safe and kind environment’ links the themes together, resembling the participants’ development of physical literacy encompassing motivation, confidence, physical competence as well as an ability to value physical activity. Supportive patient-centered exercise classes promoted a transformation of motivation grounded in the development of physical literacy among participants in specialized diabetes care. However, participants were concerned with continuing to exercise on their own after the intervention, as they experienced a lack of continuous, supervised exercise opportunities in local communities.
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Affiliation(s)
- Susanne Grøn Nielsen
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, 2730 Herlev, Denmark; (J.H.D.); (H.N.G.); (S.S.J.); (T.V.); (A.R.V.)
- Correspondence:
| | - Julie Hagstrøm Danielsen
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, 2730 Herlev, Denmark; (J.H.D.); (H.N.G.); (S.S.J.); (T.V.); (A.R.V.)
| | - Helle Nergaard Grønbæk
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, 2730 Herlev, Denmark; (J.H.D.); (H.N.G.); (S.S.J.); (T.V.); (A.R.V.)
| | - Stig Molsted
- Department of Endocrinology, Nordsjællands Hospital, 3400 Hillerød, Denmark;
| | - Sandra Schade Jacobsen
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, 2730 Herlev, Denmark; (J.H.D.); (H.N.G.); (S.S.J.); (T.V.); (A.R.V.)
| | - Tina Vilsbøll
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, 2730 Herlev, Denmark; (J.H.D.); (H.N.G.); (S.S.J.); (T.V.); (A.R.V.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 1165 Copenhagen, Denmark
| | - Annemarie Reinhardt Varming
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, 2730 Herlev, Denmark; (J.H.D.); (H.N.G.); (S.S.J.); (T.V.); (A.R.V.)
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Zupkauskiene J, Lauceviciene I, Navickas P, Ryliskyte L, Puronaite R, Badariene J, Laucevicius A. Changes in health-related quality of life, motivation for physical activity, the levels of anxiety and depression after individualized aerobic training in subjects with metabolic syndrome. Hellenic J Cardiol 2022; 66:41-51. [DOI: 10.1016/j.hjc.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 04/04/2022] [Accepted: 04/12/2022] [Indexed: 11/04/2022] Open
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Price J, Brunet J. Understanding rural-living young adult cancer survivors' motivation during a telehealth behavior change intervention within a single-arm feasibility trial. Health Informatics J 2022; 28:14604582221075560. [PMID: 35176882 DOI: 10.1177/14604582221075560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A single-arm feasibility trial was conducted to explore rural-living young adult cancer survivors' physical activity, fruit and vegetable consumption, and motivational processes underlying any behavior changes during a telehealth behavior change intervention grounded in self-determination theory. Participants (n = 7; 85.7% female; Mage = 33.9, range = 28-37) met with a health coach once a week for 60 min for 12 weeks. Participants completed pre- and post-intervention surveys that assessed their behaviors, basic psychological needs satisfaction, and behavioral regulations. Participants also completed a semi-structured interview post-intervention. Quantitative results indicate behavioral outcomes, basic psychological needs satisfaction, and behavioral regulations increased from pre- to post-intervention. Five themes provide context for the observed increases. Results provide preliminary evidence that motivation for physical activity and fruit and vegetable consumption may be facilitated by a one-on-one telehealth intervention among rural-living young adult cancer survivors. Large scale studies are needed to determine effectiveness of the intervention and identify mechanisms underpinning behavioral outcomes.
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Affiliation(s)
- Jenson Price
- School of Human Kinetics, 6363University of Ottawa, Ottawa, ON, Canada
| | - Jennifer Brunet
- School of Human Kinetics, 6363University of Ottawa, Ottawa, ON, Canada; Cancer Therapeutic Program, Ottawa Hospital Research Institute, the Ottawa Hospital, Ottawa, ON, Canada; Institut du savoir Montfort, Hôpital Montfort, Ottawa, ON, Canada
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26
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Thorsen IK, Kayser L, Teglgaard Lyk-Jensen H, Rossen S, Ried-Larsen M, Midtgaard J. " I Tried Forcing Myself to do It, but Then It Becomes a Boring Chore": Understanding (dis)engagement in Physical Activity Among Individuals With Type 2 Diabetes Using a Practice Theory Approach. QUALITATIVE HEALTH RESEARCH 2022; 32:520-530. [PMID: 34964675 DOI: 10.1177/10497323211064598] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Lack of physical activity (PA) is common among individuals with type 2 diabetes (T2D). We apply a practice theory approach to investigate PA engagement in the context of T2D. Data were collected through semi-structured individual interviews (n = 23) and focus groups (n = 3x6) and analyzed by deductive-inductive reflexive thematic analysis using a practice theory framework. Forty-one purposefully selected individuals with T2D (29 men) between the ages of 54 and 77 years were included. The analysis resulted in three main themes informed by five subthemes, reflecting the key elements of practice theory (i.e., meanings, materialities, and competencies). One overarching theme identified PA engagement as an unsustainable and insurmountable project in constant and unequal competition with the practice of physical inactivity. To increase PA among individuals with T2D, future PA interventions and strategies should aim to establish a stronger link between PA and everyday life practices.
