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Uzun S, Gürhan N. The effect of motivational interviewing on quality of life and self-efficacy behaviors of individuals with chronic illness: A meta-analysis study. Public Health Nurs 2024. [PMID: 38856679 DOI: 10.1111/phn.13339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 04/25/2024] [Accepted: 04/30/2024] [Indexed: 06/11/2024]
Abstract
OBJECTIVE This study aims to reveal the effect of the motivational interviewing on the quality of life and self-efficacy behaviors of individuals with chronic diseases. MATERIAL-METHOD For this meta-analysis study, PubMed, Web of Science, EBSCOhost, Google Scholar, and YÖK Theses databases were searched in January-May 2021 without year limitation. As a result, 38 studies were included in the study: 23 for the quality of life variable, and 21 for the self-efficacy behaviors variable (in 6 studies, both variables were examined together). The data were synthesized with meta-analysis and narrative methods. The total sample size of the studies is 25,425. RESULTS This meta-analysis study showed that the motivational interviewing applied to individuals with chronic diseases changed their quality of life (SMD: 0.296, %95 CI: 0.054-0.537, Z = 2.402, p = .016, I2 = %95). The type of chronic disease, measurement tool, sample group, disease group, age range, and whether the motivational interviewer was a nurse or not changed the effect size of the motivational interviewing on the quality of life. The self-efficacy score average of the experimental group to which motivational interviewing was applied was statistically similar to that of the control group (SMD: 0.141, %95 CI: -0.065, 0.347; Z = 1.346, p = .178, I2 = %87). CONCLUSIONS As a result of the meta-analysis, it was determined that the use of motivational interviewing increased the quality of life level of individuals with chronic diseases. However, it is thought that more research is needed because some studies were conducted with small sample size and prepost test design. The results of the study may provide guidance on the interventions to be used in improving the quality of life of individuals with chronic diseases.
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Affiliation(s)
- Sevda Uzun
- Faculty of Health Sciences, Department of Psychiatric Nursing, Gumushane Univers℩ty, Gumushane, Turkey
| | - Nermin Gürhan
- Faculty of Health Sciences, Department of Psychiatric Nursing, Tokat Gaziosmanpasa University, Tokat, Turkey
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Holder M, Kapellen T, Ziegler R, Bürger-Büsing J, Danne T, Dost A, Holl RW, Holterhus PM, Karges B, Kordonouri O, Lange K, Müller S, Raile K, Schweizer R, von Sengbusch S, Stachow R, Wagner V, Wiegand S, Neu A. Diagnosis, Therapy and Follow-Up of Diabetes Mellitus in Children and Adolescents. Exp Clin Endocrinol Diabetes 2022; 130:S49-S79. [PMID: 35913059 DOI: 10.1055/a-1624-3388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Martin Holder
- Klinikum Stuttgart, Olgahospital, Department of Pediatric Endocrinology and Diabetology, Germany
| | - Thomas Kapellen
- Department of Paediatrics and Adolescent Medicine, University Hospital, Leipzig, Germany
| | - Ralph Ziegler
- Practice for Paediatrics and Adolescent Medicine, Focus on Diabetology, Münster, Germany
| | - Jutta Bürger-Büsing
- Association of Diabetic Children and Adolescents, Diabetes Center, Kaiserslautern, Germany
| | - Thomas Danne
- Children's and Youth Hospital Auf der Bult, Hannover, Germany
| | - Axel Dost
- Department of Paediatrics and Adolescent Medicine, University Hospital Jena, Germany
| | - Reinhard W Holl
- Institute for Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Germany
| | - Paul-Martin Holterhus
- Department of General Paediatrics, University Hospital Schleswig-Holstein, Kiel Campus, Germany
| | - Beate Karges
- Endocrinology and Diabetology Section, University Hospital, RWTH Aachen University, Germany
| | - Olga Kordonouri
- Children's and Youth Hospital Auf der Bult, Hannover, Germany
| | - Karin Lange
- Department of Medical Psychology, Hannover Medical School, Hannover, Germany
| | | | - Klemens Raile
- Virchow Hospital, University Medicine, Berlin, Germany
| | - Roland Schweizer
- Department of Pediatrics and Adolescent Medicine, University Hospital Tübingen, Germany
| | - Simone von Sengbusch
- Department of Paediatrics and Adolescent Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Rainer Stachow
- Sylt Specialist Hospital for Children and Adolescents, Westerland, Germany
| | - Verena Wagner
- Joint Practice for Paediatrics and Adolescent Medicine, Rostock, Germany
| | | | - Andreas Neu
- Department of Pediatrics and Adolescent Medicine, University Hospital Tübingen, Germany
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Effects of motivational interviewing on HbA1c and depression among cases with type 1 diabetes: a meta-analysis. Int J Diabetes Dev Ctries 2021. [DOI: 10.1007/s13410-021-01003-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Winkley K, Upsher R, Stahl D, Pollard D, Kasera A, Brennan A, Heller S, Ismail K. Psychological interventions to improve self-management of type 1 and type 2 diabetes: a systematic review. Health Technol Assess 2021; 24:1-232. [PMID: 32568666 DOI: 10.3310/hta24280] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND For people with diabetes mellitus to achieve optimal glycaemic control, motivation to perform self-management is important. The research team wanted to determine whether or not psychological interventions are clinically effective and cost-effective in increasing self-management and improving glycaemic control. OBJECTIVES The first objective was to determine the clinical effectiveness of psychological interventions for people with type 1 diabetes mellitus and people with type 2 diabetes mellitus so that they have improved (1) glycated haemoglobin levels, (2) diabetes self-management and (3) quality of life, and fewer depressive symptoms. The second objective was to determine the cost-effectiveness of psychological interventions. DATA SOURCES The following databases were accessed (searches took place between 2003 and 2016): MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, PsycINFO, EMBASE, Cochrane Controlled Trials Register, Web of Science, and Dissertation Abstracts International. Diabetes conference abstracts, reference lists of included studies and Clinicaltrials.gov trial registry were also searched. REVIEW METHODS Systematic review, aggregate meta-analysis, network meta-analysis, individual patient data meta-analysis and cost-effectiveness modelling were all used. Risk of bias of randomised and non-randomised controlled trials was assessed using the Cochrane Handbook (Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928). DESIGN Systematic review, meta-analysis, cost-effectiveness analysis and patient and public consultation were all used. SETTING Settings in primary or secondary care were included. PARTICIPANTS Adolescents and children with type 1 diabetes mellitus and adults with types 1 and 2 diabetes mellitus were included. INTERVENTIONS The interventions used were psychological treatments, including and not restricted to cognitive-behavioural therapy, counselling, family therapy and psychotherapy. MAIN OUTCOME MEASURES Glycated haemoglobin levels, self-management behaviours, body mass index, blood pressure levels, depressive symptoms and quality of life were all used as outcome measures. RESULTS A total of 96 studies were included in the systematic review (n = 18,659 participants). In random-effects meta-analysis, data on glycated haemoglobin levels were available for seven studies conducted in adults with type 1 diabetes mellitus (n = 851 participants) that demonstrated a pooled mean difference of -0.13 (95% confidence interval -0.33 to 0.07), a non-significant decrease in favour of psychological treatment; 18 studies conducted in adolescents/children with type 1 diabetes mellitus (n = 2583 participants) that demonstrated a pooled mean difference of 0.00 (95% confidence interval -0.18 to 0.18), indicating no change; and 49 studies conducted in adults with type 2 diabetes mellitus (n = 12,009 participants) that demonstrated a pooled mean difference of -0.21 (95% confidence interval -0.31 to -0.10), equivalent to reduction in glycated haemoglobin levels of -0.33% or ≈3.5 mmol/mol. For type 2 diabetes mellitus, there was evidence that psychological interventions improved dietary behaviour and quality of life but not blood pressure, body mass index or depressive symptoms. The results of the network meta-analysis, which considers direct and indirect effects of multiple treatment comparisons, suggest that, for adults with type 1 diabetes mellitus (7 studies; 968 participants), attention control and cognitive-behavioural therapy are clinically effective and cognitive-behavioural therapy is cost-effective. For adults with type 2 diabetes mellitus (49 studies; 12,409 participants), cognitive-behavioural therapy and counselling are effective and cognitive-behavioural therapy is potentially cost-effective. The results of the individual patient data meta-analysis for adolescents/children with type 1 diabetes mellitus (9 studies; 1392 participants) suggest that there were main effects for age and diabetes duration. For adults with type 2 diabetes mellitus (19 studies; 3639 participants), baseline glycated haemoglobin levels moderated treatment outcome. LIMITATIONS Aggregate meta-analysis was limited to glycaemic control for type 1 diabetes mellitus. It was not possible to model cost-effectiveness for adolescents/children with type 1 diabetes mellitus and modelling for type 2 diabetes mellitus involved substantial uncertainty. The individual patient data meta-analysis included only 40-50% of studies. CONCLUSIONS This review suggests that psychological treatments offer minimal clinical benefit in improving glycated haemoglobin levels for adults with type 2 diabetes mellitus. However, there was no evidence of benefit compared with control interventions in improving glycated haemoglobin levels for people with type 1 diabetes mellitus. FUTURE WORK Future work should consider the competency of the interventionists delivering a therapy and psychological approaches that are matched to a person and their life course. STUDY REGISTRATION This study is registered as PROSPERO CRD42016033619. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 28. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kirsty Winkley
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Rebecca Upsher
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Daniel Stahl
- Department of Biostatistics, Institute of Psychiatry, King's College London, London, UK
| | - Daniel Pollard
- Health Economics and Decision Science, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Architaa Kasera
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alan Brennan
- Health Economics and Decision Science, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Simon Heller
- Academic Unit of Diabetes, Endocrinology and Metabolism, Department of Oncology & Metabolism, University of Sheffield, Sheffield, UK
| | - Khalida Ismail
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Bergmame L, Shaw S. Clinical Utility of Psychoeducational Interventions for Youth with Type 1 Diabetes: A Scoping Review. CONTINUITY IN EDUCATION 2021; 2:76-108. [PMID: 38774890 PMCID: PMC11104390 DOI: 10.5334/cie.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 04/03/2021] [Indexed: 05/24/2024]
Abstract
Adolescence is a challenging time for the medical management of type 1 diabetes. Thus, a range of psychoeducational interventions have been developed to improve diabetes management among youth. Systematic reviews of this literature have emphasized the effectiveness of interventions for improving patient outcomes. However, knowledge beyond what works is required for interventions to be adopted into routine clinical practice. The objective of this scoping review was to map the clinical utility of the literature based on a variety of indicators, including the problem base, context placement, information gain, transparency, pragmatism, and patient-centeredness of the research. This lens for reviewing research is consistent with the biopsychosocial model and an increasing focus on reducing disability, including activity limitation and participation restriction. PsycINFO, MEDLINE, and CINHAL databases were searched for evaluative psychoeducational intervention studies published between January 2005 and October 2020. Two cited reference searches and one reference list search were also performed. Fifty studies describing 46 different interventions were identified. The clinical utility of the interventions was highly variable. A detailed overview of the clinical utility of the literature is provided with an emphasis on current gaps and shortcomings to be addressed in future research. This work helps advance the translation of clinical knowledge into practice in schools, homes, and communities; and, ultimately, improve the health and well-being of adolescents with T1D.
