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Chona EZ, Kayange LF, Iseselo MK. Barriers and facilitators to satisfaction with diabetes care: The perspectives of patients attending public diabetic clinics in Dar es Salaam, Tanzania. PLoS One 2024; 19:e0302858. [PMID: 38722988 PMCID: PMC11081265 DOI: 10.1371/journal.pone.0302858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/11/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND The prevalence of diabetes has been increasing steadily over the past decade in low- and middle-income countries (LMICs) with about three-quarters of people living with the disease globally residing in these countries. Patient satisfaction can be used as a proxy measure of overall facility performance, and its use has been recommended for determining the quality of services provided by healthcare centres and organizations. This study aimed to explore barriers and facilitators towards satisfaction with diabetes care among patients attending public diabetic clinics in Dar es Salaam, Tanzania. METHODS A qualitative descriptive study was carried out among people with diabetes attending public diabetic clinics in Dar es Salaam, Tanzania. Using a purposeful sampling technique, 35 people with diabetes were interviewed from May 2023 to July 2023 with the principles of saturation guiding sample size determination. A semi-structured face-to-face interview guide was employed in data collection. The audio-recorded interviews were transcribed and analyzed using a conventional content analysis approach after translation. NVivo 12.0 computer software was employed to organize and code the data. RESULTS A total of 35 participants were enrolled in this study with a mean (±SD) age of 58.5 (±13.76) years. Four predominant themes and 12 categories were identified after data analysis including two barriers and two facilitators toward patients' satisfaction with diabetes care. Financial constraints and unfavourable clinic environments were identified as barriers. Furthermore, good provider-patient relationships and continuity of care emerged as facilitators. CONCLUSION Barriers and facilitators to patients' satisfaction with diabetes identified in this study are greatly determined by socio-economic and cultural conditions, highlighting the role of the healthcare delivery systems and allied stakeholders in regulatory and policy development to address the existing barriers and consolidate the proven facilitators.
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Affiliation(s)
- Emmanuel Z. Chona
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Lusajo F. Kayange
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Masunga K. Iseselo
- Department of Clinical Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Wilson D, Diji AKA, Marfo R, Amoh P, Duodu PA, Akyirem S, Gyamfi D, Asare H, Armah J, Enyan NIE, Kyei-Dompim J. Dietary adherence among persons with type 2 diabetes: A concurrent mixed methods study. PLoS One 2024; 19:e0302914. [PMID: 38713660 DOI: 10.1371/journal.pone.0302914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 04/15/2024] [Indexed: 05/09/2024] Open
Abstract
BACKGROUND Poor adherence to dietary recommendations among persons with type 2 diabetes (T2D) can lead to long-term complications with concomitant increases in healthcare costs and mortality rates. This study aimed to identify factors associated with dietary adherence and explore the barriers and facilitators to dietary adherence among persons with T2D. METHODS A concurrent mixed methods study was conducted in two hospitals in the Ashanti Region of Ghana. One hundred and forty-two (142) persons with T2D were consecutively sampled for the survey. Dietary adherence and diabetes-related nutritional knowledge (DRNK) were assessed using the Perceived Dietary Adherence Questionnaire (PDAQ) and an adapted form of the General Nutritional Knowledge Questionnaire (GNKQ-R) respectively. A purposive sample of fourteen participants was selected for interviews to explore the factors that influence dietary adherence. Qualitative data were analysed using NVivo version 20 software and presented as themes. Furthermore, binary logistic regression was performed using IBM SPSS version 29.0 to identify the factors associated with dietary adherence. RESULTS Nearly fifty-one percent (50.7%) of the participants in this study had good dietary adherence. In multivariable logistics regression, it was found that increase in DRNK (AOR = 1.099, 95% CI: 1.001-1.206, p = 0.041) score and living in an urban area (AOR = 3.041, 95% CI: 1.007-9.179, p = 0.047) were significantly associated with good dietary adherence. Inductive thematic analysis revealed four facilitators of dietary adherence (access to information on diet, individual food preferences and eating habits, perceived benefits of dietary adherence, and presence of social support) and four barriers (inability to afford recommended diets, barriers related to foods available in the environment, conflict between dietary recommendations and individual eating habits, and barriers related to the social environment). CONCLUSION The findings support the need for interventions including continuous dietary education tailored to individual preferences and dietary habits, expansion of poverty reduction social interventions and formulation of policies that will improve access to healthy foods in communities.
