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Wilson D, Diji AKA, Marfo R, Amoh P, Duodu PA, Akyirem S, Gyamfi D, Asare H, Armah J, Enyan NIE, Kyei-Dompim J. Dietary adherence among persons with type 2 diabetes: A concurrent mixed methods study. PLoS One 2024; 19:e0302914. [PMID: 38713660 DOI: 10.1371/journal.pone.0302914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 04/15/2024] [Indexed: 05/09/2024] Open
Abstract
BACKGROUND Poor adherence to dietary recommendations among persons with type 2 diabetes (T2D) can lead to long-term complications with concomitant increases in healthcare costs and mortality rates. This study aimed to identify factors associated with dietary adherence and explore the barriers and facilitators to dietary adherence among persons with T2D. METHODS A concurrent mixed methods study was conducted in two hospitals in the Ashanti Region of Ghana. One hundred and forty-two (142) persons with T2D were consecutively sampled for the survey. Dietary adherence and diabetes-related nutritional knowledge (DRNK) were assessed using the Perceived Dietary Adherence Questionnaire (PDAQ) and an adapted form of the General Nutritional Knowledge Questionnaire (GNKQ-R) respectively. A purposive sample of fourteen participants was selected for interviews to explore the factors that influence dietary adherence. Qualitative data were analysed using NVivo version 20 software and presented as themes. Furthermore, binary logistic regression was performed using IBM SPSS version 29.0 to identify the factors associated with dietary adherence. RESULTS Nearly fifty-one percent (50.7%) of the participants in this study had good dietary adherence. In multivariable logistics regression, it was found that increase in DRNK (AOR = 1.099, 95% CI: 1.001-1.206, p = 0.041) score and living in an urban area (AOR = 3.041, 95% CI: 1.007-9.179, p = 0.047) were significantly associated with good dietary adherence. Inductive thematic analysis revealed four facilitators of dietary adherence (access to information on diet, individual food preferences and eating habits, perceived benefits of dietary adherence, and presence of social support) and four barriers (inability to afford recommended diets, barriers related to foods available in the environment, conflict between dietary recommendations and individual eating habits, and barriers related to the social environment). CONCLUSION The findings support the need for interventions including continuous dietary education tailored to individual preferences and dietary habits, expansion of poverty reduction social interventions and formulation of policies that will improve access to healthy foods in communities.
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Affiliation(s)
- Dorothy Wilson
- School of Nursing and Midwifery, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Abigail Kusi-Amponsah Diji
- School of Nursing and Midwifery, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Richard Marfo
- School of Nursing and Midwifery, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Paulina Amoh
- School of Nursing and Midwifery, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Precious Adade Duodu
- Department of Nursing, School of Human and Health Sciences, University of Huddersfield, Huddersfield, England, United Kingdom
| | - Samuel Akyirem
- School of Nursing, Yale University, West Haven, Connecticut, United States of America
| | - Douglas Gyamfi
- University of Maryland School of Nursing, Baltimore, MD, United States of America
| | - Hayford Asare
- School of Nursing and Midwifery, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Jerry Armah
- College of Nursing, University of Florida, Gainesville, Florida, United States of America
| | | | - Joana Kyei-Dompim
- School of Nursing and Midwifery, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Chowdhury HA, Joham AE, Kabir A, Rahman AKMF, Ali L, Harrison CL, Billah B. Exploring type 2 diabetes self-management practices in rural Bangladesh: facilitators, barriers and expectations-a qualitative study protocol. BMJ Open 2024; 14:e081385. [PMID: 38697759 PMCID: PMC11086285 DOI: 10.1136/bmjopen-2023-081385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 03/25/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a global public health crisis impacting low-income and middle-income countries such as Bangladesh. While self-management is encouraged for individuals with T2DM, there is a significant lack of knowledge regarding the factors of facilitators, barriers and expectations associated with T2DM self-management in Bangladesh. This research aims to investigate the potential elements that support, impede and are anticipated in the effective practice of self-management for T2DM in rural areas of Bangladesh. METHODS AND ANALYSIS This study will use an exploratory qualitative approach. 16 focus group discussions, 13 in-depth interviews and 9 key informant interviews will be conducted among multilevel stakeholders, including people with T2DM, their caregivers, healthcare providers, health managers/administrators and policy planners. Interviews will be audio-recorded, transcribed, translated and analysed using thematic analysis. ETHICS AND DISSEMINATION This research project has been approved by the Monash University Human Research Ethics Committee (project reference number: 39483) and the Ethical Review Committee of the Centre for Injury Prevention and Research, Bangladesh (Memo: CIPRB/ERC/2023/14). Research findings will be disseminated in peer-reviewed journals and conference presentations. Published reports will include group data. Individual data privacy will be strictly maintained.
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Affiliation(s)
- Hasina Akhter Chowdhury
- School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Centre for Injury Prevention and Research Bangladesh (CIPRB), Dhaka, Bangladesh
| | - Anju E Joham
- Monash Centre for Health Research and Implementation-MCHRI, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia
- Department of Diabetes, Monash University, Melbourne, Victoria, Australia
| | - Ashraful Kabir
- School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - A K M Fazlur Rahman
- Centre for Injury Prevention and Research Bangladesh (CIPRB), Dhaka, Bangladesh
| | - Liaquat Ali
- Pothikrit Institute of Health Studies (PIHS), Dhaka, Bangladesh
| | - Cheryce L Harrison
- Monash Centre for Health Research and Implementation-MCHRI, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Baki Billah
- School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Maudet‐Coulomb É, Martin‐Krumm C, Tarquinio C, Mino J. Adapted physical activity interventions and motivational levers: What benefits for type 2 diabetics? A systematic review. Health Sci Rep 2024; 7:e1644. [PMID: 38469114 PMCID: PMC10925881 DOI: 10.1002/hsr2.1644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 09/23/2023] [Accepted: 10/11/2023] [Indexed: 03/13/2024] Open
Abstract
Background and Aims Scientific research continues to advance and improve the medical management of type 2 diabetes. However, the importance of lifestyle management remains invaluable in treatment and tertiary prevention of this disease. Day-to-day sedentariness is the fourth most important risk factor for mortality in France. Numerous studies have demonstrated that physical activity is beneficial to people with type 2 diabetes and various recommendations have been made to encourage it. However, it is universally agreed that interventions that promote physical activity, while they may enhance its practice in the short term, do not impact on it over longer periods. It therefore seems essential to focus interventions on an individual's capacity to persist with physical activity in the long term. By looking at the literature, the aim of this review is to synthesize group and supervised physical activity interventions for people with type 2 diabetes using variables based on the following levers: motivation and self-efficacy. Methods The PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) methodology examined studies in English or French that are registered in the PubMed, PsycINFO, and SportDiscus databases and were published between 2005 and 2023, according to the following keywords: Motivation OR self-efficacy AND physical activity AND type 2 diabetes AND intervention. Results and Conclusion Seven studies out of 1207 were included. Despite the pertinence of the concepts of motivation and self-efficacy and their complementarity in physical activity management programs, few studies have yet proposed a combined intervention for people with type 2 diabetes.
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Affiliation(s)
- Élise Maudet‐Coulomb
- EA 4360 APEMACUniversity of LorraineMoselleMetzFrance
- Bas‐RhinSiel Bleu Research InstituteStrasbourgFrance
| | - Charles Martin‐Krumm
- EA 4360 APEMACUniversity of LorraineMoselleMetzFrance
- School of Practical PsychologistsInstitut Catholique de Paris, EA Religion, Culture et SociétéParisFrance
- Essone, Armed Forces Biomedical Research InstituteBrétignyFrance
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Lewinski AA, Shapiro A, Crowley MJ, Whitfield C, Jones JR, Jeffreys AS, Coffman CJ, Howard T, McConnell E, Tanabe P, Barcinas S, Bosworth HB. Diabetes distress in Veterans with type 2 diabetes mellitus: Qualitative descriptive study. J Health Psychol 2024:13591053241233387. [PMID: 38384142 DOI: 10.1177/13591053241233387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
Diabetes distress (DD) is a negative psychosocial response to living with type 2 diabetes mellitus (T2DM). We sought insight into Veterans' experiences with DD in the context of T2DM self-management. The four domains in the Diabetes Distress Scale (i.e. regimen, emotional, interpersonal, healthcare provider) informed the interview guide and analysis (structural coding using thematic analysis). The mean age of the cohort (n = 36) was 59.1 years (SD 10.4); 8.3% of patients were female and 63.9% were Black or Mixed Race; mean A1C was 8.8% (SD 2.0); and mean DDS score was 2.4 (SD 1.1), indicating moderate distress. Veterans described DD and challenges to T2DM self-management across the four domains in the Diabetes Distress Scale. We found that (1) Veterans' challenges with their T2DM self-management routines influenced DD and (2) Veterans experienced DD across a wide range of domains, indicating that clinical interventions should take a "whole-person" approach.Trial Registration: NCT04587336.
