The Effectiveness of an Educational Intervention Based on Theories and Models on Diabetes Outcomes: A Systematic Review

Lasting effects of a brief, scalable diabetes conversation map psychosocial intervention on health beliefs and health behaviors: A large randomized controlled trial in Taiwan

The current study aimed to examine the effects of a conversation map (CM) psychosocial intervention on diet and exercise health beliefs and health behaviors among people with diabetes (PWD). Based on the Health Belief Model, this large-scale randomized controlled trial (N = 615) investigated whether an added 1-h theory-driven CM intervention (N = 308), compared with usual shared-care service only (N = 307), could significantly better improve PWD's diet and exercise health beliefs and health behaviors at 3-month posttest. Multivariate linear autoregression analysis demonstrated that, controlling for baseline, the CM group had significantly better diet (β = .270) and exercise (β = .280) health behaviors at 3-month posttest than the control group. The intervention effects on health behavior change were primarily mediated through desired changes in targeted health beliefs, as informed by the theory. For example, as regards diet, the CM group had significantly greater increases in perceived susceptibility (β = .121), perceived benefits (β = .174), and cues to action (β = .268), as well as greater decreases in perceived barriers (β = -.156), between pretest and 3-month posttest. In conclusion, future diabetes care may integrate brief theory-driven CM interventions, as in this study, into current shared-care practice to help PWD improve diabetes self-management health behaviors more effectively. Implications for practice, policy, theory, and research are discussed.

Medication Bias During the Hospital-to-Family Transition Among Young and Middle-Aged Chinese Patients with Type 2 Diabetes: A Qualitative Study

Objective

This study aimed to examine the prevalence of medication non-adherence among young and middle-aged Chinese individuals diagnosed with type 2 diabetes, and to explore the underlying causes of such deviations.

Methods

The Medication Discrepancy Tool (MDT) was used to assess medication deviations in a cohort of 100 patients who had been discharged from the hospital. Furthermore, 15 subjects were interviewed to gain a better understanding of their medication non-adherence experiences.

Results

The rate of medication deviation in the studied cohort was 79.5%, with the most frequent deviation being a reduction in the types of drugs taken. The primary cause of this deviation was found to be patient-derived, with the most common reason being symptom improvement. Iatrogenic medication deviation was most often caused by incomplete or inaccurate medication education for medical staff at discharge, resulting in patients having to guess their own medication. Internal and extrinsic motivating factors were identified as the primary causes of medication deviation behavior.

Conclusion

This study has demonstrated that medication non-adherence is a major issue among young and middle-aged Chinese individuals diagnosed with type 2 diabetes. Therefore, it is essential for nurses to be aware of the importance of medication adherence management and working.

Cognitive Behavioral Therapy for self-care behaviors with type 2 diabetes mellitus patients: A systematic review

BACKGROUND AND AIMS

Self-care behavior is associated with the risk of microvascular and macrovascular complications. Self-care behaviors can be improved through positive thinking, attitude, and knowledge. Cognitive behavioral therapy (CBT) can be one of the interventions for improving self-care behaviors. However, the ideal model and duration of the intervention and an effective assessment instrument to measure the improvement in self-care behaviors remain unidentified. Therefore, this review aimed to assess the effectiveness of CBT, including its models, duration, and instruments, in improving self-care behaviors in patients with type 2 diabetes mellitus (T2DM).

METHODS

The Scopus, Cochrane Library, PubMed, EBSCO Host, Directory of Open Access Journals, GARUDA, Taylor & Francis, and Gray Literature databases were systematically searched to identify studies that were in English and published in 2011-2021. The quality of the identified articles was assessed using The Critical Appraisal Skill Programme.

RESULTS

We found 368 patients in seven randomized controlled trials. CBT was significantly effective in improving overall self-care behavior, including blood glucose monitoring, physical activity, and medication compliance.