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Affiliation(s)
- Dorothy Wilson
- School of Nursing and Midwifery, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Abigail Kusi-Amponsah Diji
- School of Nursing and Midwifery, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Richard Marfo
- School of Nursing and Midwifery, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Paulina Amoh
- School of Nursing and Midwifery, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Precious Adade Duodu
- Department of Nursing, School of Human and Health Sciences, University of Huddersfield, Huddersfield, England, United Kingdom
| | - Samuel Akyirem
- School of Nursing, Yale University, West Haven, Connecticut, United States of America
| | - Douglas Gyamfi
- University of Maryland School of Nursing, Baltimore, MD, United States of America
| | - Hayford Asare
- School of Nursing and Midwifery, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Jerry Armah
- College of Nursing, University of Florida, Gainesville, Florida, United States of America
| | | | - Joana Kyei-Dompim
- School of Nursing and Midwifery, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Korsah KA. The Use of Religious Capital as a Coping Strategy in Self-care by Type 2 Diabetes Patients in a Ghanaian Hospital. JOURNAL OF RELIGION AND HEALTH 2023; 62:4399-4416. [PMID: 36547782 PMCID: PMC10682067 DOI: 10.1007/s10943-022-01722-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 06/17/2023]
Abstract
Given the importance Ghanaians attribute to spirituality and religiosity in terms of disease causation and management, this study explored the use of religious capital as a coping strategy by individuals with type 2 diabetes mellitus in self-care at the Techiman Holy Family Hospital Diabetes Clinic in the Bono East Region of Ghana. An exploratory descriptive qualitative research design was employed for the study. Semi-structured interviews were conducted with a convenience sample of twenty-seven (27) individuals recruited from the diabetes clinic. Content analysis was employed to find themes, which included: (1) Use of Prayer and Fasting for Courage from God, (2) Reliance on God as the Creator of Human Beings who Cures and Heals Diseases in the Body, (3) God as Source of life in times of Illness (Drawing life from God in times of illness), (4) Faith and Hope in God, and (5) Doctors and Nurses as Substitutes for God. The findings advocate the need to incorporate religiosity and spirituality into the provision of healthcare for individuals with diabetes to help them live productive lives.
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Affiliation(s)
- Kwadwo Ameyaw Korsah
- Department of Adult Health, School of Nursing and Midwifery, College of Health Sciences, University of Ghana, P. O. Box LG43, Legon, Accra, Ghana.
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Opoku R, Ackon SK, Kumah E, Botchwey COA, Appiah NE, Korsah S, Peprah M. Self-care behaviors and associated factors among individuals with type 2 diabetes in Ghana: a systematic review. BMC Endocr Disord 2023; 23:256. [PMID: 37993843 PMCID: PMC10664613 DOI: 10.1186/s12902-023-01508-x] [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: 06/15/2023] [Accepted: 11/08/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Self-care remains an effective model for diabetes management and care in low-and-middle-income countries due to the limited resources available for the clinical management of the disease and its complications This study examined adherence to self-care behaviors and associated factors among people with type 2 diabetes in Ghana. METHODS PubMed, PsycINFO, Scopus, Web of Science, Embase and Google scholar were used to identify quantitative observational studies published between 1990 and September 30, 2023. Studies exclusive to persons with type 2 diabetes ≥ 18 years of age in a Ghanaian setting were included in this review. Findings of primary studies were analyzed using narrative synthesis. RESULTS Twelve studies, presenting data on a total of 2,671 persons with type 2 diabetes, were included. All the studies were published in the last decade (2015-2022) and a majority of them were from the Greater Accra Region. The mean number of days (per week) participants adhered to a self-care behavior were in the ranges of 3.9-4.4 for diet, 4.2-4.8 for physical activity, 0.5-2.2 for self-monitoring of blood glucose (SMBG), and 2.9-5.0 for foot care. Adherence rates for medication were in the range of 33.5-84.5%. Patient-related factors, sociodemographic/economic-related factors, condition-related factors, and healthcare system-related factors were associated with various self-care behaviors. CONCLUSION Adherence to self-care behaviors among persons with type 2 diabetes in Ghana remains an ongoing challenge with significant variations in adherence among patients with different characteristics.