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Affiliation(s)
- Ida K Thorsen
- The Centre for Physical Activity Research, Rigshospitalet, 4321University of Copenhagen, Copenhagen, Denmark
| | - Lars Kayser
- Department of Public Health, 4321University of Copenhagen, Copenhagen, Denmark
| | | | - Sine Rossen
- Copenhagen Centre for Cancer and Health, Municipality of Copenhagen, Copenhagen, Denmark
| | - Mathias Ried-Larsen
- The Centre for Physical Activity Research, Rigshospitalet, 4321University of Copenhagen, Copenhagen, Denmark
| | - Julie Midtgaard
- Centre for Applied Research in Mental Health Care (CARMEN), Mental Health Centre Glostrup, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, 4321University of Copenhagen, Copenhagen, Denmark
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Yoon S, Wee S, Loh DHF, Bee YM, Thumboo J. Facilitators and Barriers to Uptake of Community-Based Diabetes Prevention Program Among Multi-Ethnic Asian Patients With Prediabetes. Front Endocrinol (Lausanne) 2022; 13:816385. [PMID: 35295990 PMCID: PMC8919042 DOI: 10.3389/fendo.2022.816385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/03/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE This study aimed to identify facilitators and barriers to the uptake of a community-based diabetes prevention program (DPP) from the perspectives of decliners with prediabetes in a multi-ethnic Asian community. METHODS Semi-structured interviews were conducted with 29 individuals with prediabetes who declined participation in a large community-based diabetes prevention program in Singapore. Thematic analysis was undertaken to identify themes, which were subsequently mapped onto the Capacity-Opportunity-Motivation and Behavior model (COM-B). RESULTS We identified 16 key themes under three COM-B domains. Health status at the time of invitation, perceived ability of self-management, understanding of prediabetes condition and/or the program intention (Capability) were important determinants. Family commitment had the strong potential to enable or hinder physical and social Opportunity related to participation. Many participants desired involvement of physician as part of program invitation and component. Fear of exacerbation coupled with an automatic aversion for suffering influenced Motivation for participation. CONCLUSION Identifying facilitators and barriers embedded in the COM-B will assist systematic program modifications to increase participation of individuals with prediabetes. How information about modifiable risk factors is communicated by physicians at the point of diagnosis and program introduction is key to participation. Co-locating programs with family activity, development of mHealth, readiness assessment, and tailored explanation of program purpose may increase participation. These findings will be used to guide future national interventions in the community to ensure successful implementation.
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Affiliation(s)
- Sungwon Yoon
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
- *Correspondence: Sungwon Yoon,
| | - Sharon Wee
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
| | - Dionne H. F. Loh
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
| | - Yong Mong Bee
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - Julian Thumboo
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
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James A, Lawrence B, O’Connor M. Healthy Eating as a New Way of Life: A Qualitative Study of Successful Long-Term Diet Change. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2022; 59:469580221090397. [PMID: 35418258 PMCID: PMC9016560 DOI: 10.1177/00469580221090397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Improving diet quality has been shown to be an effective way to improve
health and well-being. Yet information on how to assist those wanting to
transition to and maintain a healthier diet is still limited. The aim of
this study was to explore what motivated people to initiate and maintain a
healthy diet. Methods Semi-structured interviews were conducted with 20 participants (all
Australian residents) who had made significant improvements to their diets
and had maintained these changes for a minimum of two years
(nfemale = 15, nmale = 5, Mage = 37.7, SD = 12.4). The transcripts were analysed
using thematic analysis which identified five overarching themes: A desire
to feel better, investigation and learning, helpful habits, benefits, and
values. Results Participants reported a strong wish to feel better and investigated the role
of diet as a possible way to improve well-being. Through daily habits and
continuous engagement with the topic, healthy eating became a way of life
for many participants. Experiencing the benefits of a healthier diet and
having developed strong values regarding diet and health supported long-term
maintenance. Conclusions Findings from the present study contribute to the literature in highlighting
the importance of internal motivation and autonomy for health behaviours.
Findings may inform the development of healthy eating interventions.
Encouraging autonomy, fostering values aligned with a healthier diet, and
helping individuals establish daily habits is likely to support change.