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Affiliation(s)
- Allison A Lewinski
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Health Care System, Durham, NC, USA
- Duke University School of Nursing, Durham, NC, USA
| | - Abigail Shapiro
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Health Care System, Durham, NC, USA
| | - Matthew J Crowley
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Health Care System, Durham, NC, USA
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Chelsea Whitfield
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Health Care System, Durham, NC, USA
| | - Joanne Roman Jones
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Health Care System, Durham, NC, USA
- Department of Nursing, Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Amy S Jeffreys
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Health Care System, Durham, NC, USA
| | - Cynthia J Coffman
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Health Care System, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Teresa Howard
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Health Care System, Durham, NC, USA
| | - Eleanor McConnell
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Health Care System, Durham, NC, USA
- Geriatric Research, Education and Clinical Center (GRECC), Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Paula Tanabe
- Duke University School of Nursing, Durham, NC, USA
- Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Susan Barcinas
- College of Education, North Carolina State University, Raleigh, NC, USA
| | - Hayden B Bosworth
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Health Care System, Durham, NC, USA
- Duke University School of Nursing, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC USA
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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Gupta SK, Lakshmi P, Chakrapani V, Rastogi A, Kaur M. Understanding the diabetes self-care behaviour in rural areas: Perspective of patients with type 2 diabetes mellitus and healthcare professionals. PLoS One 2024; 19:e0297132. [PMID: 38330094 PMCID: PMC10852243 DOI: 10.1371/journal.pone.0297132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 12/28/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Diabetes self-care behaviour plays a crucial role in managing the diabetes effectively and preventing complications. Patients with type 2 diabetes mellitus (T2DM) and health care professionals (HCPs) of rural areas often face unique challenges when it comes to diabetes self-care practices (SCPs). Therefore, this study aim to explore the perspectives of patients with T2DM and HCPs on diabetes SCPs. METHODS Eight focus group discussions (FGDs) among individuals with T2DM and In-depth interviews (IDIs) with 15 HCPs were conducted in rural areas of Punjab, North India. Capability, Opportunity, Motivation, and Behaviour model (COM-B) was employed for thematic framework analyses. RESULTS The study participants perceived that a limited understanding of diabetes mellitus (DM), beliefs in alternative therapies, drug side effects, attitudes towards DM (psychological capability), comorbidities (physical capability), family support (social opportunity), financial and time constraints, and weather conditions (physical opportunity) contributed to lack of DM SCPs. Physicians' guidance and support were motivating them to adhere to SCPs, especially when aligned with their sense of self-efficacy (reflective motivation). HCPs constraints in providing patient-centred care are due to training limitations (psychological capability) and a lack of essential resources (physical opportunities). Participants expressed need for comprehensive diabetes care (automatic motivation) through structured diabetes education intervention to improve diabetes SCPs. CONCLUSIONS The study findings indicate that various factors influence diabetes SCPs from the perspectives of both patients with T2DM and HCPs and emphasizes the need for a multi-faceted approach to improve diabetes SCPs in rural areas. Implementing a structured diabetes self-care intervention strategy in rural areas may help for preventing and mitigating the impact of diabetes-related complications in rural areas.
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Affiliation(s)
- Saurabh Kumar Gupta
- Department of Community Medicine and School of Public Health, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - P.V.M. Lakshmi
- Department of Community Medicine and School of Public Health, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Ashu Rastogi
- Department of Endocrinology, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manmeet Kaur
- Department of Community Medicine and School of Public Health, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
- HEAL Foundation, Chandigarh, India
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Liaghat B, Folkestad L, Skou ST, Koes B, Stammerjohan AF, Hartvigsen J. Prevalence and consequences of spinal pain among people with type 1 and type 2 diabetes mellitus in Denmark. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3744-3752. [PMID: 37659046 DOI: 10.1007/s00586-023-07911-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 07/30/2023] [Accepted: 08/19/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE To describe 1-week and 1-year prevalence of spinal pain and its consequences in relation to leisure activity, work-life, and care-seeking in people with type 1 and 2 diabetes mellitus (DM). METHODS A cross-sectional survey including adults diagnosed with DM from two Danish secondary care centres. Using the Standardised Nordic Questionnaire, spinal pain prevalence (cervical, thoracic, lumbar) and its consequences were evaluated (proportions, 95% confidence intervals) and compared to the general population. RESULTS Among 3767 people, 1-week and 1-year spinal pain prevalence were 11.6-32.4 and 18.5-49.6%, respectively, highest for lumbar pain (24.6-49.6%). The prevalence was similar between DM types for cervical and thoracic pain, but higher in type 2 for lumbar spine. Women had higher pain prevalence across spinal regions and DM types, while cervical and thoracic pain estimates were higher for age < 60 vs. ≥ 60. Within the past year, > 50% reported pain > 30 days, high proportions had reduced their activities (leisure time, 43.7-63.9%; work, 20.7-33.3%), 13.3-28.1% reported sick-leave > 30 days, and 44.3-48.5% had sought care due to spinal pain. CONCLUSION Spinal pain is common in people with type 1 and 2 DM, resulting in considerable consequences for work/leisure activities, sick-leave, and healthcare utilisation as compared to the general population.
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Affiliation(s)
- Behnam Liaghat
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark.
- Centre for Evidence-Based Orthopaedics, Department of Orthopaedic Surgery, Zealand University Hospital, Køge, Denmark.
| | - Lars Folkestad
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient Exploratory Network, University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Bart Koes
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
- Department of General Practice, Erasmus MC, Rotterdam, The Netherlands
| | - Amalie Frost Stammerjohan
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
| | - Jan Hartvigsen
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
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Alramadhan F, Herring RP, Beeson WL, Nelson A, Shah H. Religiosity and type 2 diabetes self-management among Muslims residing in California. Heliyon 2023; 9:e19725. [PMID: 37809987 PMCID: PMC10558997 DOI: 10.1016/j.heliyon.2023.e19725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 08/26/2023] [Accepted: 08/31/2023] [Indexed: 10/10/2023] Open
Abstract
Type 2 diabetes (T2D) is a public health issue that needs to be addressed. In the U.S., 11.3% of the population have diabetes. It is estimated that 90-95% of all diabetes cases are T2D cases. One of the best methods to address T2D is self-management. Prior research found a relationship between religiosity and T2D self-management. The purpose of this study was to examine religiosity and T2D self-management. This was a cross-sectional and qualitative study, which included Muslim adults, who have T2D and live in California. We utilized snowballing to recruit participants and the saturation concept to determine the number of participants. Additionally, we used semi-structured design for the interviews and focus groups. We had 30 participants for the interviews (however, only 25 provided demographic data) and 28 for the combined focus groups. Zoom was used to conduct the interviews and two focus groups. The grounded theory was used to deduce themes from the interviews and focus groups. The main themes for religiosity and self-management are Allah sustains life, everything will be ok/hope, faith gives strength, and the role of self within the fate concept. The themes for self-efficacy are diabetes requires new life approach, stress, and Islamic religious practices promote self-management. The main theme for perceived seriousness is taking action and making changes. Our findings provide significant insight about the relationship between religiosity, perceived seriousness, fatalism, and self-efficacy and self-management of T2D. A recommendation based on this study is that providers and health educators should be aware of the different experiences Muslims with T2D face, and tailor recommendations and programs based on that.
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Affiliation(s)
| | | | | | - Anna Nelson
- Loma Linda University, School of Public Health, California, USA
| | - Huma Shah
- Loma Linda University, School of Public Health, California, USA
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Ong CY, Lee WCD, Low SG, Low LL, Vasanwala FF. Attitudes and perceptions of people with diabetes mellitus on patient self-management in diabetes mellitus: a Singapore hospital's perspective. Singapore Med J 2023; 64:467-474. [PMID: 35083371 PMCID: PMC10395802 DOI: 10.11622/smedj.2022006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 11/11/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Chong Yau Ong
- Department of Medicine, Newcastle University Medicine Malaysia, Johor, Malaysia
| | | | - Sher Guan Low
- Post-Acute & Continuing Care, SingHealth Community Hospitals, Singapore
| | - Lian Leng Low
- Post-Acute & Continuing Care, SingHealth Community Hospitals, Singapore
- Department of Family Medicine Continuing Care, Singapore General Hospital, Singapore
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Liaghat B, Folkestad L, Skou ST, Koes B, Hartvigsen J. Prevalence and consequences of musculoskeletal pain in the upper and lower extremities: A cross-sectional analysis of patients with type 1 and type 2 diabetes in Denmark. Prim Care Diabetes 2023; 17:267-272. [PMID: 36890059 DOI: 10.1016/j.pcd.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 01/18/2023] [Accepted: 02/22/2023] [Indexed: 03/08/2023]
Abstract
AIMS To describe the one-week and 12-month prevalence of musculoskeletal pain in the upper and lower extremities and consequences in relation to care seeking, leisure time activity, and work life in patients with type 1 and 2 diabetes. METHODS A cross-sectional survey including adults diagnosed with type 1 and 2 diabetes from two Danish secondary care databases. Questions covered pain prevalence (shoulder, elbow, hand, hip, knee, ankle) and its consequences based on the Standardised Nordic Questionnaire. Data was presented using proportions (95 % confidence intervals). RESULTS The analysis included 3767 patients. The one-week prevalence was 9.3-30.8 % and 12-month prevalence 13.9-41.8 %, highest for shoulder pain (30.8-41.8 %). The prevalence was similar between type 1 and 2 diabetes for the upper extremity, but higher in type 2 for the lower extremity. Women had a higher pain prevalence for any joint for both diabetes types, while estimates did not vary between age groups (<60 or ≥60 years). More than half of the patients had reduced their activities at work or leisure time, and more than one-third had sought care during the past year because of pain. CONCLUSIONS Musculoskeletal pain in the upper and lower extremities is common in patients with type 1 and 2 diabetes from Denmark, with considerable consequences for work and leisure activities.