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Diagnostik, Therapie und Verlaufskontrolle des Diabetes mellitus im Kindes- und Jugendalter. DIABETOLOGE 2021. [DOI: 10.1007/s11428-021-00769-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Bakır E, Çavuşoğlu H, Mengen E. Effects of the Information-Motivation-Behavioral Skills Model on Metabolic Control of Adolescents with Type 1 Diabetes in Turkey: Randomized Controlled Study. J Pediatr Nurs 2021; 58:e19-e27. [PMID: 33371976 DOI: 10.1016/j.pedn.2020.11.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/27/2020] [Accepted: 11/29/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE To evaluate the effects of information-motivation-behavioral skills model interventions given by nurses during home visits on the knowledge levels, personal and social motivation levels, behavioral skills, and HbA1C levels of adolescents with poor glycemic control. DESIGN AND METHODS The present study was designed as randomized controlled trial. 50 adolescents with type 1 diabetes were equally divided into study and control groups. Socio-Demographic Form, Diabetes Information Evaluation Form, The Child Attitude Toward Illness Scale, The Multidimensional Scale of Perceived Social Support, and Diabetes Management Self-Efficacy Scale were utilized in data collection. The scales were administered at the beginning of the study and six months later. HbA1c levels of adolescents were evaluated in the third and sixth months. Multiple home visits and phone calls were made to each participant in the intervention group. Interventions to improve the information-motivation-behavioral skills model-based knowledge, personal and social motivation, and behavioral skills were applied during the home visits. RESULTS As a result of information-motivation-behavioral skills model-based interventions, knowledge levels (p<0.001), personal motivation levels (p = 0.001), social motivation levels (p = 0.004), and behavioral skills (p<0.001) of the study group improved. Additionally, HbA1c levels decreased significantly in the third (p<0.001) and sixth months (p<0.001). CONCLUSION Information-Motivation-Behavioral Skills Model-based intervention effectively improved glycemic control among adolescents with type 1 diabetes. PRACTICE IMPLICATIONS Nurses should develop strategies to increase personal motivation, social motivation, and behavioral skills to training programs planned for adolescents with type 1 diabetes.
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Affiliation(s)
- Elif Bakır
- Pediatric Nursing Department, Hacettepe University, Turkey.
| | - Hicran Çavuşoğlu
- Head of Pediatric Nursing Department, Hacettepe University, Turkey.
| | - Eda Mengen
- Department of Pediatric Endocrinology, Turkey.
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Tuomaala AK, Hero M, Tuomisto MT, Lähteenmäki M, Miettinen PJ, Laine T, Wehkalampi K, Kiiveri S, Ahonen P, Ojaniemi M, Kaunisto K, Tossavainen P, Lapatto R, Sarkola T, Pulkkinen MA. Motivational Interviewing and Glycemic Control in Adolescents With Poorly Controlled Type 1 Diabetes: A Randomized Controlled Pilot Trial. Front Endocrinol (Lausanne) 2021; 12:639507. [PMID: 33776935 PMCID: PMC7994365 DOI: 10.3389/fendo.2021.639507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/23/2021] [Indexed: 11/13/2022] Open
Abstract
A multicenter randomized controlled pilot trial investigated whether motivational interviewing (MI) by diabetes physicians improves glycemic control and variability in the context of follow-up for adolescent patients with poorly controlled type 1 diabetes. Patients (n = 47) aged 12 to 15.9 years who showed poor glycemic control (HbA1c >75 mmol/mol/9.0%) were randomized to standard education (SE) only or MI+SE, with study physicians randomized to employ MI+SE (N = 24 patients) or SE only (N = 23). For one year of follow-up, the main outcome measurements were obtained at three-month visits (HbA1c) or six-monthly: time in range (TIR) and glycemic variability (CV). Mean adjusted 12-month change in HbA1c was similar between the MI+SE and SE-only group (-3.6 vs. -1.0 mmol/mol), and no inter-group differences were visible in the mean adjusted 12-month change in TIR (-0.8 vs. 2.6%; P = 0.53) or CV (-0.5 vs. -6.2; P = 0.26). However, the order of entering the study correlated significantly with the 12-month change in HbA1c in the MI+SE group (r = -0.5; P = 0.006) and not in the SE-only group (r = 0.2; P = 0.4). No link was evident between MI and changes in quality of life. The authors conclude that MI's short-term use by diabetes physicians managing adolescents with poorly controlled type 1 diabetes was not superior to SE alone; however, improved skills in applying the MI method at the outpatient clinic may produce greater benefits in glycemic control.
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Affiliation(s)
- Anna-Kaisa Tuomaala
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Matti Hero
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Martti T. Tuomisto
- Faculty of Social Sciences (Psychology), Tampere University, Tampere, Finland
| | - Maria Lähteenmäki
- Faculty of Social Sciences (Psychology), Tampere University, Tampere, Finland
| | - Päivi J. Miettinen
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tiina Laine
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Karoliina Wehkalampi
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sanne Kiiveri
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pekka Ahonen
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marja Ojaniemi
- Department of Pediatrics and Research Unit for Pediatrics, Pediatric Neurology, Pediatric Surgery, Child Psychiatry, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Otorhinolaryngology and Ophthalmology, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Kari Kaunisto
- Department of Pediatrics and Research Unit for Pediatrics, Pediatric Neurology, Pediatric Surgery, Child Psychiatry, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Otorhinolaryngology and Ophthalmology, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Päivi Tossavainen
- Department of Pediatrics and Research Unit for Pediatrics, Pediatric Neurology, Pediatric Surgery, Child Psychiatry, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Otorhinolaryngology and Ophthalmology, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Risto Lapatto
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Taisto Sarkola
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
| | - Mari-Anne Pulkkinen
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- *Correspondence: Mari-Anne Pulkkinen,
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Alvarado-Martel D, Boronat M, Alberiche-Ruano MDP, Algara-González MA, Ramallo-Fariña Y, Wägner AM. Motivational Interviewing and Self-Care in Type 1 Diabetes: A Randomized Controlled Clinical Trial Study Protocol. Front Endocrinol (Lausanne) 2020; 11:574312. [PMID: 33362714 PMCID: PMC7759186 DOI: 10.3389/fendo.2020.574312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 11/06/2020] [Indexed: 11/22/2022] Open
Abstract
Background Type 1 diabetes is a disease with complex therapeutic recommendations that require day-to-day lifestyle changes. Motivational Interviewing is a communication tool that has proved effective in changing behaviors in people with addictions, obesity and type 2 diabetes. Our objective is to evaluate the effects of a Motivational Interviewing intervention in people with type 1 diabetes. Methods Sixty-six patients with type 1 diabetes and hemoglobin A1c >= 8% have been included and randomly assigned (computer-generated sequence, sealed envelopes, ratio 1:1) either to the intervention or to the control group. In the intervention group, appointments every 4 months with the endocrinologist include Motivational Interviewing; in the control group, the appointments proceed as usual. Patients will be followed for 16 months. The primary outcome will be self-care behaviors, assessed by a validated questionnaire, the Diabetes Self-Care Inventory-Revised Version. Secondary outcomes include: HbA1c, motivation for self-care, self-efficacy, health-related quality of life, satisfaction with professional-patient relationship, and fulfillment of patients' own objectives. The practitioners receive training in Motivational Interviewing in order to help them promote adherence to self-care, encourage patient motivation and improve the doctor-patient relationship. The Motivational Interviewing intervention will be evaluated by two psychologists, blinded to the assigned treatment, through video recordings of the sessions and the administration of a purpose-built questionnaire, the EVEM 2.0 scale. Discussion There is evidence that MI can improve self-care in type 2 diabetes. In this study, we aim to evaluate the effect of MI on self-care and HbA1c in people with type 1 diabetes. Clinical Trial Registration https://clinicaltrials.gov/ct2/show/NCT03906786, identifier NCT03906786.