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Affiliation(s)
- Anna James
- WA Cancer Prevention Research Unit, Discipline of Psychology, School of Population Health, Curtin University, Perth, WA, Australia
| | - Blake Lawrence
- WA Cancer Prevention Research Unit, Discipline of Psychology, School of Population Health, Curtin University, Perth, WA, Australia
| | - Moira O’Connor
- WA Cancer Prevention Research Unit, Discipline of Psychology, School of Population Health, Curtin University, Perth, WA, Australia
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Sallay V, Klinovszky A, Csuka SI, Buzás N, Papp-Zipernovszky O. Striving for autonomy in everyday diabetes self-management-qualitative exploration via grounded theory approach. BMJ Open 2021; 11:e058885. [PMID: 34952888 PMCID: PMC9066350 DOI: 10.1136/bmjopen-2021-058885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The rapid worldwide increase in the incidence of diabetes significantly influences the lives of individuals, families and communities. Diabetes self-management requires personal autonomy and the presence of a supportive social environment. These attributes can considerably ameliorate the outcomes of the chronic condition. However, little is known about individual variations in overcoming the illness-related challenges and in the achievement of autonomy in daily activities. This paper seeks to bridge this knowledge gap. DESIGN This qualitative study used the grounded theory approach. Semi-structured interviews were conducted, and the data collection and data analysis probed participant experiences of autonomy through the self-management of their daily socio-physical environments. SETTING Participants were recruited from the outpatient ward of a university clinic in Hungary. PARTICIPANTS The study was conducted with 26 adult patients with type 2 diabetes mellitus (15 females and 11 males aged between 26 and 80 years; M=62.6 years; SD=13.1). The inclusion criteria were: T2D diagnosis at least 1 year before the beginning of the study; prescribed insulin injection therapy; aged over 18 years; native Hungarian speaker and not diagnosed with dementia or any form of cognitive impairment. RESULTS The study established three principal aspects of the active construction of personal autonomy in diabetes self-management: coping strategies vis-à-vis threats posed by the symptoms and the treatment of the disease; autonomous ways of creating protective space and time and relationship processes that support everyday experiences of self-directedness. CONCLUSIONS The results of this study confirm the validity of the self-determination theory in diabetes self-management. They also imply that pathways towards constructing everyday experiences of self-directedness in participants lead through self-acceptance, supporting family relationships and a doctor-patient relationship characterised by partnership. The tentative empirical model of pathways towards patients' experience of self-directedness can serve as a framework for future research, patient-centred clinical practice, and education.
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Affiliation(s)
- Viola Sallay
- Institute of Psychology, University of Szeged, Szeged, Hungary
| | - Andrea Klinovszky
- Department of Health Economics, University of Szeged, Szeged, Hungary
| | - Sára Imola Csuka
- Károly Rácz Doctoral School, Semmelweis University, Budapest, Hungary
- Institute for the Psychology of Special Needs, Eötvös Loránd University, Budapest, Hungary
| | - Norbert Buzás
- Department of Health Economics, University of Szeged, Szeged, Hungary
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Houttu V, Csader S, Nieuwdorp M, Holleboom AG, Schwab U. Dietary Interventions in Patients With Non-alcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis. Front Nutr 2021; 8:716783. [PMID: 34368214 PMCID: PMC8339374 DOI: 10.3389/fnut.2021.716783] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 06/22/2021] [Indexed: 12/15/2022] Open
Abstract
Background: With no approved pharmacotherapy to date, the present therapeutic cornerstone for non-alcoholic fatty liver diseases (NAFLD) is a lifestyle intervention. Guidelines endorse weight loss through dietary modifications, physical exercise, or both. However, no consensus exists on the optimal dietary treatment. Objectives: The aim of our systematic review and meta-analysis was to summarize and assess the evidence for applied types of dietary interventions on the liver and metabolic outcomes in patients with NAFLD, aside from any effects of exercise intervention. Methods: This systematic review was conducted according to the Preferred Reporting Items of Systematic Reviews and Meta-analysis (PRISMA) statement guidelines. The search was conducted in PubMed, Scopus, and Cochrane databases in February 2020. Included were only dietary interventions without exercise. This study was registered at PROSPERO: CRD42020203573. Results: Eight randomized controlled trials, seven with endpoint reduction of hepatic steatosis, one with an assessment of endpoint fibrosis, were included in this systematic review, five of which were included in the meta-analysis. Mediterranean dietary interventions without energy restriction (n = 3) showed significant reduction of intrahepatic lipid content (IHL) (SDM: -0.57, 95% CI: -1.04, -0.10), but there was no significant change in alanine transaminase (ALT) (SDM: 0.59, 95% CI: -0.5, -1.68). Hypocaloric dietary interventions with foods high in unsaturated fatty acids (n = 2) led to a significant decrease in ALT (SDM: -1.09, 95% CI: -1.49, -0.69) and aspartate aminotransferase (AST) (SDM: -0.75, 95% CI: -1.27, 0.23); yet effects on steatosis could not be aggregated due to different assessment techniques. Mediterranean diet did not lead to significant changes in concentrations of gamma-glutamyl transpeptidase (γGT), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), fasting glucose or insulin, or homeostatic assessment for insulin resistance. Conclusions: In patients with NAFLD, Mediterranean and hypocaloric dietary interventions favoring unsaturated fatty acids result in improvements in IHL and transaminases. Since many dietary intervention studies are combined with exercise interventions and there is a paucity of ample-sized studies examining dietary interventions on the more advanced and clinically relevant stages of NAFLD, that is active and fibrotic NASH, with multiparametric imaging and liver histology as outcome measures, the optimal dietary invention in NAFLD remains to be defined.