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Affiliation(s)
- Richmond Opoku
- Department of Health Administration and Education, University of Education, Winneba, Ghana
| | - Solomon Kwesi Ackon
- Department of Health Administration and Education, University of Education, Winneba, Ghana
| | - Emmanuel Kumah
- Department of Health Administration and Education, University of Education, Winneba, Ghana.
| | | | - Nana Esi Appiah
- Maxillofacial Surgery Unit, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Shadrach Korsah
- Mastercard Foundation Scholars Program, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Michael Peprah
- Department of Health Administration and Education, University of Education, Winneba, Ghana
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Tuobenyiere J, Mensah GP, Korsah KA. Patient perspective on barriers in type 2 diabetes self-management: A qualitative study. Nurs Open 2023; 10:7003-7013. [PMID: 37488987 PMCID: PMC10495717 DOI: 10.1002/nop2.1956] [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: 01/04/2023] [Revised: 05/21/2023] [Accepted: 07/12/2023] [Indexed: 07/26/2023] Open
Abstract
AIM To explore the perceived barriers in Type 2 Diabetes care among patients with diabetes. Design The study adopted a qualitative exploratory-descriptive design. METHODS A semi-structured interview guide was used to collect data from fifteen (15) purposively sampled patients with Type 2 Diabetes at a primary level health facility in the Bono East region. Participants' ages ranged between 42-72 years. The interviews were audio-recorded, transcribed verbatim and analysed using thematic content analysis. RESULTS Patients with Type 2 Diabetes encountered a range of barriers in diabetes care. These barriers included lack of knowledge of diabetes dietary management strategies, financial constraints, non-compliance to treatment, lack of glucometers, lack of social support, and increased waiting time at health care facilities. The findings indicate that more education on diabetes and dietary management is required as well as social support from peers, family, and non-governmental organizations. PATIENT OR PUBLIC CONTRIBUTION Diabetes self-management barriers as revealed by the patients who were participants of this study requires nurses and midwives to ensure that self-management education is well understood by patients and their relatives. This would empower the patients and bring clarity to their confusion about self-care practices.
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Affiliation(s)
- Justin Tuobenyiere
- General Nursing Department, Holy Family Nursing and Midwifery Training CollegeTechimanGhana
| | | | - Kwadwo Ameyaw Korsah
- Department of Adult Health, School of Nursing and MidwiferyUniversity of GhanaAccraGhana
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Lamptey R, Amoakoh-Coleman M, Djobalar B, Grobbee DE, Adjei GO, Klipstein-Grobusch K. Diabetes self-management education interventions and self-management in low-resource settings; a mixed methods study. PLoS One 2023; 18:e0286974. [PMID: 37450431 PMCID: PMC10348576 DOI: 10.1371/journal.pone.0286974] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 05/27/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION Diabetes is largely a self-managed disease; thus, care outcomes are closely linked to self-management behaviours. Structured self-management education (DSME) interventions are, however, largely unavailable in Africa. AIM We sought to characterise DSME interventions in two urban low-resource primary settings; and to explore diabetes self-management knowledge and behaviours, of persons living with diabetes (PLD). RESEARCH DESIGN AND METHODS A convergent parallel mixed-methods study was conducted between January and February 2021 in Accra, Ghana. The sampling methods used for selecting participants were total enumeration, consecutive sampling, purposive and judgemental sampling. Multivariable regression models were used to study the association between diabetes self-management knowledge and behaviours. We employed inductive content analysis of informants' experiences and context, to complement the quantitative findings. RESULTS In total, 425 PLD (70.1% (n = 298) females, mean age 58 years (SD 12), with a mean blood glucose of 9.4 mmol/l (SD 6.4)) participated in