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Affiliation(s)
- Behnam Liaghat
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Centre for Evidence-Based Orthopaedics, Department of Orthopaedic Surgery, Zealand University Hospital, Køge, Denmark.
| | - Lars Folkestad
- Department of Endocrinology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Open Patient Exploratory Network, University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Bart Koes
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Department of General Practice, Erasmus MC, Rotterdam, the Netherlands
| | - Jan Hartvigsen
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Chiropractic Knowledge Hub, Odense, Denmark
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Ghammari F, Jalilian H, Khodayari‐zarnaq R, Gholizadeh M. Barriers and facilitators to type 2 diabetes management among slum-dwellers: A systematic review and qualitative meta-synthesis. Health Sci Rep 2023; 6:e1231. [PMID: 37123550 PMCID: PMC10140644 DOI: 10.1002/hsr2.1231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/24/2023] [Accepted: 04/06/2023] [Indexed: 05/02/2023] Open
Abstract
Background and Aims The prevalence of type 2 diabetes (T2D) is on the rise worldwide, especially in developing countries. There is a significant difference between the slum-dwellers and other urban dwellers in terms of T2D incidence rate and access to healthcare services. This review aimed to identify barriers and facilitators to T2D management among slum-dwellers. Methods A systematic review was conducted to identify barriers and facilitators to T2D management from January 1, 2002 to May 30, 2022. We searched MEDLINE via PubMed, Scopus, Web of Sciences, and Google Scholar. The inclusion criteria were: qualitative or mixed-methods research, published in English, focused on slum-dwellers and T2D or its complications, and assessed barriers and facilitators to T2D management among slum-dwellers. Quality appraisal was conducted using the QATSDD critical appraisal tool. A thematic approach was used for data analysis and synthesis. Results A total of 17 articles were included in this review. Three analytical themes were identified: (1) Individual factors consisting of four themes: lifestyle behaviors, informational, psychological, and financial factors; (2) Health system factors consisting of three themes: patient education processes, financial protection, and service delivery; and (3) Contextual factors consisting of three themes: family support, social support, and environmental factors. Conclusion Our review disclosed that the individual, health system, and context influence T2D management among slum-dwellers. Policymakers can use the findings of this review to reduce barriers and augment facilitators to improve healthcare utilization and self-care management among patients with T2D in slums.
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Affiliation(s)
- Fawzieh Ghammari
- Department of Health Policy and Management, School of Management and Medical InformaticsTabriz University of Medical SciencesTabrizIran
| | - Habib Jalilian
- Department of Health Services Management, School of HealthAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Rahim Khodayari‐zarnaq
- Department of Health Policy and Management, School of Management and Medical InformaticsTabriz University of Medical SciencesTabrizIran
| | - Masumeh Gholizadeh
- Department of Health Policy and Management, School of Management and Medical InformaticsTabriz University of Medical SciencesTabrizIran
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Meireles M, Cortez-Ribeiro AC, Polck D, Almeida-de-Souza J, Ferro-Lebres V. Olive Leaf Tea Impact on Postprandial Glycemia: A Randomized Cross-Over Trial. Foods 2023; 12:foods12030528. [PMID: 36766057 PMCID: PMC9914386 DOI: 10.3390/foods12030528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/10/2023] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
This study investigates the effect of olive leaf tea (OLT) on postprandial glycemia in healthy volunteers when ingested with a high-carbohydrate meal, compared with a placebo tea (CON). Healthy adults participated in a double-blind, randomized, placebo-controlled, and cross-over design trial receiving a high-rich carbohydrate meal with either 250 mL of OLT or CON at two different times after a washout period. The sequence order was randomized at a ratio of 1:1. Capillary blood glucose was measured in a 2 h period after ingestion. Eighteen participants were initially randomized. Of these, thirteen completed the trial and were analyzed. The consumption of OLT resulted in a delay in peak time (48.5 ± 4.2 min vs. 35.7 ± 4.0 min, p = 0.03) and a significant increase in glucose area under the curve compared to placebo (14,502.7 ± 640.8 vs. 13,633.3 ± 869.4 mg/dL·min, p = 0.03). Results are depicted as mean ± SEM. The OLT and CON palatability were generally well accepted. No adverse effects were reported. OLT did not ameliorate a glycemic curve induced by carbohydrate-rich meal ingestion, suggesting that at least when ingested acutely in a single meal, OLT does not have antihyperglycemic effects. Future studies should account for chronic consumption providing a better understanding of glycemic regulation over time.
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Affiliation(s)
- Manuela Meireles
- Centro de Investigação da Montanha (CIMO), Instituto Politécnico de Bragança, (Mountain Research Center—Polytechnic Institute of Bragança), Campus Santa Apolónia, 5300-253 Bragança, Portugal
- Laboratório para Sustentabilidade e Tecnologia em Regiões de Montanha, Instituto Politécnico de Bragança, (LA SusTEC—Associated Laboratory for Sustainability and Technology in Inland Regions, Polytechnic Institute of Bragança), Campus Santa Apolónia, 5300-253 Bragança, Portugal
- Correspondence:
| | | | - Denise Polck
- Polytechnic Institute of Bragança, Campus Santa Apolónia, 5300-253 Bragança, Portugal
| | - Juliana Almeida-de-Souza
- Centro de Investigação da Montanha (CIMO), Instituto Politécnico de Bragança, (Mountain Research Center—Polytechnic Institute of Bragança), Campus Santa Apolónia, 5300-253 Bragança, Portugal
- Laboratório para Sustentabilidade e Tecnologia em Regiões de Montanha, Instituto Politécnico de Bragança, (LA SusTEC—Associated Laboratory for Sustainability and Technology in Inland Regions, Polytechnic Institute of Bragança), Campus Santa Apolónia, 5300-253 Bragança, Portugal
| | - Vera Ferro-Lebres
- Centro de Investigação da Montanha (CIMO), Instituto Politécnico de Bragança, (Mountain Research Center—Polytechnic Institute of Bragança), Campus Santa Apolónia, 5300-253 Bragança, Portugal
- Laboratório para Sustentabilidade e Tecnologia em Regiões de Montanha, Instituto Politécnico de Bragança, (LA SusTEC—Associated Laboratory for Sustainability and Technology in Inland Regions, Polytechnic Institute of Bragança), Campus Santa Apolónia, 5300-253 Bragança, Portugal
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12
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Vilafranca Cartagena M, Arreciado Marañón A, Artigues-Barbera E, Tort-Nasarre G. Successful Practices in Performing and Maintaining Physical Activity in Adults with Type 2 Diabetes Mellitus: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14041. [PMID: 36360920 PMCID: PMC9658001 DOI: 10.3390/ijerph192114041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/22/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
Physical activity has proven to be greatly beneficial in patients with DM2. However, few adhere to physical activity recommendations and are motivated to engage in regular physical activity and the numerous interventions conducted to change their habits tend to be unsuccessful in the long term. The objective in this research is to study patients who adhere to physical activity in order to guide patients who have not succeeded in making this change, assisted by the successful tools in the context of community nursing. A qualitative descriptive study was conducted. The sample included 10 patients with type 2 diabetes mellitus who adhered to physical activity in Catalonia, Spain, having been selected using intentional sampling. We recorded semi-structured interviews with the participants and conducted a thematic analysis. Five categories were identified and grouped into two themes: (1) Integrate physical activity as a lifestyle (meaning of DM2 and physical activity, adaptation to change and strategies on a day-to-day basis, physical activity) and (2) Find support to change physical activity (company and personal motivational strategies). In conclusion, a good adherence to physical activity was achieved thanks to motivation maintained over time related to autonomous motivation and the psychological and physiological benefits that physical activity provides patients, external support and encouragement, and the allocation of time to adhere without making great lifestyle changes.