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Affiliation(s)
- Veera Houttu
- Department of Vascular Medicine, Amsterdam University Medical Center, Location Amsterdam Medical Center at the University of Amsterdam, Amsterdam, Netherlands
- Department of Experimental Vascular Medicine, Amsterdam University Medical Center, Location Amsterdam Medical Center at the University of Amsterdam, Amsterdam, Netherlands
| | - Susanne Csader
- School of Medicine, Institute of Public Health and Clinical Nutrition, The University of Eastern Finland, Kuopio, Finland
| | - Max Nieuwdorp
- Department of Vascular Medicine, Amsterdam University Medical Center, Location Amsterdam Medical Center at the University of Amsterdam, Amsterdam, Netherlands
- Department of Experimental Vascular Medicine, Amsterdam University Medical Center, Location Amsterdam Medical Center at the University of Amsterdam, Amsterdam, Netherlands
| | - Adriaan G. Holleboom
- Department of Vascular Medicine, Amsterdam University Medical Center, Location Amsterdam Medical Center at the University of Amsterdam, Amsterdam, Netherlands
- Department of Experimental Vascular Medicine, Amsterdam University Medical Center, Location Amsterdam Medical Center at the University of Amsterdam, Amsterdam, Netherlands
| | - Ursula Schwab
- School of Medicine, Institute of Public Health and Clinical Nutrition, The University of Eastern Finland, Kuopio, Finland
- Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland
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Hale L, Higgs C, Keen D, Smith C. Long Term Exercise Engagement of Adults Living With Type Two Diabetes Is Enhanced by a Person-Centred Care Approach Delivered by Knowledgeable, Well Trained Health Care Professionals. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:692311. [PMID: 36188765 PMCID: PMC9397728 DOI: 10.3389/fresc.2021.692311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/10/2021] [Indexed: 01/03/2023]
Abstract
Background: Regular engagement in exercise or physical activity is a key evidence-based recommendation in the self-management of type 2 diabetes (T2D). The Diabetes Community Exercise Programme (DCEP) is an exercise and educational programme aimed at supporting adults living with T2D to take control of their health and to live well with T2D. It was specifically developed to enhance the self-efficacy of people to engage in exercise for a long term and is underpinned by the spirit of motivational interviewing. This study explores what DCEP attendees and health care professionals (HCPs) who deliver the programme perceived DCEP to be and what motivated attendance. Such insights further the knowledge of how people with T2D can be supported to engage in exercise or physical activity programmes. Method: This qualitative study used open-ended interviews of 17 DCEP attendees and 12 HCPs delivering DCEP. Interviews occurred at the completion of the initial twice-a-week, 12-week duration part of the programme and prior to attendees starting with a twice-weekly maintenance exercise class, which forms the second part of the programme. Interviews were audio-recorded, transcribed verbatim and analysed with the General Inductive Approach. Results: The two themes constructed from the analysis were person-centred care and attention to logistics and administration. Person-centred care comprised four subthemes: monitoring, individualised exercise within a sociable group setting, flexible education and discussion, and HCP training, and these components appeared to support attendees to engage in exercise. The second theme spoke about the processes, that was either present or that should be included, that enabled DCEP delivery, such as appropriate venues, flexible approaches to time of day and the requirement of good administrative support. Conclusion: The Diabetes Community Exercise Programme did motivate people with T2D to engage in exercise. Important to this was the emphasis on a person-centred approach that focussed on the health status monitoring and educational and social aspects of the programme, which in turn facilitated exercise engagement. Knowledgeable HCPs who require training in the delivery of person-centred care to tailor the exercise and education to the individual is imperative. Equally important are optimal exercise environments and well-trained administrative support.
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Adhikari M, Devkota HR, Cesuroglu T. Barriers to and facilitators of diabetes self-management practices in Rupandehi, Nepal- multiple stakeholders' perspective. BMC Public Health 2021; 21:1269. [PMID: 34187461 PMCID: PMC8243465 DOI: 10.1186/s12889-021-11308-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 06/17/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Self-management of diabetes is associated with glycaemic control and adherence to medication and healthy lifestyle practices. There is lack of information on the barriers to and facilitators of diabetes self-management practices in low income country, Nepal. This study aimed to explore the barriers to and facilitators of Type 2 diabetes self-management practices taking multiple stakeholders' perspectives in Nepal. METHODS Four focus group discussions and 16 semi-structured interviews with people with Type 2 diabetes, caregivers, health care providers and health managers were conducted from April to May 2018 in Rupandehi district of Western Nepal. They were audio-recorded, transcribed, and analysed using a thematic approach. RESULTS Five main themes emerged that influenced diabetes self-management practices: individual factors, socio-cultural and economic factors, health system and policy factors, availability and accessibility of resources, and environmental factors. The important barriers were: lack of knowledge about diabetes self-management practices, cultural practices, insufficient counselling, lack of guidelines and protocols for counselling, and financial problems. The major facilitators were: motivation; support from family, peers, and doctors; and availability of resources in the community. CONCLUSION Based on our findings, a multilevel approach is needed to address these barriers and facilitators. These findings will help guide strategies to develop programs that impart knowledge and skills to improve the diabetes self-management practices of people with Type 2 diabetes.