the quantitative study. Two managers, five professionals, two diabetes experts and 16 PLD participated in in-depth interviews. Finally, 24 PLD were involved in four focus group discussions. The median diabetes self-management knowledge score was 40% ((IQR 20-60). For every one unit increase in diabetes self-management knowledge, there were corresponding increases in the diet (5%;[95% CI: 2%-9%, p<0.05]), exercise (5%; [95% CI:2%-8%, p<0.05]) and glucose monitoring (4%;[95% CI:2%-5%, p<0.05]) domains of the diabetes self-care activities scale respectively. The DSME interventions studied, were unstructured and limited by resources. Financial constraints, conflicting messages, beliefs, and stigma were the themes underpinning self-management behaviour. CONCLUSIONS The DSME interventions studied were under-resourced, and unstructured. Diabetes self-management knowledge though limited, was associated with self-management behaviour. DSME interventions in low resource settings should be culturally tailored and should incorporate sessions on mitigating financial constraints. Future studies should focus on creating structured DSME interventions suited to resource-constrained settings.
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Affiliation(s)
- Roberta Lamptey
- Polyclinic/ Family Medicine Department, Korle Bu Teaching Hospital, Accra, Ghana
- Department of Community Health, University of Ghana Medical School, Accra, Ghana
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Mary Amoakoh-Coleman
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Babbel Djobalar
- Internal Medicine Department, Korle Bu Teaching Hospital, Accra, Ghana
| | - Diederick E. Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - George Obeng Adjei
- Centre for Tropical Clinical Pharmacology and Therapeutics, University of Ghana Medical School, Accra, Ghana
- Office of Research Innovation and Development, University of Ghana, Legon, Ghana
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Botchway M, Davis RE, Merchant AT, Appiah LT, Sarfo-Kantanka O, Moore S. Social networks, perceived social support, and HbA1c in individuals with type 2 diabetes mellitus in urban Ghana. ETHNICITY & HEALTH 2023; 28:281-298. [PMID: 35098827 DOI: 10.1080/13557858.2022.2033172] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 01/20/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Although links between social relationships and health are well established, few studies have concurrently examined the effects of compositional, structural, and functional dimensions of social networks on glycemic (HbA1c) control in low- and middle-income countries such as Ghana. In these settings where informal social relationships are critical for access to resources, evaluating the links between social network characteristics, social support, and glycemic control may provide clarity about important relationships that facilitate the well-being of individuals with type 2 diabetes mellitus (T2DM). DESIGN In 2018, we conducted a hospital-based, cross-sectional survey of noninstitutionalized adults with T2DM in Ghana. Using data from 247 study participants, multivariable linear regression models were used to estimate associations between: 1) HbA1c and three social network characteristics (kin composition, household composition, and network density); 2) social support and the three social network characteristics; and 3) HbA1c and social support. We also examined gender differences in these associations and applied mediation techniques to determine if network characteristics operated through social support to affect HbA1c. RESULTS Findings indicated that higher kin composition and higher household composition were each significantly associated with increased social support. Neither social support nor social network characteristics were significantly related to HbA1c, and there were no gender differences in any of these associations. CONCLUSION Although family and household members were identified as important sources of social support for diabetes management, the ways in which they influence HbA1c control among Ghanaians require further investigation. Future studies can examine whether changes in social support over time, social support satisfaction, or other dimensions of social relationships improve T2DM outcomes in countries like Ghana.
