Coping with diabetes: Provider attributes that influence type 2 diabetes adherence

Empowering diabetes management: The impact of patient-provider collaboration on type 2 diabetes outcomes through autonomy support and shared decision-making

OBJECTIVES

Through the lens of self-determination theory, this quantitative study investigates how patient-provider collaboration through perceived shared decision-making (SDM) and autonomy support impact type 2 diabetes (T2D) outcomes.

METHODS

We sampled 474 individuals over 18 years old who self-identified as having T2D. Completed and valid responses were received from 378 participants from two separate groups in an online survey. Data was analyzed using the IBM Statistical Package for Social Sciences (SPSS), AMOS package, version 28, and Mplus, version 8.8.

RESULTS

Patient-provider collaboration through autonomy support improved treatment satisfaction (β = .16, ρ < .05) and self-management adherence (β = .43, ρ < .001). While collaboration through SDM improved treatment satisfaction (β = .25, ρ < .01), it worsened SM adherence (β = -.31, ρ < .001). The negative impact of SDM on self-management adherence was mitigated by our moderator, coping ability. However, coping ability minimally impacted treatment satisfaction and SM adherence when autonomous support was provided.

CONCLUSIONS

Autonomy support increases treatment satisfaction and self-management adherence. SDM enhances treatment satisfaction but may adversely affect self-management adherence. The study also suggests that coping ability can mitigate the negative effect of SDM on self-management adherence, although its influence is limited when autonomy support is provided by the provider.

PRACTICAL IMPLICATIONS

For providers, SDM and autonomy support permits shared power over treatment decisions while fostering independence over self-management tasks. Providers should evaluate patients' coping ability and adapt their approach to care based on the patient's coping capacity.

Cardiovascular Health Behavior Prediction Model in Patients With Type 2 Diabetes

BACKGROUND

To prevent cardiovascular disease in adults with type 2 diabetes, it is necessary to identify the factors that affect cardiovascular health behavior.

OBJECTIVE

The aim of this study was to verify the causal relationship between illness perception and diabetes knowledge as cognitive representations, depression as emotional representations, self-efficacy as cognitive coping, and oral health and cardiovascular health behaviors as behavioral coping strategies. A hypothetical model was established based on a literature review and the self-regulation model.

METHODS

In this study, a cross-sectional survey design was used, and the participants were adults 30 years or older who had been given a diagnosis of type 2 diabetes for more than 6 months and were recruited from South Korea. Data from 272 participants were collected through face-to-face interviews or Google surveys in 2021, and analyzed using SPSS 25.0 and AMOS 22.0.

RESULTS

Oral health behavior (β = 0.26, P < .001) and self-efficacy (β = 0.16, P = .048) had a direct effect on cardiovascular health behavior, and illness perception (β = 0.24, P = .018) and depression (β = -0.25, P < .001) had an indirect effect through self-efficacy (β = 0.24, P = .016), with a total explanatory power of 19.1%. Oral health behavior was directly affected by illness perception and self-efficacy, and self-efficacy was directly affected by illness perception, diabetes knowledge, and depression (P < .05).

CONCLUSION

To practice cardiovascular health behaviors in adults with diabetes, self-efficacy for diabetes management should be enhanced. To this end, it is necessary to increase illness perception and knowledge, and reduce depression through cardiovascular disease prevention education for them, and the importance of oral health behaviors should also be emphasized.

Daily living activities' performance by male diabetics with sexual dysfunction in South Africa

BACKGROUND

Sexual dysfunction (SD) is a common complication among men living with diabetes (MLWD), which adds to stresses induced by medical condition. Effect of stress on their daily living activities has been only poorly described.

AIM

This study aimed to explore the behaviour and challenges of MLWD experiencing SD in respect of daily living activities.

SETTING

Five clinics in Senwabarwana in Limpopo province.

METHODS

Qualitative approach and phenomenological exploratory design were adopted to collect data from 15 male participants selected from five clinics using purposive homogeneous sampling. One-on-one interviews were conducted using voice recorders, and field notes were taken of non-verbal cues. Unstructured interview guide with principal question enabled instructive probing to be conducted. Data were analysed using eight steps of Tesch's inductive, descriptive and open coding technique.