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Affiliation(s)
| | | | - Tomris Cesuroglu
- Faculty of Science, Vrije University, Amsterdam, The Netherlands
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Using self-determination theory to understand the social prescribing process: a qualitative study. BJGP Open 2021; 5:BJGPO.2020.0153. [PMID: 33402331 PMCID: PMC8170608 DOI: 10.3399/bjgpo.2020.0153] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/02/2020] [Indexed: 11/15/2022] Open
Abstract
Background Social prescribing (SP) assists patients to engage in social activities and connect to community supports as part of a holistic approach to primary care.Rx: Community was a SP project, which was implemented within 11 community health centres (CHCs) situated across Ontario, Canada. Aim To explore how SP as a process facilitates positive outcomes for patients. Design & setting Qualitative methods were used. Eighteen focus groups were conducted at CHCs or by video-conferencing, and involved 88 patients. In addition, eight in-depth telephone interviews were undertaken. Method Interviews and focus groups were transcribed verbatim, and analysed thematically using a theoretical framework based on self-determination theory (SDT). Results Participants who had received social prescriptions described SP as an empathetic process that respects their needs and interests. SP facilitated the patient’s voice in their care, helped patients to develop skills in addressing needs important to them, and fostered trusting relationships with staff and other participants. Patients reported their social support networks were expanded, and they had improved mental health and ability in self-management of chronic conditions. Patients who became involved in SP as voluntary 'health champions' reported this was a positive experience and they gained a sense of purpose by giving back to their communities in ways that felt meaningful for them. Conclusion SP produced positive outcomes for patients, and it fits well within the community health centre model of primary care. Future research should examine the impact on health outcomes and examine the return on investment of developing and implementing SP programmes.
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Barrado-Martín Y, Heward M, Polman R, Nyman SR. People living with dementia and their family carers' adherence to home-based Tai Chi practice. DEMENTIA 2020; 20:1586-1603. [PMID: 32924589 PMCID: PMC8216316 DOI: 10.1177/1471301220957758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objectives The aim of this study was to understand what influenced people living with dementia and their family carers’ adherence to the home-based component of a Tai Chi exercise intervention. Method Dyads, of people living with dementia and their family carers, who participated in the intervention arm of the Tai Chi for people living with dementia trial, were invited to join weekly Tai Chi classes for 20 weeks and practice at home. Semi-structured dyadic home interviews were conducted on average after 16 weeks of classes. The views of 15 dyads with a range of home practice adherence were sought in semi-structured interviews. The interviews were analysed using an inductive thematic approach. Results Most participants found time to practise Tai Chi at home and practised for 18 hours on average. Amongst the barriers to adherence were participants’ competing commitments and a booklet not sufficiently conveying the Tai Chi movements. Hence, a video or DVD was requested by participants. Facilitators of their adherence to the home-based component of the intervention were their enjoyment of the practice and the development of a habit, which was supported by their commitment to the study and their willingness to benefit from Tai Chi. Conclusion Enjoyment and perceived benefits had a great impact on participants living with dementia and their carers’ adherence to home-based Tai Chi practice. However, difficulties to perceive the Tai Chi movements through images might be hindering sustained participation. Hence, alternative aids such as videos and DVDs should be explored to facilitate adherence.
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Affiliation(s)
- Yolanda Barrado-Martín
- Department of Psychology and Ageing & Dementia Research Centre (ADRC), 6657Bournemouth University, Fern Barrow, Poole, UK Centre for Ageing & Population Studies, Research Department of Primary Care & Population Health, London, UK
| | - Michelle Heward
- Ageing & Dementia Research Centre (ADRC) and Department of Rehabilitation and Sport Science, 6657Bournemouth University, Fern Barrow, Poole, UK
| | - Remco Polman
- School Exercise & Nutrition Sciences, 72524Queensland University of Technology, Australia
| | - Samuel R Nyman
- Department of Psychology and Ageing & Dementia Research Centre (ADRC), 6657Bournemouth University, Fern Barrow, Poole, UK Department of Medical Science, Public Health, Bournemouth University, Fern Barrow, Poole, UK
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Emm-Collison LG, Sebire SJ, Salway R, Thompson JL, Jago R. Multidimensional motivation for exercise: A latent profile and transition analysis. PSYCHOLOGY OF SPORT AND EXERCISE 2020; 47:101619. [PMID: 32127781 PMCID: PMC7015274 DOI: 10.1016/j.psychsport.2019.101619] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 11/08/2019] [Accepted: 11/08/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To: a) identify motivational profiles for exercise, using Self-Determination Theory as a theoretical framework, among a sample of parents of UK primary school children; b) explore the movement between motivational profiles over a five year period; and c) examine differences across these profiles in terms of gender, physical activity and BMI. DESIGN Data were from the B-Proact1v cohort. METHODS 2555 parents of British primary school children participated across three phases when the child was aged 5-6, 8-9, and 10-11. Parents completed a multidimensional measure of motivation for exercise and wore an ActiGraph GT3X + accelerometer for five days in each phase. Latent profile and transition analyses were conducted using a three-step approach in MPlus. RESULTS Six profiles were identified, comprising different combinations of motivation types. Between each timepoint, moving between profiles was more likely than remaining in the same one. People with a more autonomous profile at a previous timepoint were unlikely to move to more controlled or amotivated profiles. At all three timepoints, more autonomous profiles were associated with higher levels of MVPA and lower BMI. CONCLUSIONS The results show that people's motivation for exercise can be described in coherent and consistent profiles which are made up of multiple and simultaneous types of motivation. More autonomous motivation profiles were more enduring over time, indicating that promoting more autonomous motivational profiles may be central to facilitating longer-term physical activity engagement.