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Affiliation(s)
- Dácil Alvarado-Martel
- Endocrinology and Nutrition Department, University Hospital Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
- Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria (ULPGC), Las Palmas de Gran Canaria, Spain
| | - Mauro Boronat
- Endocrinology and Nutrition Department, University Hospital Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
- Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria (ULPGC), Las Palmas de Gran Canaria, Spain
| | - María del Pino Alberiche-Ruano
- Endocrinology and Nutrition Department, University Hospital Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
- Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria (ULPGC), Las Palmas de Gran Canaria, Spain
| | - María Andrea Algara-González
- Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria (ULPGC), Las Palmas de Gran Canaria, Spain
| | - Yolanda Ramallo-Fariña
- Evaluation Unit (SESCS), Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Madrid, Spain
| | - Ana M. Wägner
- Endocrinology and Nutrition Department, University Hospital Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
- Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria (ULPGC), Las Palmas de Gran Canaria, Spain
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Pulkkinen MA, Tuomaala AK, Hero M, Gordin D, Sarkola T. Motivational Interview to improve vascular health in Adolescents with poorly controlled type 1 Diabetes (MIAD): a randomized controlled trial. BMJ Open Diabetes Res Care 2020; 8:8/1/e001216. [PMID: 32723754 PMCID: PMC7388880 DOI: 10.1136/bmjdrc-2020-001216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 06/05/2020] [Accepted: 06/16/2020] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION We studied if motivational interviewing (MI) added to standard educational care (SEC) improves vascular health in adolescents with poorly controlled type 1 diabetes. RESEARCH DESIGN AND METHODS 47 adolescents with type 1 diabetes of at least 2 years duration and hemoglobin A1c >75 mmol/mol (>9.0%) on two visits were randomized to MI+SEC or SEC. We also compared vascular health parameters of patients with type 1 diabetes at trial baseline with a group of healthy historical controls matched for age and body size. RESULTS 39 adolescents (20 MI+SEC) completed the vascular health study. At 12 months, parameter changes were not statistically significantly different between MI+SEC and SEC (carotid-femoral pulse wave velocity (cfPWV): mean difference 0.052 m/s (95% CI -0.395 to 0.500, p=0.81); carotid-radial PWV (crPWV): 0.118 m/s (95% to 0.478 to 0.713, p=0.69), carotid intima-media thickness (IMT): 0.002 mm (95% CI -0.37 to 0.40, p=0.93), systolic blood pressure (BP) z-score: 0.495 (95% CI -0.099 to 1.09, p=0.10). At baseline, duration of type 1 diabetes was associated with radial IMT (r=0.430, p=0.007) and cfPWV (r=0.373, p=0.018), and carotid, femoral and brachial IMT were correlated with continuous glucose monitoring (CGM) SD (r=0.440, p=0.017; r=0.377, p=0.048; r=0.387, p=0.038). There was an inverse association between CGM time-in-range (3.9-10.0 mmol/L) and crPWV (r=-0.476, p=0.022) changes. Systolic BP change was associated with body mass index change (r=0.374, p=0.019) and IMT change (r=0.461, p=0.016 for carotid IMT; r=0.498, p=0.010 for femoral IMT). PWVs were higher and common carotid compliance lower among patients with type 1 diabetes at baseline compared with healthy controls, but no other differences were found. CONCLUSION There was no effect of MI added to SEC on vascular health parameters. Although disease duration and glycemic control were associated with vascular health at baseline, there were only limited associations between glycemic control and vascular health parameter changes. Vascular health parameter changes were interrelated suggesting clustering of cardiovascular risk. TRIAL REGISTRATION NUMBER NCT02637154.
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Affiliation(s)
- Mari-Anne Pulkkinen
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anna-Kaisa Tuomaala
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Matti Hero
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Daniel Gordin
- Folkhälsan Research Center, Folkhälsan Institute of Genetics, Helsinki, Finland
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Diabetes and Obesity, Research Programs Unit, University of Helsinki, Helsinki, Finland
| | - Taisto Sarkola
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
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Abstract
PURPOSE OF REVIEW This manuscript describes how person-reported outcomes (PROs) can be utilized in care for young people with diabetes in the context of motivation. RECENT FINDINGS The use of person-reported outcome measures (PROMS) in clinical care is feasible and acceptable, and helps focus the clinical encounter on life domains important to the person with diabetes. Results with regard to impact on self-management and glycemic outcomes are limited. Motivation is an important factor for self-management. Based on self-determination theory, autonomy-supportive, person-centered, and collaborative communication by diabetes care providers is associated with better outcomes. PROMs can facilitate this conversation. Understanding of youth motivation for maintaining or improving self-management behaviors requires a person-centered approach. PROMs can be used to facilitate an autonomy-supportive and person-centered conversation in clinical care. Training diabetes care providers in autonomy-supportive, person-centered conversation skills to discuss PROs might help to tap into youth's motivation, but further research is needed.
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Affiliation(s)
- Maartje de Wit
- Medical Psychology, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
| | - Judith Versloot
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Ian Zenlea
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Eveline R Goethals
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
- KU Leuven, Leuven, Belgium
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Barry-Menkhaus SA, Wagner DV, Riley AR. Small Interventions for Big Change: Brief Strategies for Distress and Self-Management Amongst Youth with Type 1 Diabetes. Curr Diab Rep 2020; 20:3. [PMID: 32002682 PMCID: PMC7083649 DOI: 10.1007/s11892-020-1290-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE OF REVIEW Diabetes self-management and diabetes distress are complex processes implicated in glycemic control and other health outcomes for youth with type 1 diabetes. Growing integration of medical and behavioral care provides opportunities for brief psychosocial interventions during routine diabetes care. This review focuses on interventions for self-management and diabetes distress that can be delivered alongside usual medical care or via a single-patient encounter. RECENT FINDINGS Recent research underscores the potential of brief interventions delivered by both medical providers and integrated behavioral health professionals, but little is known regarding the comparative effectiveness of different interventions or the factors that impact dissemination and implementation. This article asserts that brevity is critical to maximizing the reach, scalability, and impact of psychosocial interventions for youth with type 1 diabetes. The authors review existing evidence for brief interventions, describe several untested clinical strategies, and make recommendations for accelerating the translational study of brief interventions.
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Affiliation(s)
- Samantha A Barry-Menkhaus
- The Madison Clinic for Pediatric Diabetes and Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA, USA
| | - David V Wagner
- Institute on Development & Disability, Department of Pediatrics, Oregon Health & Science University, 707 SW Gaines St., Portland, OR, 97239, USA
| | - Andrew R Riley
- Institute on Development & Disability, Department of Pediatrics, Oregon Health & Science University, 707 SW Gaines St., Portland, OR, 97239, USA.
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Li Z, Chen Q, Yan J, Liang W, Wong WCW. Effectiveness of motivational interviewing on improving Care for Patients with type 2 diabetes in China: A randomized controlled trial. BMC Health Serv Res 2020; 20:57. [PMID: 31973759 PMCID: PMC6979352 DOI: 10.1186/s12913-019-4776-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 11/22/2019] [Indexed: 11/12/2022] Open
Abstract
Background To assess the effects of a motivational interviewing (MI)-based patient empowerment program (PEP) on type 2 diabetes mellitus (DM) patient self-management compared to traditional diabetes health education. Methods Two hundred and twenty-five patients, recruited from community health centers (CHCs) and the family medicine clinic in the University of Hong Kong-Shenzhen Hospital in Shenzhen, were randomly assigned to the intervention or control groups. Patients in the intervention group (n = 117) received a four-session PEP in small groups over 1 month by trained nurses and doctors. The control group (n = 108) received the traditional lecture-style health education on DM. All the patients were followed up for 3 months. Outcomes included problem areas in diabetes (PAID) that measures diabetes-related emotional distress, patient enablement index (PEI), mental health, patient satisfaction respectively as well as lifestyle behaviors were assessed at baseline, post-activity and 3 months. Results At post-intervention and the 3-month follow-up, the PAID score improved significantly in the intervention group (12.7 ± 13.6, 5.8 ± 7.6) compared to the control group (22.7 ± 22.8, 11.7 ± 14.6). No difference was found between groups for changes to exercise, diet, and medication adherence. The PEI score improved significantly at the 3-month follow-up in the MI group (7.27 ± 2.45 vs 5.81 ± 2.97). Conclusion The PEP has a significant effect on improving diabetes-related distress, but MI was not significantly different from the traditional health education programs when it comes to the readiness to change. Trial registration NCT04120844, ClinicalTrials.Gov. Date of registration: October 9th 2019 (Retrospectively registered).
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Affiliation(s)
- Zhe Li
- Family Medicine Department, The University of Hong Kong - Shenzhen Hospital, 1, Haiyuan 1st Road, Futian District, Shenzhen, China
| | - Qingqi Chen
- Family Medicine Department, The University of Hong Kong - Shenzhen Hospital, 1, Haiyuan 1st Road, Futian District, Shenzhen, China
| | - Jingya Yan
- WHO Health Promoting Hospital Office, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Wei Liang
- Endocrinology Department, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - William C W Wong
- Family Medicine Department, The University of Hong Kong - Shenzhen Hospital, 1, Haiyuan 1st Road, Futian District, Shenzhen, China. .,Clinical Associate Professor, Department of Family Medicine and Primary Care, The University of Hong Kong, 1, Haiyuan 1st Road, Futian District, Shenzhen, China.
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Morone J. Systematic review of sociodemographic representation and cultural responsiveness in psychosocial and behavioral interventions with adolescents with type 1 diabetes. J Diabetes 2019; 11:582-592. [PMID: 30565425 DOI: 10.1111/1753-0407.12889] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/31/2018] [Accepted: 12/09/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The increasing incidence of type 1 diabetes (T1D) in youth aged less than 20 years in the USA is a mounting public health concern. Specific sociodemographic characteristics-racial/ethnic minority, low socioeconomic status (SES), single-parent home and underinsured-have been associated with increased risk for poor glycemic control and poor self-management in adolescents with T1D. METHODS Sample demographic and cultural responsiveness methods in psychosocial and behavioral interventions focused on improving self-management and glycemic control in adolescents with T1D were systematically evaluated, to identify if studies were targeting these high-risk groups. Keyword searches of PsychInfo, PubMed and CINAHL identified 259 studies published between 2006 and 2016, of adolescents (13-18 years old) with T1D; 28 studies met inclusion criteria. RESULTS Samples focused predominantly on White adolescents with fair glycemic control, from middle-high income, two-parent households with private insurance. The majority of studies scored poorly in cultural responsiveness and moderately in culturally responsive reporting. Studies lacked descriptions of culturally inclusive recruitment and sampling methods, and use of culturally responsive assessments for diverse groups. The majority of studies recruited and enrolled homogeneous adolescent samples from the lowest risk groups. CONCLUSION T1D intervention researchers must increase targeted recruitment and sampling methods to include more high-risk pediatric T1D groups, expand sociodemographic reporting, and increase the use of culturally responsive recruitment and sampling methods, such as those used in community-based participatory research. Such efforts have the potential to reduce T1D disparities by making interventions more relevant to the unique needs, goals and priorities of highest risk groups.