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Affiliation(s)
- Mireia Vilafranca Cartagena
- Department of Nursing, Faculty of Health Science and Welfare, University of Vic-Central University of Catalonia (UVIC-UCC), Av. Universitària 4-6, 08242 Manresa, Spain
- Althaia Foundation, C/Dr Joan Soler 1-3, 08243 Manresa, Spain
| | - Antonia Arreciado Marañón
- Department of Nursing, Faculty of Medicine, Autonomous University of Barcelona, Campus Bellaterra, 08193 Cerdanyola del Vallès, Spain
- Multidisciplinary Research Group in Health and Society (GREMSAS), (2017 SGR 917), 08007 Barcelona, Spain
| | - Eva Artigues-Barbera
- Balafia Primary Care Center, Av. de Rosa Parks. Gerència Territorial Lleida, Catalan Health Institute (ICS), 08007 Barcelona, Spain
- Research Support Unit Lleida, Fundació Institut Universitari per a la Recerca al’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Rambla Ferran 44, 25007 Lleida, Spain
| | - Glòria Tort-Nasarre
- Department of Nursing, Faculty of Nursing and Physiotherapy, University of Lleida, C/Montserrat Roig, 25198 Lleida, Spain
- SAP ANOIA, Gerència Territorial Catalunya Central, Catalan Health Institute (ICS), 08007 Barcelona, Spain
- AFIN Research Group and Outreach Centre, Autonomous University of Barcelona, Campus Bellaterra, 08193 Cerdanyola del Vallès, Spain
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13
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Wang RH, Hong YW, Li CC, Li SL, Liu JL, Wu CH, Chiu CJ. Using social media data in diabetes care: bridging the conceptual gap between health providers and the network population. BMC PRIMARY CARE 2022; 23:241. [PMID: 36115943 PMCID: PMC9482184 DOI: 10.1186/s12875-022-01846-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 08/29/2022] [Indexed: 11/10/2022]
Abstract
Background Patients with diabetes who have poor health literacy about the disease may exhibit poor compliance and thus subsequently experience more complications. However, the conceptual gap of diabetes between health providers and the general population is still not well understood. Decoding concerns about diabetes on social media may help to close this gap. Methods Social media data were collected from the OpView social media platform. After checking the quality of the data, we analyzed the trends in people’s discussions on the internet using text mining. The natural language process includes word segmentation, word counting and counting the relationships between the words. A word cloud was developed, and clustering analyses were performed. Results There were 19,565 posts about diabetes collected from forums, community websites, and Q&A websites in the summer (June, July, and August) of 2017. The three most popular aspects of diabetes were diet (33.2%), life adjustment (21.2%), and avoiding complications (15.6%). Most discussions about diabetes were negative. The negative/positive ratios of the top three aspects were avoiding complications (7.60), problem solving (4.08), and exercise (3.97). In terms of diet, the most popular topics were Chinese medicine and special diet therapy. In terms of life adjustment, financial issues, weight reduction, and a less painful glucometer were discussed the most. Furthermore, sexual dysfunction, neuropathy, nephropathy, and retinopathy were the most worrisome issues in avoiding complications. Using text mining, we found that people care most about sexual dysfunction. Health providers care about the benefits of exercise in diabetes care, but people are mostly concerned about sexual functioning. Conclusion A conceptual gap between health providers and the network population existed in this real-world social media investigation. To spread healthy diabetic education concepts in the media, health providers might wish to provide more information related to the network population’s actual areas of concern, such as sexual function, Chinese medicine, and weight reduction. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01846-0.
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Lepesis V, Marsden J, Paton J, Rickard A, Latour JM. Experiences of foot and ankle mobilisations combined with home stretches in people with diabetes: a qualitative study embedded in a proof-of-concept randomised controlled trial. J Foot Ankle Res 2022; 15:7. [PMID: 35093130 PMCID: PMC8801130 DOI: 10.1186/s13047-022-00512-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 01/12/2022] [Indexed: 01/18/2023] Open
Abstract
Background The benefits of exercise and staying active are widely reported in the literature, however adherence and engagement with exercise amongst people with long-term illness and diabetes is poor. Physiotherapy aims to promote independence and physical activity using a range of strategies, including manual therapy and education/advice on exercises. However, low adherence impacts negatively on treatment outcomes. In this study, the practicality of physiotherapy interventions in patients who participate in a proof-of-concept (PoC) randomised controlled trial (RCT) will be considered. Aim To explore the experiences of people with diabetes who received an intervention package of foot and ankle mobilisations combined with home stretches for a 6-week period. Design An embedded qualitative study in a proof-of-concept RCT using semi-structured interviews and thematic analysis. Participants Purposive sample of 16 participants (mean age 73 years) with a diagnosis of diabetes (mean duration 13.4 years) were recruited. Results Analysis revealed seven themes informing the adherence and non-adherence to the exercise intervention. Themes describing the positive experiences were: 1) support from others to do the exercises; 2) psychological factors to motivate exercise adherence; 2) physical factors contributing to exercise adherence; 4) acceptability of home exercises during and beyond the study. Other themes described barriers: 5) social factors that contributed to exercise disengagement; 6) emotional limitations that influence exercise avoidance; 7) physical circumstances that made exercise participation burdensome. Themes highlighted positive influences by physiotherapists, the motivation of doing exercises while participating in a study, improving the perceived range of motion in their foot and ankle and reducing discomfort in these joints whilst being more active with daily activities. Conclusion Our findings highlighted that the intervention of foot and ankle mobilisations combined with home stretches is feasible for study participants. Psycho-social support, self-efficacy, and physiotherapy support are motivational to adhere to the study intervention and might contribute to the success of a full-scale RCT. Supplementary Information The online version contains supplementary material available at 10.1186/s13047-022-00512-z.
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15
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Alloatti F, Bosca A, Di Caro L, Pieraccini F. Diabetes and conversational agents: the AIDA project case study. DISCOVER ARTIFICIAL INTELLIGENCE 2021. [PMCID: PMC8456073 DOI: 10.1007/s44163-021-00005-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
One of the key aspects in the process of caring for people with diabetes is Therapeutic Education (TE). TE is a teaching process for training patients so that they can self-manage their care plan. Alongside traditional methods of providing educational content, there are now alternative forms of delivery thanks to the implementation of advanced Information Technologies systems such as conversational agents (CAs). In this context, we present the AIDA project: an ensemble of two different CAs intended to provide a TE tool for people with diabetes. The Artificial Intelligence Diabetes Assistant (AIDA) consists of a text-based chatbot and a speech-based dialog system. Their content has been created and validated by a scientific board. AIDA Chatbot—the text-based agent—provides a broad spectrum of information about diabetes, while AIDA Cookbot—the voice-based agent—presents recipes compliant with a diabetic patient’s diet. We provide a thorough description of the development process for both agents, the technology employed and their usage by the general public. AIDA Chatbot and AIDA Cookbot are freely available and they represent the first example of conversational agents in Italian to support diabetes patients, clinicians and caregivers.
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16
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Vasconcelos C, Cabral M, Ramos E, Mendes R. The impact of a community-based food education programme on dietary pattern in patients with type 2 diabetes: Results of a pilot randomised controlled trial in Portugal. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:e318-e327. [PMID: 33761180 DOI: 10.1111/hsc.13356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 01/07/2021] [Accepted: 02/24/2021] [Indexed: 06/12/2023]
Abstract
The purpose of this study was to analyse the effects of a food education programme, with easy-to-implement strategies integrated in a community-based exercise programme, on dietary pattern of patients with type 2 diabetes (T2D). Thirty-three patients (65.4 ± 5.9 years old) were engaged in a 9-month randomised controlled trial: a supervised exercise programme (control group [CON]; n = 15; combined exercise; three sessions per week; 75 min per session) or the same exercise programme plus a concomitant 16-week food education programme (experimental group [EXP]; n = 18; 15-min. group classes and dual-task strategies during exercise). Dietary pattern was assessed using a 3-day food record at baseline and at 9 months. The intake of total fat, polyunsaturated fat, and the daily servings of vegetables significantly increased in EXP compared with the CON group. Retention and adherence to the programme were 54% and 49.5 ± 27.2%, respectively. This food education programme improved dietary pattern of patients with T2D. Special attention should be given to strategies that support participants' attendance.