RESULTS

Participants reported stressful experiences, difficulty coping with diabetes and its accompanying complication of SD that led to fear of losing their wives. They indicated that as a result of stress and difficulty in coping with the condition, they were engaged in less physical activity than before their diagnosis.

CONCLUSION

Sexual dysfunction is prevalent among male diabetics and often feel stressed and worried about losing their wives. They struggle to cope with conditions to the point where they are less capable of performing tasks than they were before diagnosis. These outcomes are critical issues that should be addressed in any diabetes treatment strategy.Contribution: Support-based collaboration of healthcare providers with spouses and revision of South African diabetes management strategy to incorporate healthy coping strategies are recommended.

A Nurse-Led Telehealth Program for Diabetes Foot Care: Feasibility and Usability Study

BACKGROUND

Diabetes mellitus can lead to severe and debilitating foot complications, such as infections, ulcerations, and amputations. Despite substantial progress in diabetes care, foot disease remains a major challenge in managing this chronic condition that causes serious health complications worldwide.

OBJECTIVE

The primary aim of this study was to examine the feasibility and usability of a telehealth program focused on preventive diabetes foot care. A secondary aim was to descriptively measure self-reported changes in diabetes knowledge, self-care, and foot care behaviors before and after participating in the program.

METHODS

The study used a single-arm, pre-post design in 2 large family medical practice clinics in Texas. Participants met individually with the nurse practitioner once a month for 3 months using synchronous telehealth videoconferencing. Each participant received diabetes foot education guided by the Integrated Theory of Health Behavior Change. Feasibility was measured with rates of enrollment and program and assessment completion. Usability was measured with the Telehealth Usability Questionnaire. Diabetes knowledge, self-care, and foot care behaviors were measured with validated survey instruments at baseline, 1.5 months, and 3 months.

RESULTS

Of 50 eligible individuals, 39 (78%) enrolled; 34 of 39 (87%) completed the first videoconference and 29 of 39 (74%) completed the second and third videoconferences. Of the 39 who consented, 37 (95%) completed the baseline assessment; 50% (17/34) of those who attended the first videoconference completed the assessment at 1.5 months, and 100% (29/29) of those who attended the subsequent videoconferences completed the final assessment. Overall, participants reported a positive attitude toward the use of telehealth, with a mean Telehealth Usability Questionnaire score of 6.24 (SD 0.98) on a 7-point scale. Diabetes knowledge increased by a mean of 15.82 (SD 16.69) points of 100 (P<.001) from baseline to 3 months. The values for the Summary of Diabetes Self-Care Activities measure demonstrated better self-care, with participants performing foot care on average 1.74 (SD 2.04) more days per week (P<.001), adhering to healthy eating habits on average 1.57 (SD 2.12) more days per week (P<.001), and being physically active on average 1.24 (SD 2.21) more days per week (P=.005). Participants also reported an improvement in the frequency of foot self-examinations and general foot care behaviors. The mean scores for foot care increased by a mean of 7.65 (SD 7.04) points (scale of 7 to 35) from baseline to 3 months postintervention (P<.001).

CONCLUSIONS

This study demonstrates that a nurse-led telehealth educational program centered on diabetes foot care is feasible, acceptable, and has the potential to improve diabetes knowledge and self-care, which are precursors to preventing debilitating foot complications.

Exploring treatment adherence in long-term sick-listed workers and the impact of coping strategies, illness perceptions and perceived health

Background

Treatment adherence is important to improve return to work in sick-listed workers. Especially in long-term sick-listed workers who apply for a disability benefit and therefore have not (fully) returned to work, it is of great value to gain insight in the adherence to advice of physicians. Non-adherence could be one of the main reasons why they have not returned to work and are sick-listed for a long-term. The aim of the study is to explore treatment adherence and possible associated factors to advice from medical and occupational health physicians in long-term sick-listed workers.

Methods

The study is a cross-sectional survey study among 561 long-term (partly) sick-listed workers applying for a disability benefit. Associations of sociodemographic characteristics, disease related factors, coping strategies (Utrecht Coping List, UCL), illness perception (Illness Cognition Questionnaire, ICQ) and perceived health (Short-Form 12, SF12) with treatment adherence (measured with the Medical Outcomes Study Measures of Patient Adherence, MOS-MPA) were analysed separately for adherence to medical advice (n = 348, mean age 51.3 ± 9.1 years, 55.9% female) and adherence to occupational advice (n = 229, mean age 50.4 ± 9.5 years, 54.1% female).