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Affiliation(s)
- Lydia G. Emm-Collison
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ, UK
| | - Simon J. Sebire
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ, UK
| | - Ruth Salway
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ, UK
| | - Janice L. Thompson
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Russell Jago
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ, UK
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Gray ID, Kross AR, Renfrew ME, Wood P. Precision Medicine in Lifestyle Medicine: The Way of the Future? Am J Lifestyle Med 2020; 14:169-186. [PMID: 32231483 PMCID: PMC7092395 DOI: 10.1177/1559827619834527] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/21/2018] [Accepted: 02/08/2019] [Indexed: 02/06/2023] Open
Abstract
Precision medicine has captured the imagination of the medical community with visions of therapies precisely targeted to the specific individual's genetic, biological, social, and environmental profile. However, in practice it has become synonymous with genomic medicine. As such its successes have been limited, with poor predictive or clinical value for the majority of people. It adds little to lifestyle medicine, other than in establishing why a healthy lifestyle is effective in combatting chronic disease. The challenge of lifestyle medicine remains getting people to actually adopt, sustain, and naturalize a healthy lifestyle, and this will require an approach that treats the patient as a person with individual needs and providing them with suitable types of support. The future of lifestyle medicine is holistic and person-centered rather than technological.
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Affiliation(s)
- Ian D. Gray
- Avondale College of Higher Education, Cooranbong,
New South Wales, Australia
| | - Andrea R. Kross
- Avondale College of Higher Education, Cooranbong,
New South Wales, Australia
| | - Melanie E. Renfrew
- Avondale College of Higher Education, Cooranbong,
New South Wales, Australia
| | - Paul Wood
- Avondale College of Higher Education, Cooranbong,
New South Wales, Australia
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Ee C, de Courten B, Avard N, de Manincor M, Al-Dabbas MA, Hao J, McBride K, Dubois S, White RL, Fleming C, Egger G, Blair A, Stevens J, MacMillan F, Deed G, Grant S, Templeman K, Chang D. Shared Medical Appointments and Mindfulness for Type 2 Diabetes-A Mixed-Methods Feasibility Study. Front Endocrinol (Lausanne) 2020; 11:570777. [PMID: 33123089 PMCID: PMC7573307 DOI: 10.3389/fendo.2020.570777] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/10/2020] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Type 2 diabetes (T2DM) is a major health concern with significant personal and healthcare system costs. There is growing interest in using shared medical appointments (SMAs) for management of T2DM. We hypothesize that adding mindfulness to SMAs may be beneficial. This study aimed to assess the feasibility and acceptability of SMAs with mindfulness for T2DM within primary care in Australia. MATERIALS AND METHODS We conducted a single-blind randomized controlled feasibility study of SMAs within primary care for people with T2DM living in Western Sydney, Australia. People with T2DM, age 21 years and over, with HbA1c > 6.5% or fasting glucose >7.00 mmol/L within the past 3 months were eligible to enroll. The intervention group attended six 2-h programmed SMAs (pSMAs) which were held fortnightly. pSMAs included a structured education program and mindfulness component. The control group received usual care from their healthcare providers. We collected quantitative and qualitative data on acceptability as well as glycemic control (glycated hemoglobin and continuous glucose monitoring), lipids, anthropometric measures, blood pressure, self-reported psychological outcomes, quality of life, diet, and physical activity using an ActiGraph accelerometer. RESULTS Over a 2-month period, we enrolled 18 participants (10 females, 8 males) with a mean age of 58 years (standard deviation 9.8). We had 94.4% retention. All participants in the intervention group completed at least four pSMAs. Participants reported that attending pSMAs had been a positive experience that allowed them to accept their diagnosis and empowered them to make changes, which led to beneficial effects including weight loss and better glycemic control. Four pSMA participants found the mindfulness component helpful while two did not. All of the seven participants who contributed to qualitative evaluation reported improved psychosocial wellbeing and found the group setting beneficial. There was a significant difference in total cholesterol levels at 12 weeks between groups (3.86 mmol/L in intervention group vs. 4.15 mmol/L in the control group; p = 0.025) as well as pain intensity levels as measured by the PROMIS-29 (2.11 vs. 2.38; p = 0.034). CONCLUSION pSMAs are feasible and acceptable to people with T2DM and may result in clinical improvement. A follow-up fully-powered randomized controlled trial is warranted. CLINICAL TRIAL REGISTRATION Australia and New Zealand Clinical Trial Registry, identifier ACTRN12619000892112.