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Affiliation(s)
- Carlos Vasconcelos
- Department of Sports Sciences, Exercise and Health, University of Trás-os-Montes e Alto Douro, Vila Real, Portugal
- School of Education of Viseu, Polytechnic Institute of Viseu, Viseu, Portugal
| | - Maria Cabral
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Elisabete Ramos
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Romeu Mendes
- Department of Sports Sciences, Exercise and Health, University of Trás-os-Montes e Alto Douro, Vila Real, Portugal
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Northern Region Health Administration, Porto, Portugal
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17
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Huang YM, Shiyanbola OO. Investigation of Barriers and Facilitators to Medication Adherence in Patients With Type 2 Diabetes Across Different Health Literacy Levels: An Explanatory Sequential Mixed Methods Study. Front Pharmacol 2021; 12:745749. [PMID: 34690778 PMCID: PMC8527013 DOI: 10.3389/fphar.2021.745749] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/13/2021] [Indexed: 01/09/2023] Open
Abstract
Type 2 diabetes (T2D) incurs tremendous healthcare costs associated with various complications due to poor blood sugar control. Medication adherence, which is correlated with patients’ health literacy, should be consistently practiced to achieve optimal control of blood sugar. A comprehensive understanding of specific communication and psychosocial factors related to medication-taking behaviors across different levels of health literacy among people with T2D will guide the development of effective interventions and strategies to enhance medication adherence. To understand barriers and facilitators to medication adherence in people with T2D across different health literacy levels, the Health Literacy Pathway Model was used to identify the psychosocial and communication factors that may influence medication adherence. This mixed methods study used an explanatory sequential design, including a quantitative survey followed by qualitative semi-structured interviews. Two hundred and five participants completed the survey questionnaire, and 23 participants completed semi-structured interviews. Confirmed by quantitative and qualitative data, having stronger self-efficacy and fewer concerns about medications, as well as experiencing fewer perceived barriers to medication-taking, are necessary for better medication adherence among those with low adherence. Our findings will be useful to tailor interventions for diabetes care through addressing concerns among low-adherent patients with low health literacy and emphasizing self-efficacy and perceived barriers to medication adherence among all low-adherent patients with T2D.
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Affiliation(s)
- Yen-Ming Huang
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Olayinka O Shiyanbola
- Division of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, United States
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18
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Kuo HJ, Huang YC, García AA. An integrative review of fatigue in adults with type 2 diabetes mellitus: Implications for self-management and quality of life. J Clin Nurs 2021; 31:1409-1427. [PMID: 34585452 DOI: 10.1111/jocn.16058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/15/2021] [Accepted: 09/12/2021] [Indexed: 01/19/2023]
Abstract
AIMS AND OBJECTIVES To synthesise empirical studies on factors related to fatigue and its impact on diabetes self-management (DSM) and quality of life (QOL) in adults with type 2 diabetes mellitus (T2DM). BACKGROUND Fatigue is commonly reported in people with T2DM, a chronic condition that is highly prevalent worldwide. However, a holistic understanding of the consequences and factors related to fatigue in adults with T2DM is not well synthesised. DESIGN This integrative review used Whittemore and Knafl's methodology and was reported according to the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklist. METHODS The theory of unpleasant symptoms (TOUS) was used as a conceptual model to guide the review. The PubMed, PsychINFO and CINAHL databases were searched to identify studies that recruited adults with T2DM, were peer-reviewed, written in English and investigated fatigue as a primary or secondary outcome. Two investigators independently appraised the quality of the studies and extracted the data. RESULTS Twenty-nine articles met the inclusion criteria: 23 observational studies, two randomised controlled trials, one quasi-experimental study and three qualitative studies. All articles were of high quality. Physiological (e.g. T2DM duration, complications and inflammatory biomarkers), psychological (e.g. diabetes distress, depression and sleep quality) and situational factors (e.g. race/ethnicity, education and social support) were related to fatigue. Studies reported fatigue as a barrier to physical activity, healthy eating behaviours and the physical aspect of QOL. CONCLUSIONS Multiple factors are related to fatigue in adults with T2DM. Gaps in the literature include the multiple dimensions of fatigue, the effectiveness of interventions to alleviate fatigue and fatigue experiences in under-represented populations. RELEVANCE TO CLINICAL PRACTICE This integrative review supports the complex origin of fatigue and its impact on adults with T2DM. Nurses should evaluate modifiable factors related to fatigue and provide support to help improve DSM and QOL in this population.
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Affiliation(s)
- Hsuan-Ju Kuo
- The University of Texas at Austin School of Nursing, Austin, Texas, USA
| | - Ya-Ching Huang
- Texas State University St. David's School of Nursing, Round Rock, Texas, USA
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19
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Lan X, Lu X, Yi B, Chen X, Jin S. Factors associated with self-management behaviors of patients with chronic obstructive pulmonary disease. Jpn J Nurs Sci 2021; 19:e12450. [PMID: 34398525 DOI: 10.1111/jjns.12450] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 05/31/2021] [Accepted: 07/06/2021] [Indexed: 01/06/2023]
Abstract
AIMS To examine self-management behaviors level and discuss the associated factors among chronic obstructive pulmonary disease (COPD) patients. METHODS A descriptive study design was used. A convenience sample of 124 COPD patients was recruited from three hospitals in Fuzhou. Self-management Behaviors, Social Support Rating Scale and The Family APGAR Score were used to collect data. Descriptive statistics, one-way analysis of variance (ANOVA), Pearson correlation and multiple linear regression were used for data analysis. RESULTS The overall score of self-management behaviors ranged 4-41, with a mean score of 21.26 ± 7.72. Pearson correlation analyses and ANOVA revealed that age, course of disease, education, marital status, family function, subjective support, objective support, and availability of support were positively correlated with overall self-management behaviors (p < .05). Multiple linear regression analyses revealed that subjective support and availability of support significantly predicted self-management behaviors. CONCLUSIONS The level of self-management behaviors of COPD patients was suboptimal. We suggest that people in the patients' social network should provide support for them, and help them use available resources to improve the level of self-management behaviors.
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Affiliation(s)
- Xiuyan Lan
- Department of Pulmonary and Critical Care Medicine, Fujian Provincial Hospital , Fuzhou, China.,Fujian Medical University Affiliated Clinical Medical Institute, Fuzhou, China
| | - Xinyan Lu
- ENT-Head&Neck Surgery, Guiqian International General Hospital, Guiyang, China
| | - Bilan Yi
- Department of Pulmonary and Critical Care Medicine, Fujian Provincial Hospital , Fuzhou, China.,Fujian Medical University Affiliated Clinical Medical Institute, Fuzhou, China
| | - Xiaohuan Chen
- Fujian Medical University Affiliated Clinical Medical Institute, Fuzhou, China.,Nursing Department, Fujian Provincial Hospital, Fuzhou, China
| | - Shuang Jin
- Fujian Medical University Affiliated Clinical Medical Institute, Fuzhou, China.,Nursing Department, Fujian Provincial Hospital, Fuzhou, China
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20
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Kitagawa M, Inagaki M, Okuwa M, Tasaki K, Horiguchi T, Asada Y, Nagamune M. Development of a Family Support Scale for Diet Therapy for Male Workers with type 2 diabetes. Jpn J Nurs Sci 2021; 19:e12444. [PMID: 34236136 DOI: 10.1111/jjns.12444] [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: 03/19/2021] [Revised: 05/15/2021] [Accepted: 06/13/2021] [Indexed: 11/30/2022]
Abstract
AIM Dietary self-care for patients with type 2 diabetes can be improved with family support. The purpose of this study was to develop a scale to assess family support for diet therapy for male workers with type 2 diabetes and to examine its reliability and validity. METHODS In this cross-sectional study, we collected data from 110 Japanese male workers with type 2 diabetes. Data were analyzed using exploratory factor analysis, reliability testing, and validity testing. RESULTS The resultant Family Support Scale for Diet Therapy for Male Workers (FSS-DMW) with type 2 diabetes consisted of 31 items and a six-factor structure. The six factors explained 72.9% of the variance, and Cronbach's alpha for the total scale was .964. The scale correlated as expected with the Social Support Scale for Chronic Illness and the dietary subscale of the Japanese version of the Summary of Diabetes Self-Care Activities Measure. CONCLUSION The FSS-DMW is a reliable and valid measure which can be used to assess family support for diet therapy for male workers with type 2 diabetes and has the potential to be used as a clinical instrument for family guidance.
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Affiliation(s)
- Mai Kitagawa
- Department of Chronic Care, Division of Health Sciences, Graduate School of Medical, Pharmaceutical, and Health Sciences, Kanazawa, Japan.,Department of Clinical Nursing, Division of Health Sciences, Institute of Medical, Pharmaceutical, and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Michiko Inagaki
- Department of Clinical Nursing, Division of Health Sciences, Institute of Medical, Pharmaceutical, and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Mayumi Okuwa
- Department of Clinical Nursing, Division of Health Sciences, Institute of Medical, Pharmaceutical, and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Keiko Tasaki
- Department of Clinical Nursing, Division of Health Sciences, Institute of Medical, Pharmaceutical, and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Tomomi Horiguchi
- Department of Clinical Nursing, Division of Health Sciences, Institute of Medical, Pharmaceutical, and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Yuya Asada
- Department of Clinical Nursing, Division of Health Sciences, Institute of Medical, Pharmaceutical, and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Mizuyo Nagamune
- Department of Chronic Care, Division of Health Sciences, Graduate School of Medical, Pharmaceutical, and Health Sciences, Kanazawa, Japan
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Contextually Appropriate Tools and Solutions to Facilitate Healthy Eating Identified by People with Type 2 Diabetes. Nutrients 2021; 13:nu13072301. [PMID: 34371811 PMCID: PMC8308352 DOI: 10.3390/nu13072301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/28/2021] [Accepted: 07/01/2021] [Indexed: 12/22/2022] Open
Abstract
Type 2 diabetes (T2D) is a complex, multifaceted disease and its treatment involves lifestyle intervention (LI) programs that participants may find difficult to adopt and maintain. The objective of this study is to understand the lived experiences of participants with T2D regarding healthy eating behavior change, in order to identify and incorporate relevant information, skills, and educational approaches into LI programs. An explorative qualitative study was undertaken. Purposeful sampling was used to recruit 15 participants. One-on-one, semi-structured, open-ended, and in-depth interviews were conducted. An essentialist paradigm was adopted to accurately report the experiences, meaning, and reality of participants. An inductive approach was used to analyze the data. Participants reported that being diagnosed and living with T2D could be overwhelming, and their ability to manage was influenced by health care providers (HCP), family, and individual context. Many experienced a loop of “good–bad” eating behaviors. Participants expressed desires for future diabetes management that would include program content (nutrition, physical activity, mental health, foot care, and consequences of T2D), program features (understand context, explicit information, individualized, hands-on learning, applicable, realistic, incremental, and practical), program components (access to multidisciplinary team, set goals, track progress and be held accountable, one-on-one sessions, group support, maintenance/follow-up), and policy change. In conclusion, the results of this study indicate that T2D management requires more extensive, comprehensive, and ongoing support, guided by the individual participant.