CONCLUSION

Individual and group CBT interventions applied face-to-face, via telephone, and via internet show an increase in self-care behavior in patients with T2DM. The duration of treatment had a significant effect at 3 months to 1 year with 12-21 sessions. CBT is performed by a CBT licensed nurse or psychiatrist, nutritionist, CBT psychologist with experience in diabetes care, doctors, research students.

Stakeholders' Experiences and Perspectives Regarding Care Quality for Women With Breast Cancer: A Systematic Review

BACKGROUND

The considerable growth in the number of patients with breast cancer leads to substantial pressure on healthcare services; however, the main measures that will evaluate what is important to the key stakeholders in improving the quality of breast cancer care are not well defined.

OBJECTIVE

This study aimed to synthesize providers' and patients' experiences and perspectives regarding barriers and quality breast cancer care in health services.

METHODS

PubMed, Scopus, MEDLINE, Web of Knowledge, and the Cochrane Library databases were searched, and articles published in English up to August 2020 were screened. Two reviewers independently screened all articles. Data were obtained directly from different stakeholder groups including patients, health providers, and professionals.

RESULTS

The search strategy identified 21 eligible articles that met inclusion criteria and reported perspectives of 847 health providers and 24 601 patients regarding healthcare quality. Health providers and patients with breast cancer noted information needs, psychosocial support, responsibility for care, and coordination of care as important quality improvement characteristics of the healthcare system.

CONCLUSION

Shifting to high-quality breast cancer care would likely be a complicated process, and there is a need for the cancer care services to consider important characteristics of quality cancer care as a care priority, that is, to be responsive.

IMPLICATION FOR PRACTICE

Breast cancer survivorship care programs and interventions may need to consider the barriers or common challenges to care noted in this review, especially regarding information sharing and the need for social support and care cooperation.

The role of social networks in diabetes self‐care: A cross‐sectional study

Background

Patient involvement with diabetes self‐care is critical to reducing complications, morbidity, and mortality. Social media, as one of the most important forms of digital health, has always been available for diabetes self‐care, although the role of these media in supporting patient self‐care is unclear.

Aims

The aim of this study was to investigate the role of social networks in diabetes self‐care. In this study, the most important social networks used to receive self‐care services, diabetes self‐care behaviors, diabetes self‐care educations and benefits of using various services provided through social networks were identified.

Methods

The present study is a cross‐sectional study that was conducted through an electronic researcher‐made questionnaire in 2021. Two hundred and eighteen patients were selected to participate in the study from centers of diabetes of Fasa city, south of Iran. Sampling was performed by convenience sampling and in accordance with inclusion and exclusion criteria. Data were analyzed by descriptive statistics and analytical tests.

Results

In the data analysis section on Diabetes self‐care behaviors, there was no significant relationship between gender (p = 0.292), age (p = 0.49), type of diabetes (p = 0.909) and duration of diabetes (p = 0.076) with the use of self‐care services provided through social networks. There was a significant relationship between education level and the use of self‐care services provided through social networks (p = 0.01). “Recognizing diabetes and its complications,” “observing personal hygiene,” and “the impact of physical activity on diabetes control” were the most important educations. “Increasing patient knowledge and understanding about diabetes and its complications,” “reducing the consumption of high‐calorie foods and sugars,” and “observing personal and public health” were the most important social network's benefits, respectively.

Conclusions

Various self‐care educations and services provided through social networks can increase the in‐depth knowledge of diabetic patients about self‐care techniques and their effective role in controlling and managing diabetes and performing more self‐care processes.

Is patient activation a mediator of the effect of a health promoting intervention in adults at high risk of type 2 diabetes? A longitudinal path model analysis within a randomised trial

Background

Exploring mediators of preventive intervention effects has important implications for the planning of complex interventions. Our aim was to assess the extent to which knowledge, skills and confidence to manage health, here measured as “patient activation”, was a mediator of the effect of the intervention “Live your life without diabetes” on weight, waist circumference and systolic blood pressure at 12 months follow-up in adults at high risk of type 2 diabetes.