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Affiliation(s)
- Marian Botchway
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, USA
| | - Rachel E Davis
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Anwar T Merchant
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Lambert T Appiah
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Spencer Moore
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Health & Society Group, Wageningen University & Research, Wageningen, Netherlands
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Rivera-Picón C, Benavente-Cuesta MH, Quevedo-Aguado MP, Sánchez-González JL, Rodríguez-Muñoz PM. Factors Associated with Adherence to Treatment in Patients with HIV and Diabetes Mellitus. J Pers Med 2023; 13:269. [PMID: 36836503 PMCID: PMC9967318 DOI: 10.3390/jpm13020269] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
We aim to identify the factors that influence the therapeutic adherence of subjects with chronic disease. The design followed in this work was empirical, not experimental, and cross-sectional with a correlational objective. The sample consisted of a total of 400 subjects (199 patients with HIV and 201 patients with diabetes mellitus). The instruments applied for data collection were a sociodemographic data questionnaire, the 4-item Morisky Medication Adherence Scale (MMAS-4) and the Coping Strategies Questionnaire. In the group of subjects with HIV, that the use of emotional coping strategies was related to lower adherence to treatment. On the other hand, in the group of subjects with diabetes mellitus, the variable related to compliance with treatment was the duration of illness. Therefore, the predictive factors of adherence to treatment were different in each chronic pathology. In the group of subjects with diabetes mellitus, this variable was related to the duration of the disease. In the group of subjects with HIV, the type of coping strategy used predicted adherence to treatment. As a result of these results, it is possible to develop health programmes to promote, from nursing consultations to adherence to treatment of patients with HIV and diabetes mellitus.
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Affiliation(s)
- Cristina Rivera-Picón
- Faculty of Health Sciences, Nursing, Pontifical University of Salamanca, 37002 Salamanca, Spain
| | | | | | | | - Pedro Manuel Rodríguez-Muñoz
- Faculty of Nursing and Physiotherapy, University of Salamanca, 37008 Salamanca, Spain
- Department of Nursing, Instituto Maimónides de Investigación Biomédica de Córboda, 14005 Córdoba, Spain
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Deshmane AR, Muley AS. Adherence and Barriers to Medical Nutrition Therapy and the Effect on Glycemic Control Among Individuals With Type 2 Diabetes in India. CURRENT RESEARCH IN NUTRITION AND FOOD SCIENCE JOURNAL 2022. [DOI: 10.12944/crnfsj.10.3.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Medical Nutrition Therapy (MNT) has a remarkable effect on glycemic control among individuals with Type 2 Diabetes. However, the extent of adherence to MNT isn't hundred percent. Therefore, we aim to determine the adherence level towards the MNT advised by a Registered Dietitian (RD); to identify the barriers and associated contributing factors and strategies to improve the compliance towards the MNT among people with Type 2 Diabetes. A cross-sectional study was conducted among people with Type 2 Diabetes visiting the out-patient diabetes clinic from Kolhapur city, India. A structured questionnaire was used to capture the adherence and non-adherence, reasons and barriers to adhering the MNT. Out of 293 participants, 41.6% were adhering to the MNT. There was a significant association between the non working group (p = 0.01), presence of co-morbidities (p = 0.03) and diabetes duration < 10 years (p = 0.05) with the increased adherence level. Similarly, there was a significant reduction of 26.7%, 38.1%, and 30.9% in the fasting, postprandial blood glucose and HbA1c values respectively in adhering group post MNT advice. More than 50% of the participants in the adhering group gave ‘To Improve overall health’ and ‘To control sugar’ as reasons to adhere. ‘Habitual to what they eat’ (64.3%), ‘Does not satisfy hunger’ (42.1%) and ‘Lack of willpower’ (42.1%), were the common barriers identified in our study. Our study shows that the MNT advised by an RD is effective in reducing the socio-cultural barriers to adherence and improves glycemic control. Strategies like making the workplace more diabetes-friendly and adopting behavior changing techniques should be implemented to increase adherence.