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22
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Adhikari M, Devkota HR, Cesuroglu T. Barriers to and facilitators of diabetes self-management practices in Rupandehi, Nepal- multiple stakeholders' perspective. BMC Public Health 2021; 21:1269. [PMID: 34187461 PMCID: PMC8243465 DOI: 10.1186/s12889-021-11308-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 06/17/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Self-management of diabetes is associated with glycaemic control and adherence to medication and healthy lifestyle practices. There is lack of information on the barriers to and facilitators of diabetes self-management practices in low income country, Nepal. This study aimed to explore the barriers to and facilitators of Type 2 diabetes self-management practices taking multiple stakeholders' perspectives in Nepal. METHODS Four focus group discussions and 16 semi-structured interviews with people with Type 2 diabetes, caregivers, health care providers and health managers were conducted from April to May 2018 in Rupandehi district of Western Nepal. They were audio-recorded, transcribed, and analysed using a thematic approach. RESULTS Five main themes emerged that influenced diabetes self-management practices: individual factors, socio-cultural and economic factors, health system and policy factors, availability and accessibility of resources, and environmental factors. The important barriers were: lack of knowledge about diabetes self-management practices, cultural practices, insufficient counselling, lack of guidelines and protocols for counselling, and financial problems. The major facilitators were: motivation; support from family, peers, and doctors; and availability of resources in the community. CONCLUSION Based on our findings, a multilevel approach is needed to address these barriers and facilitators. These findings will help guide strategies to develop programs that impart knowledge and skills to improve the diabetes self-management practices of people with Type 2 diabetes.
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Affiliation(s)
| | | | - Tomris Cesuroglu
- Faculty of Science, Vrije University, Amsterdam, The Netherlands
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Jayasvasti I, Jayasvasti M, Pengpid S, Peltzer K, Nanthananate P. Participants' Views on Lifestyle Intervention Program Enhancing Long-Term Health-Related Behaviors Improvement among Prehypertension and/or Prediabetes Mellitus Older Adults: A Qualitative Study Examined in Thailand at Health Promoting Hospitals. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2021; 58:469580211025209. [PMID: 34121492 PMCID: PMC8207270 DOI: 10.1177/00469580211025209] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This study aimed to investigate the view of prediabetes and prehypertension elderly patients living around temple on long-term self-management in proficient way underneath the lifestyle intervention program based on both focus-group discussion and In-depth interview methods to fill the gap in partially successful intervention. 62 participants were selected from 220 participants of the quantitative published study by 2 researchers. The triangulation method was used to put great emphasis on the consistency and the credibility of the results. Almost all of the participants had benefited from the program regarding proper foods, suitable exercise and an inspiration of lifestyle modification. They made changes of eating behavior and exercise behavior during program attendance, however, after the program had finished, they had minimal concern to take care of themselves. Nonetheless, more than half of them demonstrated some health-related behaviors changes due to they gave the value of the suggestion in different aspects. Moreover, high-frequency program attendance was not related to blood results improvement. The knowledge obtained from program intervention together with adequate contact between the patient and the program staff, personal problems solving, personal attitude, practice and acceptable played a key role for long-term lifestyle modification and completely successful intervention.
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Affiliation(s)
| | | | - Supa Pengpid
- ASEAN Institute for Health Development Mahidol University, Nakhon Pathom, Thailand.,Department of Research Development and Innovation, University of Limpopo, Polokwane, South Africa
| | - Karl Peltzer
- Department of Psychology, University of the Free State, Bloemfontein, South Africa.,Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
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Nixon AL, Leonardi-Bee J, Wang H, Chattopadhyay K. Barriers and facilitators to type 2 diabetes management in the Caribbean region: a qualitative systematic review. JBI Evid Synth 2021; 19:911-965. [PMID: 33394623 DOI: 10.11124/jbisrir-d-19-00424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this systematic review was to summarize the barriers and facilitators to type 2 diabetes mellitus management in the Caribbean region. INTRODUCTION The prevalence of type 2 diabetes mellitus in the Caribbean is of significant concern. Poor management of type 2 diabetes mellitus increases the risks of complications and death. Several studies have been conducted to explore the barriers and facilitators to type 2 diabetes mellitus management in the Caribbean; however, a systematic review has yet to be conducted. INCLUSION CRITERIA Eligible participants were adults (aged 18 and above) with type 2 diabetes mellitus, their families/carers, and health care professionals whose work involves the management of type 2 diabetes mellitus in the Caribbean. The review included studies that focused on their views, experiences, attitudes, understandings, perceptions, and perspectives regarding the barriers and facilitators to type 2 diabetes mellitus management. METHODS Electronic searches of MEDLINE, Embase, CINAHL/BNI (EBSCOhost), PsycINFO, AMED, Web of Science, and Scopus were conducted from database inception to March 2020. Additionally, gray literature was searched via EThOS, OpenGrey, and ProQuest Dissertations and Theses. JBI methodology for conducting qualitative systematic reviews was followed. Screening of studies, assessment of methodological quality, and data extraction were conducted independently by two reviewers. Findings from studies were synthesized using a meta-aggregation approach, and confidence in the findings was ranked using the ConQual approach. RESULTS Eight studies were included in the review, all of which focused on patients' perspectives. There were five synthesized findings, including i) cultural demands and pressures impact self-management and general care of type 2 diabetes mellitus (low confidence evidence); ii) support systems' influence on the general management of type 2 diabetes mellitus (moderate confidence evidence); iii) personal and environmental background/circumstances can encourage and limit good self-management and general management of type 2 diabetes mellitus (high confidence evidence); iv) psychological factors that influence patients' actions towards the management of type 2 diabetes mellitus (moderate confidence evidence); and v) psychological factors and their influence on patients' adherence to type 2 diabetes mellitus management (low confidence evidence). CONCLUSIONS Patients in the Caribbean have multiple barriers and facilitators that limit and promote effective management of their type 2 diabetes mellitus. Identifying the barriers and facilitators to type 2 diabetes mellitus management in the Caribbean will assist with development of effective type 2 diabetes mellitus management programs. However, further qualitative studies on barriers and facilitators to type 2 diabetes mellitus management in the Caribbean that target health care professionals and families/carers should be conducted. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42018097242.
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Affiliation(s)
- Amy Latifah Nixon
- The Nottingham Centre for Evidence Based Healthcare: A JBI Centre of Excellence, University of Nottingham, Nottingham, United Kingdom.,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Jo Leonardi-Bee
- The Nottingham Centre for Evidence Based Healthcare: A JBI Centre of Excellence, University of Nottingham, Nottingham, United Kingdom.,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Haiquan Wang
- The Nottingham Centre for Evidence Based Healthcare: A JBI Centre of Excellence, University of Nottingham, Nottingham, United Kingdom.,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Kaushik Chattopadhyay
- The Nottingham Centre for Evidence Based Healthcare: A JBI Centre of Excellence, University of Nottingham, Nottingham, United Kingdom.,Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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Vilafranca Cartagena M, Tort-Nasarre G, Rubinat Arnaldo E. Barriers and Facilitators for Physical Activity in Adults with Type 2 Diabetes Mellitus: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5359. [PMID: 34069859 PMCID: PMC8157366 DOI: 10.3390/ijerph18105359] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/03/2021] [Accepted: 05/13/2021] [Indexed: 11/21/2022]
Abstract
The treatment of Type 2 Diabetes Mellitus (DM2) comprises physical activity (PA), diet, and medication. PA provides important benefits for people with diabetes. However, the majority of patients with DM2 do not attain the recommended levels of PA. Despite the evidence of the benefits to health of engaging in PA, the recommendations have not been fully translated into clinical improvements. Using a scoping review, this study aimed to identify the factors that influence levels of physical activity in adults with DM2. Eighteen studies published from 2009-2020 were identified by a search of relevant systematic databases between March 2019 and December 2020. The scoping review was carried out in accordance with the model defined by Arksey and O'Malley. The synthesis revelated sociodemographic characteristics, and six components-personal, motivation, social, mental, clinical, and self-efficacy-were identified as factors. Those that were most frequently identified were motivation and social support. In conclusion, these results should be considered to implement strategies to encourage people with DM2 to engage in physical exercise and thus improve the management of their condition.