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Affiliation(s)
- Jennifer Morone
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
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15
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Stenberg U, Haaland-Øverby M, Koricho AT, Trollvik A, Kristoffersen LGR, Dybvig S, Vågan A. How can we support children, adolescents and young adults in managing chronic health challenges? A scoping review on the effects of patient education interventions. Health Expect 2019; 22:849-862. [PMID: 31131527 PMCID: PMC6803408 DOI: 10.1111/hex.12906] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/20/2019] [Accepted: 04/18/2019] [Indexed: 12/23/2022] Open
Abstract
Objectives This scoping review aims to give a comprehensive and systematic overview of published evaluations and the potential impact of patient education interventions for children, adolescents and young adults who are living with chronic illness and/or impairment loss. Methods Relevant literature published between 2008 and 2018 has been comprehensively reviewed, with attention paid to variations in study, intervention and patient characteristics. Arksey and O'Malley's framework for scoping studies guided the review process, and thematic analysis was undertaken to synthesize extracted data. Results Of the 7214 titles identified, 69 studies were included in this scoping review. Participant‐reported benefits of the interventions included less distress from symptoms, improved medical adherence and/or less use of medication, and improved knowledge. The majority of studies measuring physical activity and/or physiologic outcomes found beneficial effects. Interventions were also beneficial in terms of decreased use of urgent health care, hospitalization, visits to general practitioner and absence from school. By sharing experiences, participants had learned from each other and attained new insight on how they could manage illness‐related challenges. Discussion Study results corroborate previous research suggesting that different types of patient education interventions have a positive impact on children, adolescents and young adults, but research on this field is still in a starting phase. The results summed up in the current review supports the utility of patient education interventions that employ behavioural strategies tailored to the developmental needs of children, adolescents and young adults with different cultural backgrounds.
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Affiliation(s)
- Una Stenberg
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway
| | - Mette Haaland-Øverby
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway
| | | | - Anne Trollvik
- Institute of Nursing, Faculty of Public Health, Inland Norway University of Applied Sciences, Elverum, Norway
| | | | | | - André Vågan
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway
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Kahkoska AR, Lawson MT, Crandell J, Driscoll KA, Kichler JC, Seid M, Maahs DM, Kosorok MR, Mayer-Davis EJ. Assessment of a Precision Medicine Analysis of a Behavioral Counseling Strategy to Improve Adherence to Diabetes Self-management Among Youth: A Post Hoc Analysis of the FLEX Trial. JAMA Netw Open 2019; 2:e195137. [PMID: 31150087 PMCID: PMC6547107 DOI: 10.1001/jamanetworkopen.2019.5137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IMPORTANCE The Flexible Lifestyles Empowering Change (FLEX) trial, an 18-month randomized clinical trial testing an adaptive behavioral intervention in adolescents with type 1 diabetes, showed no overall treatment effect for its primary outcome, change in hemoglobin A1c (HbA1c) percentage of total hemoglobin, but demonstrated benefit for quality of life (QoL) as a prespecified secondary outcome. OBJECTIVE To apply a novel statistical method for post hoc analysis that derives an individualized treatment rule (ITR) to identify FLEX participants who may benefit from intervention based on changes in HbA1c percentage (primary outcome), QoL, and body mass index z score (BMIz) (secondary outcomes) during 18 months. DESIGN, SETTING, AND PARTICIPANTS This multisite clinical trial enrolled 258 adolescents aged 13 to 16 years with type 1 diabetes for 1 or more years, who had literacy in English, HbA1c percentage of total hemoglobin from 8.0% to 13.0%, a participating caregiver, and no other serious medical conditions. From January 5, 2014, to April 4, 2016, 258 adolescents were recruited. The post hoc analysis excluded adolescents missing outcome measures at 18 months (2 participants [0.8%]) or continuous glucose monitoring data at baseline (40 participants [15.5%]). Data were analyzed from April to December 2018. INTERVENTIONS The FLEX intervention included a behavioral counseling strategy that integrated motivational interviewing and problem-solving skills training to increase adherence to diabetes self-management. The control condition entailed usual diabetes care. MAIN OUTCOMES AND MEASURES Subgroups of FLEX participants were derived from an ITR estimating which participants would benefit from intervention, which would benefit from control conditions, and which would be indifferent. Multiple imputation by chained equations and reinforcement learning trees were used to estimate the ITR. Subgroups based on ITR pertaining to changes during 18 months in 3 univariate outcomes (ie, HbA1c percentage, QoL, and BMIz) and a composite outcome were compared by baseline demographic, clinical, and psychosocial characteristics. RESULTS Data from 216 adolescents in the FLEX trial were reanalyzed (166 [76.9%] non-Hispanic white; 108 teenaged girls [50.0%]; mean [SD] age, 14.9 [1.1] years; mean [SD] diabetes duration, 6.3 [3.7] years). For the univariate outcomes, a large proportion of FLEX participants had equivalent predicted outcomes under intervention vs usual care settings, regardless of randomization, and were assigned to the muted group (HbA1c: 105 participants [48.6%]; QoL: 63 participants [29.2%]; BMIz: 136 participants [63.0%]). Regarding the BMIz univariate outcome, mean baseline BMIz of participants assigned to the muted group was lower than that of those assigned to the intervention and control groups (muted vs intervention: mean difference, 0.48; 95% CI, 0.21 to 0.75; P = .002; muted vs control: mean difference, 0.86; 95% CI, 0.61 to 1.11; P < .001); this group also had a higher proportion of individuals with underweight or normal weight using weight status cutoffs (95 [69.9%] in muted group vs 24 [54.6%] in intervention group and 11 [30.6%] in control group; χ24 = 24.67; P < .001). The approach identified subgroups estimated to benefit based on HbA1c percentage (54 participants [25.0%]), QoL (89 participants [41.2%]), and BMIz (44 participants [20.4%]). Regarding the HbA1c percentage outcome, participants expected to benefit from the intervention did not have significantly higher baseline HbA1c percentages than those expected to benefit from usual care (9.4% vs 9.2%; difference, 0.2%; 95% CI, -0.16% to 0.56%; P = .44). However, participants in the muted group had higher mean HbA1c percentages at baseline than those assigned to the intervention or control groups (muted vs intervention: 9.9% vs 9.4%; difference, 0.5%; 95% CI, 0.13% to 0.89%; P = .02; muted vs control; 9.9% vs 9.2%; difference, 0.7%; 95% CI, 0.34% to 1.08%; P = .001). No significant differences were found between subgroups estimated to benefit in terms of the composite outcome from the FLEX intervention (91 participants [42.1%]) vs usual care (125 participants [57.9%]). CONCLUSIONS AND RELEVANCE The precision medicine approach represents a conceptually and analytically novel approach to post hoc subgroup identification. More work is needed to understand markers of positive response to the FLEX intervention. TRIAL REGISTRATION ClinicalTrial.gov identifier: NCT01286350.
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Affiliation(s)
- Anna R. Kahkoska
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill
| | - Michael T. Lawson
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill
| | - Jamie Crandell
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill
| | - Kimberly A. Driscoll
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora
| | - Jessica C. Kichler
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati Medical School, Cincinnati, Ohio
| | - Michael Seid
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati Medical School, Cincinnati, Ohio
| | - David M. Maahs
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
- Stanford Diabetes Research Center, Stanford University, Stanford, California
| | - Michael R. Kosorok
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill
- Department of Statistics and Operations Research, University of North Carolina at Chapel Hill, Chapel Hill
| | - Elizabeth J. Mayer-Davis
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill
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Dehghan-Nayeri N, Ghaffari F, Sadeghi T, Mozaffari N. Effects of Motivational Interviewing on Adherence to Treatment Regimens Among Patients With Type 1 Diabetes: A Systematic Review. Diabetes Spectr 2019; 32:112-117. [PMID: 31168281 PMCID: PMC6528390 DOI: 10.2337/ds18-0038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Motivational interviewing (MI) is a strategy for promoting adherence to treatment regimens among patients with diabetes. However, limited evidence exists regarding its effectiveness in reducing A1C. OBJECTIVE To identify and synthesize evidence about the effectiveness of patient, provider, and health system interventions to improve diabetes care among patients with type 1 diabetes. DESIGN This was a systematic review of randomized controlled trials. METHODS A search was conducted of the scientific databases MEDLINE, Elsevier, CINAHL, Google Scholar, ProQuest, Ovid, and PubMed without imposing any time limit. Only four documents met the inclusion criteria and were included in the final analysis. The methodological quality of these four articles was reviewed by three reviewers using the Jadad Scale. The main intervention and the primary outcome in this study were MI or motivational enhancement therapy and A1C, respectively. RESULTS The retrieved studies reported that MI promotes self-monitoring of blood glucose and reduces A1C. CONCLUSION MI is effective in enhancing patients' adherence to the treatment regimen and thereby decreasing A1C. Given the fact that the reviewed studies had not eliminated the effects of confounding factors, further studies are needed to assess the pure effects of MI on adherence to treatment regimens and A1C levels.