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Affiliation(s)
- Carolyn Ee
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
- *Correspondence: Carolyn Ee, ; Dennis Chang,
| | - Barbora de Courten
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
| | - Nicole Avard
- Next Practice Health, Erina, Sydney, NSW, Australia
| | - Michael de Manincor
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Mahmoud A. Al-Dabbas
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Jie Hao
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Kate McBride
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
- School of Medicine, Western Sydney University, Penrith, NSW, Australia
| | - Shamieka Dubois
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Rhiannon Lee White
- School of Health Sciences, Western Sydney University, Penrith, NSW, Australia
| | - Catharine Fleming
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
- School of Health Sciences, Western Sydney University, Penrith, NSW, Australia
| | - Garry Egger
- School of Health and Human Sciences, Southern Cross University, Lismore, NSW, Australia
| | | | - John Stevens
- School of Health and Human Sciences, Southern Cross University, Lismore, NSW, Australia
| | - Freya MacMillan
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
- School of Health Sciences, Western Sydney University, Penrith, NSW, Australia
| | - Gary Deed
- Mediwell Clinic, Brisbane, QLD, Australia
| | - Suzanne Grant
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Kate Templeman
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Dennis Chang
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
- *Correspondence: Carolyn Ee, ; Dennis Chang,
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Borek AJ, Abraham C, Greaves CJ, Tarrant M, Garner N, Pascale M. 'We're all in the same boat': A qualitative study on how groups work in a diabetes prevention and management programme. Br J Health Psychol 2019; 24:787-805. [PMID: 31273908 DOI: 10.1111/bjhp.12379] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/07/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Although many health interventions are delivered in groups, it is unclear how group context can be best used to promote health-related behaviour change and what change processes are most helpful to participants. This study explored participants' experiences of attending type 2 diabetes prevention and management programme, and their perceptions of how group participation influenced changes in diet and physical activity. DESIGN Qualitative. METHODS Semi-structured telephone interviews were conducted with 20 participants (twelve men) from nine groups in the Norfolk Diabetes Prevention Study. Interviews were audio-recorded, transcribed verbatim, and analysed using thematic analysis in NVivo. RESULTS Participants benefited from individual change processes, including information provision, structuring and prioritizing health goals, action planning, self-monitoring, and receiving feedback. They also benefited from group processes, including having a common purpose, sharing experiences, making social comparisons, monitoring and accountability, and providing and receiving social support in the groups. Participants' engagement with, and benefits from, the groups were enhanced when there was a supportive group context (i.e., group cohesion, homogeneous group composition, and a positive group atmosphere). Optimal facilitation to develop an appropriate group context and initiate effective change processes necessitated good facilitator interpersonal and professional skills, credibility and empathy, and effective group facilitation methods. Participants reported developing a sense of responsibility and making behaviour changes that resulted in improvements in health outcomes and weight loss. CONCLUSIONS This study highlights the role of individual and group processes in facilitating health-promoting behaviour change, and the importance of group context and optimal facilitation in promoting engagement with the programme. Statement of contribution What is already known on this subject? Many health interventions, including programmes to help prevent or manage diabetes and facilitate weight loss, are delivered in groups. Such group-based behaviour-change interventions are often effective in facilitating psychological and behaviour change. There is considerable research and theory on individual change processes and techniques, but less is known about which change processes and techniques facilitate behaviour change in group settings. What does this study add? This study contributes to our understanding of how participating in group-based health programmes may enhance or impede individual behaviour change. It identified individual (intrapersonal) and group (interpersonal, facilitated through group interaction) change processes that were valued by group participants. The findings also show how these change processes may be affected by the group context. A diagram summarizes the identified themes helping to understand interactions between these key processes occurring in groups. The study offers an insight into participants' views on, and experiences of, attending a group-based diabetes prevention and management programme. Thus, it helps better understand how the intervention might have helped them (or not) and what processes may have influenced intervention outcomes. Key practical recommendations for designing and delivering group-based behaviour-change interventions are presented, which may be used to improve future group-based health interventions.