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Affiliation(s)
- Mireia Vilafranca Cartagena
- Department of Nursing, Faculty of Health Science and Welfare, University of Vic-Central University of Catalonia (UVIC-UCC), Av. Universitaria 4-6, 08242 Manresa, Spain;
- Althaia Fundation, C/Dr Joan Soler 1-3, 08243 Manresa, Spain
| | - Glòria Tort-Nasarre
- Department of Nursing, Faculty of Nursing and Physiotherapy, University of Lleida, C/Montserrat Roig, 25198 Lleida, Spain;
- Health Education Research Group (GREpS), Faculty of Nursing and Physiotherapy, University of Lleida, Carrer de Montserrat Roig, 25198 Lleida, Spain
- Calaf Primary Care Center, Gerència Territorial Catalunya Central, Catalan Health Institute (ICS), Cta. Llarg19, 08280 Calaf, Spain
| | - Esther Rubinat Arnaldo
- Department of Nursing, Faculty of Nursing and Physiotherapy, University of Lleida, C/Montserrat Roig, 25198 Lleida, Spain;
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases, Instituto de Salud Carlos III, 28220 Madrid, Spain
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Cradock KA, Quinlan LR, Finucane FM, Gainforth HL, Martin Ginis KA, de Barros AC, Sanders EBN, ÓLaighin G. Identifying Barriers and Facilitators to Diet and Physical Activity Behaviour Change in Type 2 Diabetes Using a Design Probe Methodology. J Pers Med 2021; 11:jpm11020072. [PMID: 33530618 PMCID: PMC7911111 DOI: 10.3390/jpm11020072] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/11/2021] [Accepted: 01/21/2021] [Indexed: 12/19/2022] Open
Abstract
Treatment of Type 2 Diabetes (T2D) typically involves pharmacological methods and adjunct behavioural modifications, focused on changing diet and physical activity (PA) behaviours. Changing diet and physical activity behaviours is complex and any behavioural intervention in T2D, to be successful, must use an appropriate suite of behaviour change techniques (BCTs). In this study, we sought to understand the perceived barriers and facilitators to diet and PA behaviour change in persons with T2D, with a view to creating artefacts to facilitate the required behaviour changes. The Design Probe was chosen as the most appropriate design research instrument to capture the required data, as it enabled participants to reflect and self-document, over an extended period of time, on their daily lived experiences and, following this reflection, to identify their barriers and facilitators to diet and PA behaviour change. Design Probes were sent to 21 participants and 13 were fully completed. A reflective thematic analysis was carried out on the data, which identified themes of food environment, mental health, work schedule, planning, social support, cravings, economic circumstances and energy associated with diet behaviour. Similar themes were identified for PA as well as themes of physical health, weather, motivation and the physical environment.
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Affiliation(s)
- Kevin A. Cradock
- Physiology Department, School of Medicine, National University of Ireland Galway, Galway, Ireland;
- Electrical & Electronic Engineering, School of Engineering, National University of Ireland Galway, Galway, Ireland;
| | - Leo R. Quinlan
- Physiology Department, School of Medicine, National University of Ireland Galway, Galway, Ireland;
- Centre for Research in Medical Devices (CÚRAM), Science Foundation of Ireland, Galway, Ireland
- Correspondence: ; Tel.: +353-91-524411 (ext. 3710)
| | - Francis M. Finucane
- Bariatric Medicine Service, Galway Diabetes Research Centre, Health Research Board Clinical Research Facility, Galway, Ireland;
| | - Heather L. Gainforth
- School of Health and Exercise Sciences, Faculty of Health and Social Development, The University of British Columbia, Kelowna, BC V1V 1V7, Canada; (H.L.G.); (K.A.M.G.)
| | - Kathleen A. Martin Ginis
- School of Health and Exercise Sciences, Faculty of Health and Social Development, The University of British Columbia, Kelowna, BC V1V 1V7, Canada; (H.L.G.); (K.A.M.G.)
| | - Ana Correia de Barros
- Fraunhofer Portugal AICOS (Fraunhofer Center for Assistive Information and Communication Solutions), Rua Alfredo Allen, 455/461, 4200-135 Porto, Portugal;
| | - Elizabeth B. N. Sanders
- Department of Design, The Ohio State University, 100 Hayes Hall, 108 North Oval Mall, Columbus, OH 43210, USA;
| | - Gearóid ÓLaighin
- Electrical & Electronic Engineering, School of Engineering, National University of Ireland Galway, Galway, Ireland;
- Centre for Research in Medical Devices (CÚRAM), Science Foundation of Ireland, Galway, Ireland
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Bukhsh A, Goh BH, Zimbudzi E, Lo C, Zoungas S, Chan KG, Khan TM. Type 2 Diabetes Patients' Perspectives, Experiences, and Barriers Toward Diabetes-Related Self-Care: A Qualitative Study From Pakistan. Front Endocrinol (Lausanne) 2020; 11:534873. [PMID: 33329377 PMCID: PMC7729167 DOI: 10.3389/fendo.2020.534873] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 08/25/2020] [Indexed: 01/03/2023] Open
Abstract
Objective: This study aimed to qualitatively explore perspectives, practices, and barriers to self-care practices (eating habits, physical activity, self-monitoring of blood glucose, and medicine intake behavior) in urban Pakistani adults with type 2 diabetes mellitus (T2DM). Methods: Pakistani adults with T2DM were recruited from the outpatient departments of two hospitals in Lahore. Semistructured interviews were conducted and audiorecorded until thematic saturation was reached. Two researchers thematically analyzed the data independently using NVivo® software with differences resolved by a third researcher. Results: Thirty-two Pakistani adults (aged 35-75 years, 62% female) participated in the study. Six themes were identified from qualitative analysis: role of family and friends, role of doctors and healthcare, patients' understanding about diabetes, complication of diabetes and other comorbidities, burden of self care, and life circumstances. A variable experience was observed with education and healthcare. Counseling by healthcare providers, family support, and fear of diabetes-associated complications are the key enablers that encourage study participants to adhere to diabetes-related self-care practices. Major barriers to self care are financial constraints, physical limitations, extreme weather conditions, social gatherings, loving food, forgetfulness, needle phobia, and a hectic job. Conclusion: Respondents identified many barriers to diabetes self care, particularly related to life situations and diabetes knowledge. Family support and education by healthcare providers were key influencers to self-care practices among Pakistani people with diabetes.
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Affiliation(s)
- Allah Bukhsh
- School of Pharmacy, Monash University, Subang Jaya, Malaysia
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Bey-Hing Goh
- School of Pharmacy, Monash University, Subang Jaya, Malaysia
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
- Biofunctional Molecule Exploratory Research Group, School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
- Malaysia School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Edward Zimbudzi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Nephrology, Monash Health, Melbourne, VIC, Australia
| | - Clement Lo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Monash Diabetes, Monash Health, Melbourne, VIC, Australia
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Kok-Gan Chan
- Division of Genetics and Molecular Biology, Faculty of Science, Institute of Biological Sciences, University of Malaya, Kuala Lumpur, Malaysia
- Guangdong Provincial Key Laboratory of Marine Biology, Institute of Marine Sciences, Shantou University, Shantou, China
| | - Tahir Mehmood Khan
- School of Pharmacy, Monash University, Subang Jaya, Malaysia
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
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28
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Lee H, Lee H, Kim Y, Kim S, Lee YM. Network Support Using Social Networking Services to Increase Exercise Adherence Among Korean-Chinese Middle-Aged Migrant Women: Mixed Methods Study. JMIR Mhealth Uhealth 2020; 8:e19159. [PMID: 33151155 PMCID: PMC7677014 DOI: 10.2196/19159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/23/2020] [Accepted: 08/11/2020] [Indexed: 12/11/2022] Open
Abstract
Background Social networking services (SNSs) are recognized to be a promising approach to easily deliver health interventions and to enhance social support for exercise adherence. However, the patterns and aspects of social support through SNSs have not been reported and their influence on other social-cognitive factors remains inconclusive. Objective Our objective is to explore how social support delivered through SNSs impacts interactions among Korean-Chinese (KC) middle-aged women and to identify how this approach influences social-cognitive factors for exercise (eg, sense of community, self-efficacy for exercise, and social support for exercise). Methods A mixed methods design was used. Text analysis of SNS messages and text mining using the Korean Natural Language Application (KoALA) were conducted. Social-cognitive factors (eg, sense of community, self-efficacy for exercise, and social support for exercise) were assessed at baseline and after 12 weeks using a structured questionnaire. A comparison of social-cognitive factors at baseline and at 12 weeks was conducted to identify any potential significant changes, using the Wilcoxon signed-rank test. Results A total of 259 SNS messages were collected from 24 KC women, distributed among four chat groups, who participated in a 12-week walking intervention program between August and October 2018. The individual average frequency of chatting via the SNS was 10.79 (range 0-34) and the most frequent type of social support through the SNS was network support (172/259, 66.4%). The most common words extracted from the SNS were Health, Exercise, Participation, and We. Overall, the perceived levels of sense of community (P<.001) and social support for exercise (P=.002) were significantly increased at 12 weeks compared with baseline. Group 1 (P=.03) and Group 4 (P=.03), whose members demonstrated the highest frequency of network support, experienced a significant increase only in the level of sense of community. Conclusions By integrating these data and conducting a mixed methods analysis, we observed that among the types of social support, network support was a key point for the promotion of social-cognitive factors in increasing exercise adherence. Therefore, network support through SNS-based interventions should be considered as a useful strategy to help vulnerable migrant populations make changes to exercise behaviors.