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Affiliation(s)
- Nahid Dehghan-Nayeri
- Tehran University of Medical Sciences School of Nursing and Midwifery, Nursing and Midwifery Care Research Center, Tehran, Iran
| | - Fatemeh Ghaffari
- Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Tahereh Sadeghi
- Evidence-Based Care Research Center, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Naser Mozaffari
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
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18
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Mayer-Davis EJ, Maahs DM, Seid M, Crandell J, Bishop FK, Driscoll KA, Hunter CM, Kichler JC, Standiford D, Thomas JM. Efficacy of the Flexible Lifestyles Empowering Change intervention on metabolic and psychosocial outcomes in adolescents with type 1 diabetes (FLEX): a randomised controlled trial. THE LANCET. CHILD & ADOLESCENT HEALTH 2018; 2:635-646. [PMID: 30119757 PMCID: PMC6260973 DOI: 10.1016/s2352-4642(18)30208-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/22/2018] [Accepted: 06/25/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Adolescents with type 1 diabetes commonly have poor glycaemic control. We aimed to test the efficacy of a newly developed adaptive behavioral intervention (Flexible Lifestyles Empowering Change; FLEX) on metabolic and psychosocial outcomes in adolescents with type 1 diabetes. METHODS Young people (13-16 years, type 1 diabetes duration >1 year, HbA1c of 64-119 mmol/mol [8·0-13·0%], and without other serious medical conditions or pregnancy) from two clinical sites (Colorado and Ohio, USA) were eligible for enrolment. One caregiver was required to participate actively in the study. Adolescent participants were randomly assigned to the FLEX intervention, which used motivational interviewing and problem-solving skills training to enhance patients' self-management, or usual care control. Intervention fidelity was assessed by a behavioral psychologist with specific expertise in motivational interviewing and who was not otherwise involved in the study via audiotaped sessions. The primary outcome was measurement of glycated haemoglobin A1c (HbA1c) at 18 months. Secondary outcomes included motivation and intention, problem solving skills, self-management behaviors, symptoms of depression, health related quality of life, fear of hypoglycemia, diabetes family conflict, risk factors for T1D complications (BMI, blood pressure, and plasma lipids), and hypoglycemia derived from continuous glucose monitoring (percent time below 3·0 and 3·9 mmol/l [54 and 70 mg/dl]). Intention-to-treat analyses used mixed effects models, with fixed effects including site, timepoint, intervention group, intervention by timepoint, and baseline level of primary (HbA1c) or secondary outcomes (α=0·05). FLEX is registered on clinicaltrials.gov, number NCT01286350. FINDINGS Young people recruited from May 1, 2014 to April 4, 2016 were randomly assigned to FLEX (n=130) or usual care control (n=128). Mean diabetes duration was 6·4 (SD 3·8) years, and 71% (181 out of 256) of patients used insulin pump therapy. Retention was 93%, with 241 out of 258 completing the 18-month assessment. The intervention fidelity score was 4·40 of 5·00 for motivational interviewing and 97% for session content. At 18 months, HbA1c was not significantly different between intervention (83 [13] mmol/mol at baseline; 84 [19] mmol/mol at follow-up); and control (80 [14] mmol/mol at baseline; 82 [17] mmol/mol at follow-up); change in intervention versus control was -0·7 mmol/mol (95% CI -4·7 to 3·4, p=0·75). The intervention was associated with improved scores for motivation (p=0·011), problem solving (p=0·024), diabetes self-management profile (p=0·013), youth report of overall quality of life (p=0·0089), selected domains related to fear of hypoglycaemia (p=0·036 for youth's helplessness or worry; p=0·0051 for parent's efforts to maintain high blood glucose), parent report of diabetes family conflict (p=0·0001), total cholesterol (p=0·038), and diastolic blood pressure (p=0·015). A total of 54 serious adverse events were identified; 34 of these were diabetes-related, including low blood glucose requiring assistance (n=3) and high blood glucose with diabetic ketoacidosis and emergency response (n=25). INTERPRETATION The FLEX intervention did not significantly change HbA1c among these adolescents with elevated HbA1c, but did positively affect several psychosocial outcomes over 18 months. Further analyses will provide information regarding drivers of positive response to the intervention and will point to future directions for improvement in the approach. FUNDING National Institutes of Health and National Institute of Diabetes Digestive Diseases and Kidney and the Helmsley Charitable Trust.
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Affiliation(s)
- Elizabeth J Mayer-Davis
- Departments of Nutrition and Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - David M Maahs
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA, USA
| | - Michael Seid
- Cincinnati Children's Hospital Medical Center, University of Cincinnati Medical School, Cincinnati, OH, USA
| | - Jamie Crandell
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Franziska K Bishop
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Denver, CO, USA
| | - Kimberly A Driscoll
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Denver, CO, USA
| | - Christine M Hunter
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Jessica C Kichler
- Cincinnati Children's Hospital Medical Center, University of Cincinnati Medical School, Cincinnati, OH, USA
| | - Debra Standiford
- Cincinnati Children's Hospital Medical Center, University of Cincinnati Medical School, Cincinnati, OH, USA
| | - Joan M Thomas
- Departments of Nutrition and Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Cameron FJ, Russell E, McCombe J, O'Connell MA, Skinner T. The clinician factor: Personality characteristics of clinicians and their impact upon clinical outcomes in the management of children and adolescents with type 1 diabetes. Pediatr Diabetes 2018; 19:832-839. [PMID: 29573084 DOI: 10.1111/pedi.12646] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 11/20/2017] [Accepted: 01/04/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The purpose of this study was to estimate clinician qualities that influence metabolic outcomes in youth with type 1 diabetes. RESEARCH DESIGN AND METHODS Data were gathered over two 3 month periods in a large tertiary diabetes center (1500 patients, 8 clinicians) from patients with type 1 diabetes who received continuous care from each clinician. Data included sex, age, diabetes duration, insulin regimen, body mass index (BMI), insulin dose and episodes of severe hypoglycemia. Clinician data included target blood glucose levels, target glycated hemoglobin (HbA1c), Diabetes Attitude Scale and Big 5 Personality Inventory Scale. Mean HbA1c per clinician was the primary outcome variable. RESULTS The 8 clinicians saw a total of 464 patients during the first time period, and 603 in the second time period. Lowest to highest mean HbA1c per clinician varied by 0.7%. There were small but statistically significant differences between clinicians with their patients' age at diagnosis, duration of diabetes, age, gender, treatment type and BMI SD score. After controlling for these differences, the clinician characteristics that were associated with lower mean HbA1c were having no lower limit in target HbA1c and being self-reportedly "less agreeable." The impact of these clinician attitudinal traits was equivalent to the combined effects of patient characteristics and treatment type. CONCLUSIONS There was a significant variation in metabolic outcomes between treating clinicians. After controlling for patient clinical differences, clinician mean HbA1c was associated with lower limit in target HbA1c and being "less agreeable." Clinicians who were more demanding and dogmatic appeared to have better outcomes.
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Affiliation(s)
- Fergus J Cameron
- Diabetes research Group, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Australia
| | - Ellyn Russell
- Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Australia
| | - Julia McCombe
- Diabetes research Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Michele A O'Connell
- Diabetes research Group, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Australia
| | - Timothy Skinner
- Psychological and Clinical Science School, Charles Darwin University, Darwin, Australia
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20
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Psychoeducational interventions to improve adolescents’ medical management of diabetes: A comprehensive review. HEALTH PSYCHOLOGY REPORT 2018. [DOI: 10.5114/hpr.2018.70357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Stefanowicz A, Mysliwiec M, Adamkiewicz-Drozynska E. Parental knowledge and metabolic control of children and young adults with type 1 diabetes. Arch Med Sci 2018; 14:52-59. [PMID: 29379532 PMCID: PMC5778408 DOI: 10.5114/aoms.2015.53832] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 07/20/2015] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The authors aimed to answer the following questions: 1) What level of knowledge of type 1 diabetes do the parents of children and young adults with this disease have? 2) Will this level of knowledge increase after 1 year of observation? 3) Does improving the knowledge of young adults and their parents result in better metabolic control of the patients? MATERIAL AND METHODS This study included 227 patients between the ages of 5 and 20 years with type 1 diabetes. The research was conducted from March 2009 to June 2011. The following two time points were examined: the beginning of the study (test 1a) and one year later (test 1b). The knowledge levels of the patients and parents were obtained using a survey and a knowledge test. RESULTS Comparison of the results from the two study time points showed that the respondents had a significantly higher level of knowledge after 1 year (p = 0.001). The comparison of glycated hemoglobin levels between the two time points in patients with type 1 diabetes revealed that the levels were significantly higher at test 1b compared to test 1a (p = 0.0005). CONCLUSIONS The parents of children and young adults with type 1 diabetes demonstrate a satisfactory level of theoretical knowledge of therapeutic conduct and self-monitoring principles. The test 1b results demonstrated a higher level of theoretical knowledge in all respondents and poorer metabolic control. Poorer metabolic control in some patients suggests that metabolic control in type 1 diabetes depends on factors other than education. Further research is necessary to determine these additional factors.
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Affiliation(s)
- Anna Stefanowicz
- Advanced Registered Nurse Practitioner, Department of General Nursing, Chair of Nursing, Faculty of Health Sciences with Subfaculty of Nursing and Institute of Maritime and Tropical Medicine, Medical University of Gdansk, Gdansk, Poland
- Chair and Clinics of Pediatrics, Diabetology and Endocrinology, Medical University of Gdansk, Gdansk, Poland
| | - Malgorzata Mysliwiec
- Chair and Clinics of Pediatrics, Diabetology and Endocrinology, Medical University of Gdansk, Gdansk, Poland
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Schaefer MR, Kavookjian J. The impact of motivational interviewing on adherence and symptom severity in adolescents and young adults with chronic illness: A systematic review. PATIENT EDUCATION AND COUNSELING 2017; 100:2190-2199. [PMID: 28619271 DOI: 10.1016/j.pec.2017.05.037] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 05/29/2017] [Accepted: 05/31/2017] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Given the negative consequences associated with non-adherence in adolescents and young adults (AYAs) with chronic illness, it is important to identify interventions to address this issue. Therefore, this review's primary objective is to evaluate the impact of motivational interviewing (MI) on adherence and symptom level/severity in AYAs with chronic illness using a modified Cochrane method. METHOD Four databases (e.g., CINAHL, Medline, PsychINFO, and International Pharmaceutical Abstracts) were systematically reviewed. 121 articles were identified in the initial search. Article eligibility was assessed on two tiers using the inclusion criteria. RESULTS Twelve articles were retained for data extraction. Diabetes, asthma, and HIV were the most common chronic illness populations examined in the study. Eleven of the twelve articles provided support for either improved adherence, symptom reduction, or a combination of both after participants received MI. Quality of life was also enhanced in three studies. CONCLUSION Because adherence and symptom levels were positively impacted, it appears that MI may be a promising intervention for AYAs with chronic illness in addressing non-adherence and potentially improving quality of life. PRACTICE IMPLICATIONS Healthcare providers should consider implementing MI in their practice to establish rapport and potentially improve long-term health outcomes for AYAs with chronic illness.