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Affiliation(s)
- Aleksandra J Borek
- University of Exeter Medical School, University of Exeter, UK.,Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Charles Abraham
- University of Exeter Medical School, University of Exeter, UK.,School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
| | - Colin J Greaves
- University of Exeter Medical School, University of Exeter, UK.,School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, UK
| | - Mark Tarrant
- University of Exeter Medical School, University of Exeter, UK
| | - Nikki Garner
- Norfolk Diabetes Prevention Study, Norfolk & Norwich University Foundation Healthcare Trust, UK
| | - Melanie Pascale
- Norfolk Diabetes Prevention Study, Norfolk & Norwich University Foundation Healthcare Trust, UK
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Ribeiro MF, Saraiva V, Pereira P, Ribeiro C. Escala de Motivação Académica: Validação no Ensino Superior Público Português. RAC: REVISTA DE ADMINISTRAÇÃO CONTEMPORÂNEA 2019. [DOI: 10.1590/1982-7849rac2019180190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Esta investigação teve como objetivo o estudo das propriedades psicométricas e posterior validação da Escala de Motivação Académica proposta por Guimarães e Bzuneck (2008), em Portugal, através da utilização de duas amostras, a Amostra A constituída por 568 estudantes do ensino superior público e a Amostra B constituída por 589 estudantes igualmente do ensino superior publico, com uma abrangência nacional. Para tratamento dos dados foram utilizados os softwares SPSS 25 e AMOS 25. Foram conduzidas duas análises fatoriais confirmatórias em cada amostra e uma análise de grupos múltiplos, sendo que os resultados apontaram para a validade da escala reespecificada na avaliação da motivação no ensino superior e sua robustez, com destaque para correlações elevadas entre as dimensões Motivação Extrínseca por Regulação Integrada e Motivação Intrínseca, Motivação Extrínseca, por Regulação Integrada e Motivação Extrínseca por Regulação Introjetada e por Motivação Extrínseca por Regulação Externa e Desmotivação. Por outro lado, verificou-se que o modelo de escala proposto é invariante.
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Pikkemaat M, Boström KB, Strandberg EL. "I have got diabetes!" - interviews of patients newly diagnosed with type 2 diabetes. BMC Endocr Disord 2019; 19:53. [PMID: 31126267 PMCID: PMC6534850 DOI: 10.1186/s12902-019-0380-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 05/15/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND To be diagnosed with type 2 diabetes is a challenge for every patient. There are previous studies on patients' experience in general but not addressing the increased cardiovascular risk and multifactorial treatment. The aim of this study was to explore the thoughts, experiences and reactions of newly diagnosed patients with diabetes to this diagnosis and to the risk of developing complications. METHODS Ten adults (7 men/3 women, aged 50-79) diagnosed with type 2 diabetes within the last 12 months were interviewed at a primary health care center in Sweden. An interview guide was used in the semi-structured interviews that were transcribed verbatim. The analysis was qualitative and inspired by systematic text condensation (Malterud). The text was read several times and meaning units were identified. Related meaning units were sorted into codes and related codes into categories during several meetings between the authors. Finally, the categories were merged and formed themes. RESULTS We defined three main themes: Reaction to diagnosis, Life changes and Concerns about the future. Most patients reacted to the diagnosis without intensive feelings. Lifestyle changes were mainly accepted but hard to achieve. The patients' major concerns for the future were the consequences for daily life (being able to drive and read) and concerns for relatives rather than anxieties regarding medical issues such as laboratory tests. There were considerable differences in how much patients wanted to know about their future risks. CONCLUSIONS The results of this study might help to focus doctor-patient communication on issues highlighted by the patients and on the importance of individualizing information and recommendations for each patient.
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Affiliation(s)
- M Pikkemaat
- Husensjö Health Care Center, Skaragatan 102, S-25363, Helsingborg, Sweden.
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden.
| | - K Bengtsson Boström
- R&D Center Skaraborg Primary Care, Skövde, Sweden
- Department of Public Health and Community Medicine, Primary Health Care, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - E L Strandberg
- Department of Clinical Sciences Malmö, Family Medicine, Lund University, Malmö, Sweden
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Lidin M, Hellénius ML, Ekblom-Bak E, Rydell Karlsson M. Experiences from individuals with increased cardiovascular risk participating in a one-year lifestyle program. Eur J Cardiovasc Nurs 2019; 18:554-561. [PMID: 31067978 DOI: 10.1177/1474515119848967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of the current study was to describe the participants' experiences of a structured lifestyle program for persons with high cardiovascular risk. METHOD Sixteen participants with high cardiovascular risk participating in a one-year structured lifestyle intervention program were interviewed regarding their experiences of the program. The interviews were analyzed using content analyses. RESULTS The participants' (mean age 58 ± 9) experiences were categorized into three categories: "How to know," based on the participants' experience from both individual counselling and group sessions with tools to strengthen self-care; "Staff who know how," based on experience from the meeting with, and the importance of, competent health professionals; "Why feedback is essential," based on the participants' experience and effects of person-centered feedback. Several factors were deemed important in the structure of the program: an individual visit with shared goal setting, a group education session with interactive discussion, a competent, educated, and respectful health professional who gives continuous feedback, and the right tools to support self-care at home between visits. CONCLUSION Individuals participating in a structured lifestyle program experienced several factors as important: an individual visit with shared goal setting, a group education session with interactive discussion, a competent, educated, and respectful healthcare professional who gives continuous feedback, and the right tools to support self-care at home between visits.
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Affiliation(s)
- Matthias Lidin
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Mai-Lis Hellénius
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Elin Ekblom-Bak
- The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Monica Rydell Karlsson
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Ersta Sköndal Bräcke University College, Sweden
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