Results

Among participants, 63.3% to 76.4% reported they were able to do what the physician told them to do. However, about half of the participants found it easy to follow-up and implement the suggestions of the physician (54.3% for medical advice and 50.2% for occupational advice). Having a mental health disorder was negatively associated with adherence to medical advice. An active coping strategy, acceptance of the disease, and perceiving positive long-term consequences of the disease were associated with a higher adherence, whereas focusing on the negative consequences was associated with a lower adherence, both for medical and occupational advice.

Conclusions

The tendency to adhere to medical and occupational advice in long-term sick-listed workers is relatively low. In order to increase return to work in this population, medical and occupational health physicians should especially be aware of the adherence of sick-listed workers with mental health disorders, but also on those who focus on the negative consequences of their (physical or mental health) disorder.

Validating a Self-Reported Medication Nonadherence Measure in the Context of Multiple Chronic Diseases and Routes of Medication Administration Among Patients with Type 2 Diabetes

INTRODUCTION

Patients with diabetes may take oral and injectable medications and often have comorbid chronic diseases. It is unclear whether to assess nonadherence for oral and injectable medications separately or combined and for comorbid conditions separately or combined.

RESEARCH DESIGN AND METHODS

We conducted two cognitive interview studies among patients with type 2 diabetes who were prescribed medications for oral or injectable diabetes medications (Study 1) or at least one diabetes, blood pressure, and cholesterol medication (Study 2). Participants completed the two-domain DOSE-Nonadherence measure, which assesses extent of nonadherence and reasons for nonadherence. We asked about interpretation of instructions and items, recall period, ability to respond accurately with separate versus combined versions, and comprehensiveness of reasons for nonadherence to injectable medications.

RESULTS

Based on Study 1 (n=14), nonadherence to injectable and oral medications should be assessed separately. Participants believe they can respond accurately to 7-day recall period for daily medications and a one-month recall period for weekly injectable medications. New reasons for nonadherence to injectable medications were perceived as relevant. Based on Study 2 (n-12), nonadherence to medications for diabetes, blood pressure, and cholesterol should be assessed separately.

CONCLUSION

Although separate versions increase response time, it may improve accuracy. Responses to the measure can facilitate conversations about nonadherence between providers and patients to inform clinical decision-making.

A theoretical framework to improve adherence among older adults to recommendations received at a falls prevention clinic: A narrative review

BACKGROUND

Falls impose a prominent public health problem among older adults. Falls are preventable through multi-factorial interventions offered by a Falls Prevention Clinic. Yet, adherence to recommendations is often average or low, particularly for lifestyle recommendations. To achieve full health benefits from such a multifactorial intervention, improving adherence is critical.

PURPOSE

Our primary objective was to conduct a narrative review to develop a theoretical framework, categorized by intrinsic and extrinsic factors that impact adherence to falls prevention interventions, considering a Falls Prevention Clinic setting.

MATERIALS AND METHODS

We conducted a comprehensive literature review of all peer-reviewed manuscripts published between 1998 through August 2020 among older adults (i.e., aged 60 years and older) who fall. We used the following search engines: Pubmed, CINAHL, Embase, MedLine, Cochrane and Google Scholar.

RESULTS

The theoretical framework categorizes two dominate factors (comprised of specific domains) that affect adherence among older adults who fall. Intrinsic factors comprised of three domains included: demographics (age, gender, ethnicity), individual factors (participation, control, behavioural habits) and health factors (physical health, mental state, perceived severity). Extrinsic factors comprised of four domains included: caregiver factors (family dynamics, miscarried helping) medication factors (availability, accessibility, drug handling, reliability), health system (costs, communication, relationship with doctors, attention) and environmental factors (public health policy interventions). Intrinsic factors such as high socioeconomic status, high health literacy, being married and extrinsic factors such as low healthcare cost, better communication and useful policy interventions were associated with greater adherence.

CONCLUSION

This theoretical model elucidates priority factors to target for promoting adherence to reduce falls, decrease mortality and, lower fall-related healthcare costs.