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Affiliation(s)
- Megan R Schaefer
- Auburn University, Department of Psychology, Auburn, AL, United States.
| | - Jan Kavookjian
- Auburn University, Department of Health Outcomes and Research Policy, Auburn, AL, United States
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Thepwongsa I, Muthukumar R, Kessomboon P. Motivational interviewing by general practitioners for Type 2 diabetes patients: a systematic review. Fam Pract 2017; 34:376-383. [PMID: 28486622 DOI: 10.1093/fampra/cmx045] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Motivational interviewing (MI) is an effective tool to help clinicians with facilitating behavioural changes in many diseases and conditions. However, different forms of MI are required in different health care settings and for different clinicians. Although general practitioners (GPs) play a major role in Type 2 diabetes management, the effects of MI delivered by GPs intended to change the behaviours of their Type 2 diabetes patients and GP outcomes, defined as GP knowledge, satisfaction and practice behaviours, have not been systematically reviewed. METHODS An electronic search was conducted through Cochrane Library, Scopus, ProQuest, Wiley Online Library, Ovid MEDLINE, PubMed, CINAHL, MEDLINE Complete and Google Scholar from the earliest date of each database to 2017. Reference lists from each article obtained were reviewed. Measured changes in GP satisfaction, knowledge, and practice behaviours, and patient outcomes were recorded. RESULTS Eight out of 1882 studies met the criteria for inclusion. Six studies examined the effects of MI on Type 2 diabetes patient outcomes, only one of which examined its effects on GP outcomes. Two-thirds of the studies (4/6) found a significant improvement in at least one of the following patient outcomes: total cholesterol, low-density lipoproteins, fasting blood glucose, HbA1c, body mass index, blood pressure, waist circumference and physical activity. The effects of MI on GP outcomes yielded mixed results. CONCLUSIONS Few studies have examined evidence for the effectiveness of MI delivered by GPs to Type 2 diabetes patients. Evidence to support the effectiveness of MI on GP and patient outcomes is weak. Further quality studies are needed to examine the effects of MI on GP and patient outcomes.
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Affiliation(s)
- Isaraporn Thepwongsa
- Department of Community Medicine, Faculty of Medicine, Khon Kaen University, Thailand
| | | | - Pattapong Kessomboon
- Department of Community Medicine, Faculty of Medicine, Khon Kaen University, Thailand
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Reflections on Incorporating a Behavioral Intervention into a Busy Pediatric Subspecialty Clinic. J Pediatr Health Care 2017; 31:404-408. [PMID: 27692505 DOI: 10.1016/j.pedhc.2016.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 08/30/2016] [Accepted: 08/30/2016] [Indexed: 11/22/2022]
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Colson S, Côté J, Gentile S, Hamel V, Sapuppo C, Ramirez-Garcia P, Reynaud R, Lagouanelle-Simeoni MC. An Integrative Review of the Quality and Outcomes of Diabetes Education Programs for Children and Adolescents. DIABETES EDUCATOR 2016; 42:549-84. [DOI: 10.1177/0145721716658976] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose The purpose of this study was twofold: (1) to describe the content of recent diabetes education programs and their outcomes in terms of glycemic control, disease management, and psychosocial criteria for children and adolescents with type 1 diabetes and (2) to gauge the match between these programs and the recommendations of the International Society for Pediatric and Adolescent Diabetes (ISPAD). Methods The integrative review was carried out according to the Cochrane recommendations. Thirteen databases were searched for evaluations of education programs published from 2009 to 2014. Program characteristics and outcomes were described. Quality of studies was assessed, and program match with ISPAD recommendations was gauged. Results Of 2528 studies found, 43 covering 36 education programs intended for youth with type 1 diabetes were retained for review. Nine of these centered on self-care competencies, 18 on psychosocial competencies, and 9 on both types of competency (mixed program). Programs varied widely in terms of organization, procedure, and content. Glycemic control was an indicator assessed in the majority of programs, but only half of these (for the most part, self-care programs) reported positive findings in this regard. Few programs seemed to affect psychosocial indicators. An online mixed program, which was the program that best met the ISPAD recommendations, proved to have an influence on glycemic control and several psychosocial criteria. Conclusions Various avenues can be considered to improve participant engagement in education programs and to align these programs more closely with international recommendations. Further research is required to enhance knowledge in this field.
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Affiliation(s)
- Sébastien Colson
- Aix Marseille Université, Faculté de Médecine, EA3279-SPMC, Marseille, France (Mr Colson, Prof Gentile)
- Assistance Publique-Hôpitaux de Marseille (APHM)–Coordination Générale des Soins, Marseille, France (Mr Colson)
- Université de Montréal–Faculté de Sciences Infirmières, Research Chair in Innovative Nursing Practices, Montréal, Canada (Mr Colson, Prof Côté, Ms Ramirez-Garcia)
- Research Centre of the Centre Hospitalier de l’Université de Montréal, Research Chair in Innovative Nursing Practices, Montréal, Canada (Prof Côté)
- APHM, Service d’Evaluation Médicale, Marseille, France (Prof Gentile, Dr Lagouanelle-Simeoni)
| | - José Côté
- Aix Marseille Université, Faculté de Médecine, EA3279-SPMC, Marseille, France (Mr Colson, Prof Gentile)
- Assistance Publique-Hôpitaux de Marseille (APHM)–Coordination Générale des Soins, Marseille, France (Mr Colson)
- Université de Montréal–Faculté de Sciences Infirmières, Research Chair in Innovative Nursing Practices, Montréal, Canada (Mr Colson, Prof Côté, Ms Ramirez-Garcia)
- Research Centre of the Centre Hospitalier de l’Université de Montréal, Research Chair in Innovative Nursing Practices, Montréal, Canada (Prof Côté)
- APHM, Service d’Evaluation Médicale, Marseille, France (Prof Gentile, Dr Lagouanelle-Simeoni)
| | - Stéphanie Gentile
- Aix Marseille Université, Faculté de Médecine, EA3279-SPMC, Marseille, France (Mr Colson, Prof Gentile)
- Assistance Publique-Hôpitaux de Marseille (APHM)–Coordination Générale des Soins, Marseille, France (Mr Colson)
- Université de Montréal–Faculté de Sciences Infirmières, Research Chair in Innovative Nursing Practices, Montréal, Canada (Mr Colson, Prof Côté, Ms Ramirez-Garcia)
- Research Centre of the Centre Hospitalier de l’Université de Montréal, Research Chair in Innovative Nursing Practices, Montréal, Canada (Prof Côté)
- APHM, Service d’Evaluation Médicale, Marseille, France (Prof Gentile, Dr Lagouanelle-Simeoni)
| | - Valérie Hamel
- Aix Marseille Université, Faculté de Médecine, EA3279-SPMC, Marseille, France (Mr Colson, Prof Gentile)
- Assistance Publique-Hôpitaux de Marseille (APHM)–Coordination Générale des Soins, Marseille, France (Mr Colson)
- Université de Montréal–Faculté de Sciences Infirmières, Research Chair in Innovative Nursing Practices, Montréal, Canada (Mr Colson, Prof Côté, Ms Ramirez-Garcia)
- Research Centre of the Centre Hospitalier de l’Université de Montréal, Research Chair in Innovative Nursing Practices, Montréal, Canada (Prof Côté)
- APHM, Service d’Evaluation Médicale, Marseille, France (Prof Gentile, Dr Lagouanelle-Simeoni)
| | - Cédric Sapuppo
- Aix Marseille Université, Faculté de Médecine, EA3279-SPMC, Marseille, France (Mr Colson, Prof Gentile)
- Assistance Publique-Hôpitaux de Marseille (APHM)–Coordination Générale des Soins, Marseille, France (Mr Colson)
- Université de Montréal–Faculté de Sciences Infirmières, Research Chair in Innovative Nursing Practices, Montréal, Canada (Mr Colson, Prof Côté, Ms Ramirez-Garcia)
- Research Centre of the Centre Hospitalier de l’Université de Montréal, Research Chair in Innovative Nursing Practices, Montréal, Canada (Prof Côté)
- APHM, Service d’Evaluation Médicale, Marseille, France (Prof Gentile, Dr Lagouanelle-Simeoni)
| | - Pilar Ramirez-Garcia
- Aix Marseille Université, Faculté de Médecine, EA3279-SPMC, Marseille, France (Mr Colson, Prof Gentile)
- Assistance Publique-Hôpitaux de Marseille (APHM)–Coordination Générale des Soins, Marseille, France (Mr Colson)
- Université de Montréal–Faculté de Sciences Infirmières, Research Chair in Innovative Nursing Practices, Montréal, Canada (Mr Colson, Prof Côté, Ms Ramirez-Garcia)
- Research Centre of the Centre Hospitalier de l’Université de Montréal, Research Chair in Innovative Nursing Practices, Montréal, Canada (Prof Côté)
- APHM, Service d’Evaluation Médicale, Marseille, France (Prof Gentile, Dr Lagouanelle-Simeoni)
| | - Rachel Reynaud
- Aix Marseille Université, Faculté de Médecine, EA3279-SPMC, Marseille, France (Mr Colson, Prof Gentile)
- Assistance Publique-Hôpitaux de Marseille (APHM)–Coordination Générale des Soins, Marseille, France (Mr Colson)
- Université de Montréal–Faculté de Sciences Infirmières, Research Chair in Innovative Nursing Practices, Montréal, Canada (Mr Colson, Prof Côté, Ms Ramirez-Garcia)
- Research Centre of the Centre Hospitalier de l’Université de Montréal, Research Chair in Innovative Nursing Practices, Montréal, Canada (Prof Côté)
- APHM, Service d’Evaluation Médicale, Marseille, France (Prof Gentile, Dr Lagouanelle-Simeoni)
| | - Marie-Claude Lagouanelle-Simeoni
- Aix Marseille Université, Faculté de Médecine, EA3279-SPMC, Marseille, France (Mr Colson, Prof Gentile)
- Assistance Publique-Hôpitaux de Marseille (APHM)–Coordination Générale des Soins, Marseille, France (Mr Colson)
- Université de Montréal–Faculté de Sciences Infirmières, Research Chair in Innovative Nursing Practices, Montréal, Canada (Mr Colson, Prof Côté, Ms Ramirez-Garcia)
- Research Centre of the Centre Hospitalier de l’Université de Montréal, Research Chair in Innovative Nursing Practices, Montréal, Canada (Prof Côté)
- APHM, Service d’Evaluation Médicale, Marseille, France (Prof Gentile, Dr Lagouanelle-Simeoni)
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Abualula NA, Jacobsen KH, Milligan RA, Rodan MF, Conn VS. Evaluating Diabetes Educational Interventions With a Skill Development Component in Adolescents With Type 1 Diabetes: A Systematic Review Focusing on Quality of Life. DIABETES EDUCATOR 2016; 42:515-28. [PMID: 27402637 DOI: 10.1177/0145721716658356] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE Adolescents with type 1 diabetes mellitus (T1DM) may have reduced quality of life (QOL) when compared with their peers. This systematic review evaluated the effectiveness of diabetes self-management education (DSME) interventions with a skills development component on the QOL of adolescents with T1DM. METHODS Six databases were systematically searched for studies on the QOL outcomes of DSME interventions for adolescents with T1DM. Fourteen studies published between 1994 and 2014 met the inclusion criteria. RESULTS Of the 14 studies, only 4 had significant QOL outcomes for the intervention participants. Successful DSME interventions had indirect behavioral skills foci or a combination of indirect and direct behavioral skills foci and a duration ≥2 months. CONCLUSION This review provides evidence that educational interventions with an indirect behavioral skills development that facilitates diabetes management may improve QOL among adolescents with T1DM. Structured interventions targeting adolescents' QOL are needed to determine which are most effective in improving QOL. Adolescents with T1DM should be routinely screened and monitored for low QOL and referred to QOL-improving interventions.