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Affiliation(s)
- Aditi Rajesh Deshmane
- 2Clinical Nutrition and Dietetics, Indian Institute of Food Science and Technology, Aurangabad, India
| | - Arti S Muley
- 1Nutrition and Dietetics Program, Symbiosis Institute of Health Sciences, Symbiosis International (Deemed University), Pune, India
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Nebhinani M, Avasthi RD, Meena M, Parihar M, Sharma M, Nagar M, Neha, Nisha. Barriers related to self-care management among people with diabetes mellitus- A narrative review. Biomedicine (Taipei) 2022. [DOI: 10.51248/.v42i4.876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Diabetes is a challenging disease that is considered to be hard to live with as it encompasses a lot of restrictions, lifestyle and behavioural modifications. Self-care management behaviors are very much essential to control glycaemic values and future complications. Although an import aspect leading to positive health outcomes among diabetic patients, diabetes self-care management is usually is a complex process. This narrative review summates barriers related to self-care management among people with diabetes. The literature was searched through databases like PubMed and google scholar with help of keywords and MeSH terminologies. Furthermore, selected articles reference list was also screened. It is concluded that self-care management in diabetes mellitus is often surrounded by many barriers. Deficiency of environmental resources and assisted strategies, poor awareness regarding self-care skills, lack of motivation and financial constraints are the major barriers faced by people with diabetes mellitus. Endeavour to withdraw barriers are prime in aiding people living with diabetes which will help to improve their quality of life and to attain positive results.
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Catapan SDC, Nair U, Gray L, Cristina Marino Calvo M, Bird D, Janda M, Fatehi F, Menon A, Russell A. Same goals, different challenges: A systematic review of perspectives of people with diabetes and healthcare professionals on Type 2 diabetes care. Diabet Med 2021; 38:e14625. [PMID: 34154035 DOI: 10.1111/dme.14625] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 06/06/2021] [Indexed: 01/14/2023]
Abstract
AIMS To identify the views of people with Type 2 diabetes (PWD) and healthcare professionals (HCP) about diabetes care. METHODS A systematic review of qualitative studies reporting both groups' views using thematic synthesis frameworked by the eHealth Enhanced Chronic Care Model was conducted. RESULTS We searched six electronic databases between 2010 and 2020, identified 6999 studies and included 21. Thirty themes were identified with in general complementary views between PWD and HCP. PWD and HCP find lifestyle changes challenging and get frustrated when PWD struggle to achieve it. Good self-management requires a trustful PWD-HCP relationship. Diabetes causes distress and often HCP focus on clinical aspects. They value diabetes education. PWD require broader, tailored, consistent and ongoing information, but HCPs do not have enough time for providing it. There is need for diabetes training for primary HCP. Shared decision making can mitigate PWD's fears. Different sources of social support can influence PWD's ability to self-manage and PWD/HCP suggest online peer groups. PWD/HCP indicate lack of communication and collaboration between HCP. PWD's and HCP's views about quality in diabetes care differ. They believe that comprehensive, multidisciplinary and locally provided care can help to achieve better outcomes. They recognise digital health benefits, with room for personal interaction (PWD) and eHealth literacy improvements (HCP). Evidence-based guidelines are important but can detract from personalised care. CONCLUSION We hypothesise that including PWD's and HCP's complementary views, multidisciplinary teams and digital tools in the redesign of Type 2 diabetes care can help with overcoming some of the challenges and achieving common goals.