Methods

Autoregressive path models with three time points of measurement, and contemporaneous and constant b paths were used in a randomised controlled trial (RCT). The RCT took place in a Danish municipal healthcare center and included 127 individuals aged 28 to 70 years with fasting plasma glucose: 6.1–6.9 mmol/l and/or glycated haemoglobin (HbA_1c): 42.0–47.9 mmol/mol. Participants were randomised to routine care (n = 64), or intervention (n = 63). The intervention group received an empirical and theory-based intervention delivered over four two-h group sessions during five weeks, and two further sessions after one and six months. The outcomes were weight, waist circumference and systolic blood pressure, and the mediator was patient activation, measured by the self-reported Patient Activation Measure (PAM). Data for the present study was derived from questionnaires and clinical measures from baseline, three- and 12-months follow-up.

Results

Mediated effects via PAM on: weight: − 0.09 kg (95% CI − 0.38 to 0.20) out of the total effect − 1.09 kg (95% CI − 3.05 to 0.87); waist circumference: − 0.04 cm (95% CI − 0.36 to 0.28) out of the total effect − 1.86 cm (95% CI − 4.10 to 0.39); and systolic blood pressure: − 0.31 mmHg (− 1.10 to 0.49) out of the total effect − 2.73 mmHg (95% CI − 6.34 to 0.87).

Conclusion

We found no mediating effects of patient activation as a single variable of the intervention “Live your life without diabetes” on weight, waist circumference and systolic blood pressure at 12 months follow-up in adults at high risk of type 2 diabetes. Our study demonstrates an analytic approach for estimating mediating effects in complex interventions that comply with the criteria on temporal ordered data. Future studies should include possible interacting variables.

Mediation Effect of Self-Efficacy Between Health Beliefs and Glycated Haemoglobin Levels in Elderly Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study

PURPOSE

To explore the mediating effect of self-efficacy in the relationship between glycated haemoglobin (HbA1c) levels and health beliefs in community elderly patients with type 2 diabetes.

PATIENTS AND METHODS

From January to March 2022, convenience sampling was adopted to investigate 200 elderly patients with type 2 diabetes in a community in Yangzhou, China. Data were collected using the Health Beliefs Questionnaire, Self-efficacy for Diabetes, and Medication Compliance Questionnaire. Laboratory parameters included HbA1c, fasting blood glucose, postprandial blood glucose, total cholesterol, triglyceride, high-density-lipoprotein cholesterol, and low-density-lipoprotein cholesterol levels. Correlation, linear regression, and mediation analyses were performed using SPSS 27.0.

RESULTS

HbA1c levels were higher in men (women vs men: 6.80% [6.08%, 7.73%] vs.7.30% [6.30%, 9.18%]) and employed (employed vs not employed vs retired: 7.60% [6.90%, 10.45%] vs 5.85% [5.40%, 6.95%] vs 7.10% [6.20%, 8.20%]) and low self-efficacy (low vs high: 13.1% [6.55%, 13.85%] vs 6.8% [6.10%, 7.70%]). HbA1c levels were negatively associated with health beliefs (r = -0.246) and self-efficacy (r = -0.240; p<0.01). Linear regression showed that perceived susceptibility, severity, benefit, and barriers, cues to action, and self-efficacy explained 50% of the variance in HbA1c levels after adjusting for sex and current work status. The mediation effect of self-efficacy was partial between health beliefs and HbA1c levels and accounted for 24.65% of the total effect (p < 0.001).

CONCLUSION

Health beliefs influenced the improvement of self-efficacy in older patients with type 2 diabetes mellitus, which in turn could improve HbA1c control. Self-efficacy plays a partial mediating role between health beliefs and Hba1c levels in elderly patients with type 2 diabetes.