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Affiliation(s)
- Nada A Abualula
- College of Health and Human Services, George Mason University, Fairfax, Virginia, USA (Ms Abualula, Dr Milligan, Dr Jacobsen, Dr Rodan),College of Nursing, Taibah University, Madina, Saudi Arabia (Ms Abualula)
| | - Kathryn H Jacobsen
- College of Health and Human Services, George Mason University, Fairfax, Virginia, USA (Ms Abualula, Dr Milligan, Dr Jacobsen, Dr Rodan)
| | - Renee A Milligan
- College of Health and Human Services, George Mason University, Fairfax, Virginia, USA (Ms Abualula, Dr Milligan, Dr Jacobsen, Dr Rodan)
| | - Margaret F Rodan
- College of Health and Human Services, George Mason University, Fairfax, Virginia, USA (Ms Abualula, Dr Milligan, Dr Jacobsen, Dr Rodan)
| | - Vicki S Conn
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri, USA (Dr Conn)
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Carcone AI, Jacques-Tiura AJ, Hartlieb KEB, Albrecht T, Martin T. Effective Patient-Provider Communication in Pediatric Obesity. Pediatr Clin North Am 2016; 63:525-38. [PMID: 27261548 PMCID: PMC4893931 DOI: 10.1016/j.pcl.2016.02.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Effective patient-provider communication is not a primary focus of medical school curricula. Motivational interviewing (MI) is a patient-centered, directive communication framework appropriate for in health care. Research on MI's causal mechanisms has established patient change talk as a mediator of behavior change. Current MI research focuses on identifying which provider communication skills are responsible for evoking change talk. MI recommends informing, asking, and listening. Research provides evidence that asking for and reflecting patient change talk are effective communication strategies, but cautions providers to inform judiciously. Supporting a patient's decision making autonomy is an important strategy to promote health behaviors.
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Affiliation(s)
- April Idalski Carcone
- Department of Family Medicine and Public Health, Wayne State University School of Medicine, 6135 Woodward, iBio #1120, Detroit, MI 48202, 313-577-1057 (phone), 313-972-8024 (fax),
| | - Angela J. Jacques-Tiura
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, 6135 Woodward, iBio #2120, Detroit, MI 48202, 313-577-6584 (phone), 313-972-8024 (fax),
| | - Kathryn E. Brogan Hartlieb
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health & Social Work, Florida International University, 11200 SW 8th Street, AHC5 323, Miami, Florida, USA, 305-348-3252 (phone), 305-348-7782 (fax),
| | - Terrance Albrecht
- Department of Oncology, Wayne State University-Karmanos Cancer Institute,, 4100 John R, Mailcode MM03CB, Detroit, MI 48201; 576-8262 (phone),
| | - Tim Martin
- Department of Psychology, Kennesaw State University, Social Sciences (SO 402), Room 4011A, Kennesaw, Georgia, USA, 470-578-2903 (phone), 470-578-9146 (fax),
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Datye KA, Moore DJ, Russell WE, Jaser SS. A review of adolescent adherence in type 1 diabetes and the untapped potential of diabetes providers to improve outcomes. Curr Diab Rep 2015; 15:51. [PMID: 26084580 PMCID: PMC4692366 DOI: 10.1007/s11892-015-0621-6] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Only 21 % of adolescents with type 1 diabetes (T1D) meet glycemic goals set forth by the American Diabetes Association. Adherence to therapy is a particular concern in this population, and the association between poor adherence and worsening glycemic control indicates that there is a critical need to improve adherence to therapy in adolescents with T1D. In this article, we review barriers to adherence in adolescents with T1D and discuss interventions aimed at improving adherence to therapy and glycemic control. Interventions include technology-based applications, family-based therapies, motivational interviewing, and others. Notably, less than 10 % of the interventions reviewed are provider-led, clinic-based interventions, and few have focused on regimen-related aspects of adherence. This article also outlines the importance of provider communication and the role of providers in facilitating adherence behaviors in adolescents with T1D. Finally, we suggest future directions of research to improve adherence to therapy in adolescents with T1D.
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Affiliation(s)
- Karishma A. Datye
- Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Daniel J. Moore
- Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - William E. Russell
- Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Sarah S. Jaser
- Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Vanderbilt University Medical Center, Nashville, TN 37232, USA
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Powell PW, Corathers SD, Raymond J, Streisand R. New approaches to providing individualized diabetes care in the 21st century. Curr Diabetes Rev 2015; 11:222-30. [PMID: 25901504 PMCID: PMC4864491 DOI: 10.2174/1573399811666150421110316] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 03/22/2015] [Accepted: 03/23/2015] [Indexed: 01/06/2023]
Abstract
Building from a foundation of rapid innovation, the 21(st) century is poised to offer considerable new approaches to providing modern diabetes care. The focus of this paper is the evolving role of diabetes care providers collaboratively working with patients and families toward the goals of achieving optimal clinical and psychosocial outcomes for individuals living with diabetes. Advances in monitoring, treatment and technology have been complemented by trends toward patient-centered care with expertise from multiple health care disciplines. The evolving clinical care delivery system extends far beyond adjustment of insulin regimens. Effective integration of patient-centered strategies, such as shared-decision making, motivational interviewing techniques, shared medical appointments, and multidisciplinary team collaboration, into a dynamic model of diabetes care delivery holds promise in reaching glycemic targets and improving patients' quality of life.
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Affiliation(s)
- Priscilla W Powell
- Children`s Hospital of Richmond at VCU, Brook Road Campus, 2924 Brook Road, Richmond, VA 23220-1298, USA.
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Ayling K, Brierley S, Johnson B, Heller S, Eiser C. Efficacy of theory-based interventions for young people with type 1 diabetes: A systematic review and meta-analysis. Br J Health Psychol 2014; 20:428-46. [DOI: 10.1111/bjhp.12131] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 12/10/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Kieran Ayling
- Department of Psychology; University of Sheffield; UK
- Division of Primary Care; School of Medicine; University of Nottingham; UK
- NIHR CLAHRC for South Yorkshire; Sheffield UK
| | - Samantha Brierley
- Department of Psychology; University of Sheffield; UK
- NIHR CLAHRC for South Yorkshire; Sheffield UK
| | - Barbara Johnson
- Department of Psychology; University of Sheffield; UK
- NIHR CLAHRC for South Yorkshire; Sheffield UK
| | - Simon Heller
- NIHR CLAHRC for South Yorkshire; Sheffield UK
- Academic Unit of Diabetes, Endocrinology & Metabolism; Medical School; University of Sheffield; UK
| | - Christine Eiser
- Department of Psychology; University of Sheffield; UK
- NIHR CLAHRC for South Yorkshire; Sheffield UK
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Abstract
Suboptimal regimen adherence among youth with type 1 diabetes (T1D) is a common challenge for patients, families, and providers. Motivational interviewing (MI) is a brief communication style designed to elicit intrinsic motivation and strengthen commitment to behavior change goals. As pediatric MI research expands, a critical review of its evidence base and applicability to promote adherence behaviors for youth with T1D is needed. This review introduces the core tenets of MI and clinical applications in T1D, synthesizes the existing MI research in T1D, and discusses the next steps in MI research. Overall, mixed results for MI interventions in T1D reflect variations in research study design and clinical implementation. Targeting adherence rather than glycemic outcomes typically demonstrates greater results, highlighting the promise of MI to facilitate meaningful and enduring improvements in youths' T1D adherence behaviors.