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Affiliation(s)
- Soraia de Camargo Catapan
- Public Health Department, Federal University of Santa Catarina, Florianopolis, Brazil
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Uthara Nair
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Len Gray
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | | | - Dominique Bird
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Monika Janda
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Farhad Fatehi
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Anish Menon
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Metro South Health, Brisbane, Australia
| | - Anthony Russell
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Metro South Health, Brisbane, Australia
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Alaofè H, Yeo S, Okechukwu A, Magrath P, Amoussa Hounkpatin W, Ehiri J, Rosales C. Cultural Considerations for the Adaptation of a Diabetes Self-Management Education Program in Cotonou, Benin: Lessons Learned from a Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168376. [PMID: 34444125 PMCID: PMC8393923 DOI: 10.3390/ijerph18168376] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/04/2021] [Accepted: 08/04/2021] [Indexed: 12/02/2022]
Abstract
Background: Type 2 diabetes (T2D) poses a disproportionate burden on Benin, West Africa. However, no diabetes intervention has yet been developed for Benin’s contexts. This study aimed to explore specific cultural beliefs, attitudes, behaviors, and environmental factors to help adapt a diabetes self-management program to patients with T2D from Cotonou, in southern Benin. Methods: Qualitative data were collected through focus group discussions (FDGs) involving 32 patients with T2D, 16 academic partners, and 12 community partners. The FDGs were audio-recorded, transcribed verbatim from French to English, and then analyzed thematically with MAXQDA 2020. Results: Healthy food was challenging to obtain due to costs, seasonality, and distance from markets. Other issues discussed were fruits and vegetables as commodities for the poor, perceptions and stigmas surrounding the disease, and the financial burden of medical equipment and treatment. Information about local food selections and recipes as well as social support, particularly for physical activity, were identified, among other needs. When adapting the curriculum, gender dynamics and spirituality were suggested. Conclusions: The study demonstrates the need for culturally sensitive interventions and a motivation-based approach to health (spiritual and emotional support). It also lays the groundwork for addressing T2D contextually in Benin and similar sub-Saharan African countries.
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Affiliation(s)
- Halimatou Alaofè
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ 85724, USA; (S.Y.); (A.O.); (P.M.); (J.E.)
- Correspondence: ; Tel.: +1-(520)-626-5614
| | - Sarah Yeo
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ 85724, USA; (S.Y.); (A.O.); (P.M.); (J.E.)
| | - Abidemi Okechukwu
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ 85724, USA; (S.Y.); (A.O.); (P.M.); (J.E.)
| | - Priscilla Magrath
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ 85724, USA; (S.Y.); (A.O.); (P.M.); (J.E.)
| | - Waliou Amoussa Hounkpatin
- School of Nutrition and Food Science and Technology, Faculty of Agricultural Sciences, University of Abomey-Calavi (FSA-UAC), Campus d’Abomey-Calavi, Calavi 01 BP 526, Benin;
| | - John Ehiri
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ 85724, USA; (S.Y.); (A.O.); (P.M.); (J.E.)
| | - Cecilia Rosales
- Division of Public Health Practice & Translational Research, University of Arizona, Phoenix Plaza Building, 550 E. Van Buren Street, Phoenix, AZ 85006, USA;
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Silva AFRD, Moura KRD, Moura TVC, Oliveira ASSD, Moreira TMM, Silva ARVD. Telephone intervention in self-care practices with the feet of patients with diabetes: a randomized clinical trial. Rev Esc Enferm USP 2021; 55:e03737. [PMID: 34190883 DOI: 10.1590/s1980-220x2020047203737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 12/03/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the effect of a telephone intervention for self-care practices with the feet of people with type 2 diabetes mellitus. METHOD This is a randomized clinical trial with two groups, control and intervention, carried out with 102 users with type 2 diabetes mellitus linked to four Basic Health Units in a municipality in the state of Piauí. For the intervention group, six telephone interventions were carried out in three months; and the control group received only conventional follow-up. For assessment, a form was applied before and after the intervention period. RESULTS In the intragroup analysis, when comparing self-care practices with the feet in the control group in the pre- and post-tests, there was no significant difference (p > 0.05); in the intervention group, there was an increase in self-care practices in 70% of the items, with p < 0.001 to 0.03. When analyzing the practice of intergroup self-care after the telephone intervention, the positive effect of the intervention was evidenced, obtaining statistically significant differences in 60% of the items, with a value of p < 0.001 to 0.031. CONCLUSION The telephone intervention promoted greater adherence to self-care practices with the feet of patients with type 2 diabetes mellitus. Brazilian Clinical Trials Registry: RBR-3pq5th.
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Stotz SA, Ricks KA, Eisenstat SA, Wexler DJ, Berkowitz SA. Opportunities for Interventions That Address Socioeconomic Barriers to Type 2 Diabetes Management: Patient Perspectives. Sci Diabetes Self Manag Care 2021; 47:153-163. [PMID: 34078177 DOI: 10.1177/0145721721996291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of the study was to explore patient perspectives on socioeconomic barriers related to diabetes self-management and interventions to address these barriers. METHODS Focus groups (n = 8) were conducted with a diverse sample of adults with type 2 diabetes (T2D; n = 53). Researchers used a semistructured moderator guide; focus groups were audio recorded and transcribed verbatim. Researchers employed the constant comparison method for qualitative content analysis and utilized Atlas.ti (Version 8.1.1) to digitalize the analytic process. RESULTS Findings revealed 3 primary themes: (1) Existing food and nutrition resources are insufficient to support healthy eating for diabetes; (2) healthy eating is critical for diabetes management, but socioeconomic circumstances make doing so challenging; and (3) participants supported several broad categories of preferred intervention strategies. First, they endorsed lifestyle intervention informed by socioeconomic status (SES; eg, focusing on food resource management, sensitive health coaching and nutritional counseling). Next, they expressed enthusiasm for group-based learning opportunities, such as cooking classes and support groups with similar SES peers. Finally, they suggested healthy food access resources. CONCLUSIONS Participant suggestions should be incorporated into intervention development. Ultimately, these interventional strategies should be tested and refined to help improve health for individuals with type 2 diabetes.
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Affiliation(s)
- Sarah A Stotz
- Colorado School of Public Health, Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Katharine A Ricks
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Stephanie A Eisenstat
- Division of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Deborah J Wexler
- Diabetes Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Seth A Berkowitz
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Division of General Medicine & Clinical Epidemiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Asante E, Bam V, Diji AKA, Lomotey AY, Owusu Boateng A, Sarfo-Kantanka O, Oparebea Ansah E, Adjei D. Pilot Mobile Phone Intervention in Promoting Type 2 Diabetes Management in an Urban Area in Ghana: A Randomized Controlled Trial. DIABETES EDUCATOR 2020; 46:455-464. [PMID: 32998649 DOI: 10.1177/0145721720954070] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE The purpose of the study was to evaluate the feasibility and effectiveness of a nurse-led mobile phone call intervention on glycemic management and adherence to self-management practices among patients with type 2 diabetes mellitus (T2DM) in Ghana. METHODS This was a pilot randomized controlled trial to compare diabetes care as usual to a mobile phone call intervention delivered by nurses in addition to care as usual over a 12-week period in a tertiary referral hospital in Ghana. Sixty patients with T2DM were randomized to either the intervention or the control arm. The intervention group received up to 16 mobile phone calls (mean duration = 12 minutes) from a diabetes specialist nurse in addition to their care as usual. The control group received only care as usual. The primary outcome was the change in A1C over the 12-week period. The secondary outcomes were changes in self-reported adherence to medication and diabetes self-management measures over the 12-week period. RESULTS Mean baseline A1C was comparable between the intervention and control groups (9.54%, SD = 2.00% vs 9.07%, SD = 1.72%, P = .334). After 12 weeks, A1C was significantly lower in the intervention group compared to the control group. The difference in mean A1C in the control group rose by +0.26 ± 1.30% (P = .282; 95% CI, -0.23 to 0.75), whereas that of the intervention group reduced by -1.51 ± 2.67% (P = .004; 95% CI, -2.51 to -0.51). No improvements in self-management were recorded in the control group. In the intervention group, however, the only significant improvement was recorded in the area of foot care practices. Participant recruitment and retention were 100% without any attrition. About 87% (n = 26) of the intervention group completed at least 70% (≥11) of the calls. At the end of the trial, participants who received the intervention rated their satisfaction as 89.3% on average. CONCLUSION A mobile phone follow-up call by nurses emphasizing adherence to self-management practices is feasible and can improve short- to medium-term glycemic management among patients with T2DM.
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Affiliation(s)
- Ernest Asante
- Department of Nursing, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Victoria Bam
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | | | | | | | - Dennis Adjei
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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