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Affiliation(s)
- Priscilla W. Powell
- Baylor College of Medicine, Texas Children’s Hospital, 1102 Bates St. Suite 940.37, Houston, TX 77030, USA
| | - Marisa E. Hilliard
- Baylor College of Medicine, Texas Children’s Hospital, 1102 Bates St. Suite 940.35A, Houston, TX 77030, USA
| | - Barbara J. Anderson
- Baylor College of Medicine, Texas Children’s Hospital, 1102 Bates St. Suite 940.36, Houston, TX 77030, USA
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Jones A, Gladstone BP, Lübeck M, Lindekilde N, Upton D, Vach W. Motivational interventions in the management of HbA1c levels: a systematic review and meta-analysis. Prim Care Diabetes 2014; 8:91-100. [PMID: 24525286 DOI: 10.1016/j.pcd.2014.01.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 01/15/2014] [Accepted: 01/18/2014] [Indexed: 11/28/2022]
Abstract
AIMS To review the diabetes literature in order to examine the effect of motivational interventions on treatment outcome as measured by changes in glycated haemoglobin. METHODS Relevant databases were systematically searched for randomised controlled trials in which motivational interventions were examined in relation to treatment outcome in people with type 1 and type 2 diabetes mellitus. RESULTS The 13 studies identified for review included 1223 participants diagnosed with type 1 diabetes and 1895 participants diagnosed with type 2 diabetes. The analysis showed a 0.17% (95% CI: -0.09, 0.43%) improvement in glycemic control in people who received a motivational intervention compared to a control group, however, the effect was not statistically significant. CONCLUSIONS The impact of motivational interventions in the management of blood glucose levels appears to be limited. However, due to the small number of studies and issues of heterogeneity caution in interpreting the present findings is advised. Moreover, the unique contribution of motivational interventions may be better assessed by outcomes such as behaviour change and other intermediate outcomes. Further research examining the delivery and focus of motivational interventions in helping people manage their diabetes is recommended. The clinical implications of the present findings are therefore uncertain pending further research.
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MESH Headings
- Biomarkers/blood
- Blood Glucose/metabolism
- Diabetes Mellitus, Type 1/blood
- Diabetes Mellitus, Type 1/diagnosis
- Diabetes Mellitus, Type 1/psychology
- Diabetes Mellitus, Type 1/therapy
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/diagnosis
- Diabetes Mellitus, Type 2/psychology
- Diabetes Mellitus, Type 2/therapy
- Glycated Hemoglobin/metabolism
- Health Behavior
- Health Knowledge, Attitudes, Practice
- Humans
- Motivation
- Motivational Interviewing
- Patients/psychology
- Treatment Outcome
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Affiliation(s)
- Allan Jones
- Institute of Psychology, University of Southern Denmark, Denmark.
| | - Beryl Primrose Gladstone
- Institute of Medical Biometry and Medical Informatics, University Medical Center Freiburg, Germany
| | - Marlene Lübeck
- Institute of Psychology, University of Southern Denmark, Denmark
| | - Nanna Lindekilde
- Institute of Psychology, University of Southern Denmark, Denmark
| | - Dominic Upton
- Institute of Health and Society, University of Worcester, UK
| | - Werner Vach
- Institute of Medical Biometry and Medical Informatics, University Medical Center Freiburg, Germany
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Holmes CS, Chen R, Mackey E, Grey M, Streisand R. Randomized clinical trial of clinic-integrated, low-intensity treatment to prevent deterioration of disease care in adolescents with type 1 diabetes. Diabetes Care 2014; 37:1535-43. [PMID: 24623027 PMCID: PMC4030089 DOI: 10.2337/dc13-1053] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the efficacy of two office-based treatments designed to prevent deterioration in glycemic control in young adolescents with type 1 diabetes in a randomized clinical trial. An individualized, more intensive family teamwork Coping skills program was compared with a diabetes Education treatment. RESEARCH DESIGN AND METHODS A baseline assessment was followed by four brief treatment sessions and immediate posttesting over the course of 1.5 years. Families of 226 early adolescents (ages 11-14) were randomized to receive either individualized coping skills education or diabetes education as adjunctive treatment to quarterly medical appointments. Continued follow-up occurred at 3.5-month intervals for a long-term follow-up of up to 3 years. A post hoc Usual Care group facilitated comparisons of glycemic control. RESULTS Growth curve analysis showed that both treatment groups successfully prevented deterioration in adolescent disease care and simultaneously improved adolescent and parent quality of life that included indicators of more effective communication and reduced adherence barriers-without a concomitant increase in diabetes-related or general family conflict. However, contrary to expectation, the Education group was more efficacious than the Coping group in improvement of disease adherence and glycemic control over a 3-year follow-up. CONCLUSIONS Low-intensity office-based quarterly treatment can maintain or improve disease care adherence in early adolescence when provided to adolescent/parent dyads. Better outcomes are achieved when treatment goals and techniques match the needs of the targeted population.
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Affiliation(s)
- Clarissa S Holmes
- Department of Psychology, Pediatrics and Psychiatry, Virginia Commonwealth University, Richmond, VACenter for New Designs in Leadership and Scholarship, Georgetown University, Washington, DC
| | - Rusan Chen
- Center for New Designs in Leadership and Scholarship, Georgetown University, Washington, DC
| | - Eleanor Mackey
- Center for Translational Science, Children's National Health System, Washington, DC
| | - Margaret Grey
- Yale School of Nursing, Yale University, New Haven, CT
| | - Randi Streisand
- Center for Translational Science, Children's National Health System, Washington, DC
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Ridge K, Thomas S, Jackson P, Pender S, Heller S, Treasure J, Ismail K. Diabetes-oriented learning family intervention (DOLFIN): a feasibility study evaluating an intervention for carers of young persons with Type 1 diabetes. Diabet Med 2014; 31:55-60. [PMID: 24117683 DOI: 10.1111/dme.12333] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 08/10/2013] [Accepted: 09/19/2013] [Indexed: 11/30/2022]
Abstract
AIMS To describe the development of an intervention for parents and carers of young people with Type 1 diabetes and assess the feasibility, acceptability and emerging clinical themes. METHODS Participants were carers of young persons aged 10-18 years with a diagnosis of Type 1 diabetes of more than 12 months' duration in two inner-city South London hospitals. Carers were invited to attend six sessions of a group workshop where they received emotional support, diabetes education and were taught motivational interviewing techniques to support their child. RESULTS Out of 106 eligible participants, carers of 31 young people with Type 1 diabetes were recruited, 17 of whom 'completed' the intervention (attending four or more sessions). Participants discussed a variety of themes in session, including the increasing difficulty of diabetes management as children grow older, parenting techniques for managing diabetes in the home and the emotional challenges of having a child with a chronic illness. CONCLUSIONS Engaging parents in a carer intervention for Type 1 diabetes was a challenge, but parents who participated appeared to value the programme. Future interventions for carers need to take account of carers' wishes and expectations in order to maximize user uptake.
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Affiliation(s)
- K Ridge
- Department of Psychological Medicine, Institute of Psychiatry, Kings College, London
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Palladino DK, Helgeson VS. Adolescents, parents and physicians: a comparison of perspectives on type 1 diabetes self-care. Can J Diabetes 2013; 37:175-81. [PMID: 24070840 DOI: 10.1016/j.jcjd.2013.02.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 10/18/2012] [Accepted: 02/20/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE No research to date has compared the beliefs of adolescents, parents and physicians with respect to type 1 diabetes mellitus self-care perceptions and barriers. This study examined how adolescents with type 1 diabetes, their parents and physicians perceive 4 key diabetes self-care behaviours (testing blood glucose, taking insulin, exercise and diet) and what influences those behaviours. METHOD Forty-eight adolescent/parent dyads and 21 pediatric endocrinologists rated importance, difficulty and proficiency for 4 self-care behaviours, and provided up to 5 perceived influences on these behaviours. We compared adolescents to parents and families to physicians. RESULTS Groups rated all self-care behaviours as important, with taking insulin as most important. Families rated behaviours as relatively easy compared to physicians. All groups agreed that diet was both the most difficult self-care behaviour and the behaviour at which adolescents were least proficient. Although families rated teens as proficient overall, physicians disagreed. Adolescent and parent perception of diet difficulty was related to poorer glycemic control, and blood glucose testing and insulin administration proficiency were linked to better glycemic control. Compared to other groups, teens were especially likely to mention internal and hindering influences, and more likely to mention other people as negative influences. CONCLUSIONS Although all groups agreed that all self-care behaviours are important, there are key areas of discrepancy in perceptions, particularly between families and physicians. Further research should connect the beliefs examined in this study to actual self-care behaviours.
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Affiliation(s)
- Dianne K Palladino
- Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA.
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Chen SM, Creedy D, Lin HS, Wollin J. Effects of motivational interviewing intervention on self-management, psychological and glycemic outcomes in type 2 diabetes: a randomized controlled trial. Int J Nurs Stud 2011; 49:637-44. [PMID: 22209215 DOI: 10.1016/j.ijnurstu.2011.11.011] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 11/16/2011] [Accepted: 11/23/2011] [Indexed: 12/20/2022]
Abstract
BACKGROUND Type 2 diabetes is a serious and growing problem in Taiwan where it is the fifth leading cause of death, and health care costs are 4.3 times higher than for people without diabetes. OBJECTIVES The purpose of this study was to determine whether participation in a motivational interview for people with type 2 diabetes would improve their self-management, psychological and glycemic outcomes. DESIGN A randomized controlled trial to assess the effects of the motivational interviewing intervention. SETTINGS Participants were drawn from the diabetes outpatient clinic of a large teaching hospital in South Taiwan. PARTICIPANTS A sample of 250 type 2 diabetes people. METHODS Type 2 diabetes people were randomly allocated into either the motivational interview group or the usual care group from baseline to 3 months follow-up. The intervention was based on motivational interviewing which encompassed a variety of interviewing techniques, and reflected each person's readiness stage to change. The control group was provided with usual care by nursing staff. RESULTS A total of 250 type 2 diabetic participants were randomized. The retention rate in the intervention group was 83% (n=104). The motivational interview did improve participants significantly in self-management, self-efficacy, quality of life, and HbA1c among diabetes people with appropriate baseline value (<121.24, <174.57, <107.18, and >7.62, respectively) but not in depression, anxiety and stress (F=0.13, p=0.72) compared to the control group at 3 months follow-up. CONCLUSION The findings provided important evidence concerning the positive effect of motivational interventions in self-management, psychological and glycemic outcomes. This research provided evidence for future clinical practices in diabetes care.
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Affiliation(s)
- Shu Ming Chen
- School of Nursing, Fooyin University, Kaohsiung, Taiwan.
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