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Affiliation(s)
- Hyeyeon Lee
- College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Hyeonkyeong Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Youlim Kim
- College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Sookyung Kim
- College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Young-Me Lee
- School of Nursing, College of Science and Health, Depaul University, Chicago, IL, United States
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29
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Lystrup R, Carlsen D, Sharon DJ, Crawford P. Wearable and interactive technology to share fitness goals results in weight loss but not improved diabetes outcomes. Obes Res Clin Pract 2020; 14:443-448. [DOI: 10.1016/j.orcp.2020.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 01/22/2020] [Accepted: 08/27/2020] [Indexed: 12/16/2022]
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Mphwanthe G, Carolan M, Earnesty D, Weatherspoon L. Perceived barriers and facilitators to diet and physical activity among adults diagnosed with type 2 diabetes in Malawi. Glob Public Health 2020; 16:469-484. [PMID: 32780630 DOI: 10.1080/17441692.2020.1805784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Diet and physical activity are crucial to Type 2 diabetes mellitus (T2DM) self-management. However, socio-environmental, and cultural factors can impede lifestyle behaviours, and hence T2DM management. This study aimed to identify barriers, facilitators and support for diet and physical activity among adults with T2DM in Malawi selected from a larger clinical assessment study, conducted in urban and semi-urban public hospitals. Four focus group discussions were conducted, and audio-recorded, transcribed verbatim, coded, then organised and analysed using thematic analysis. Emergent themes included: family, friends, and health worker ties that facilitated both diet and physical activity as socio-support systems. Diabetes peer groups occurred more often in urban than semi-urban areas. Dietary barriers to self-management of T2DM included: cost and access to food; lack of knowledge on what and how much to eat; challenges of separate preparation and purchase of food; dilemmas of what to eat during functions and travel; and conflicting dietary information from different sources. Comorbidities and fear of public ridicule were key perceived barriers to participants being physically active. Therefore, socio-environmental factors should be considered by nutritionists, dietitians, and health workers when developing and providing nutrition and physical activity education to adults with T2DM in Malawi.
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Affiliation(s)
- Getrude Mphwanthe
- Department of Food Science, and Human Nutrition, Michigan State University, East Lansing, MI, USA.,Department of Human Nutrition and Health, Lilongwe University of Agriculture and Natural Resources (LUANAR), Lilongwe, Malawi
| | - Marsha Carolan
- Department of Human Development, and Family Studies, Michigan State University, East Lansing, MI, USA
| | - Dawn Earnesty
- Michigan State University Extension, East Lansing, MI, USA
| | - Lorraine Weatherspoon
- Department of Food Science, and Human Nutrition, Michigan State University, East Lansing, MI, USA
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31
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Alemany-Pagès M, Moura-Ramos M, Araújo S, Macedo MP, Ribeiro RT, do Ó D, Ramalho-Santos J, Azul AM. Insights from qualitative research on NAFLD awareness with a cohort of T2DM patients: time to go public with insulin resistance? BMC Public Health 2020; 20:1142. [PMID: 32690054 PMCID: PMC7372774 DOI: 10.1186/s12889-020-09249-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 07/12/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND It is estimated that around 70% of Type 2 Diabetes Mellitus patients (T2DM) have Non-Alcoholic Fatty Liver Disease (NAFLD). Awareness and education are amongst the major shortcomings of the public health response to the increasing threat of NAFLD. Characterizing the specific NAFLD-related information needs of particular high-risk metabolic communities, for instance, T2DM patients, might aid in the development of evidence-based health promotion strategies, ultimately promoting NAFLD-awareness, treatment adherence and therapeutic success rates. METHODS Semi-structured interviews with T2DM patients were conducted to gain insight into their awareness of NAFLD, including its relationship with insulin resistance and T2DM. RESULTS Awareness of NAFLD as a disease entity, as well as its progression to end-stage liver disease or its relationship with other metabolic conditions, including insulin resistance and T2DM was low. Surveillance behaviours were also suboptimal and perceptions on the self-management knowledge and praxis regarding lifestyle intervention components of T2DM treatment seemed detached from those of NAFLD. CONCLUSIONS Our findings could inform the integration of NAFLD-related content in T2DM health promotion strategies. Rising awareness on NAFLD progression and its relationship with T2DM using culturally and community-relevant constructs might facilitate the development of primary and secondary prevention programmes to promote the adherence to lifestyle interventions by influencing NAFLD threat perceptions.
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Affiliation(s)
- Mireia Alemany-Pagès
- CNC-Center for Neuroscience and Cell Biology, CIBB, Rua Larga, University of Coimbra, Rua Larga, 3000-504, Coimbra, Portugal.
- University of Coimbra, IIIUC-Institute for Interdisciplinary Research, 3030-789, Coimbra, Portugal.
| | - Mariana Moura-Ramos
- Centro Hospitalar e Universitário de Coimbra, Reproductive Medicine Unit, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, 3000-115, Coimbra, Portugal
| | - Sara Araújo
- CES-Centre for Social Studies, University of Coimbra, 3000-104, Coimbra, Portugal
| | - Maria Paula Macedo
- APDP-Portuguese Diabetic Association, 1250-189, Lisbon, Portugal
- CEDOC-Centro de Estudos de Doenças Crónicas, NOVA Medical School/Faculdade de Ciências Médicas, 1150-082, Lisbon, Portugal
- Department of Medical Sciences, University of Aveiro, 3810-193, Aveiro, Portugal
| | | | - Dulce do Ó
- APDP-Portuguese Diabetic Association, 1250-189, Lisbon, Portugal
| | - João Ramalho-Santos
- CNC-Center for Neuroscience and Cell Biology, CIBB, Rua Larga, University of Coimbra, Rua Larga, 3000-504, Coimbra, Portugal
- Department of Life Sciences, Calçada Martim de Freitas, University of Coimbra, 3000-456, Coimbra, Portugal
| | - Anabela Marisa Azul
- CNC-Center for Neuroscience and Cell Biology, CIBB, Rua Larga, University of Coimbra, Rua Larga, 3000-504, Coimbra, Portugal.
- University of Coimbra, IIIUC-Institute for Interdisciplinary Research, 3030-789, Coimbra, Portugal.
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Abstract
BACKGROUND Diabetes mellitus is a major global threat to public health. Reducing the daily obstacles of coping with the disease for patients with diabetes may improve management. PURPOSE The aim of this study was to investigate daily obstacles to coping with Type 2 diabetes mellitus (T2DM) and related factors. METHODS A descriptive and cross-sectional design was used. Data were collected from 186 patients with T2DM who were hospitalized in an endocrinology clinic in Turkey. The Hospital Anxiety and Depression Scale and the Diabetes Obstacles Questionnaire were used to collect data. Multiple linear regression analysis was performed to explore the predictors of obstacles to coping in patients with T2DM. RESULTS The highest mean score was achieved on the obstacles to coping with diabetes (2.57 ± 3.78) among the subscales of the Diabetes Obstacles Questionnaire. After regression analysis, level of treatment compliance was identified as the most significant predictor (β = .289, p < .001). Anxiety, depression, smoking status, and highest level of education were also identified as significant predictors. CONCLUSIONS On the basis of these results, nurses should plan and implement interventions to improve treatment compliance and assist patients to overcome obstacles to disease management. Moreover, patient anxiety, depression, and lifestyle behaviors should be addressed.
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Fritschi C, Park C, Quinn L, Collins EG. Real-Time Associations Between Glucose Levels and Fatigue in Type 2 Diabetes: Sex and Time Effects. Biol Res Nurs 2020; 22:197-204. [PMID: 32008368 DOI: 10.1177/1099800419898002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Fatigue is a pervasive and serious complaint among aging adults with type 2 diabetes. Anecdotally, hyperglycemia was thought to cause fatigue, but prior cross-sectional analyses failed to find any relationship between glucose levels and fatigue. However, study methodology may have caused this relationship to be missed. Our aim was to use concurrent and continuous data across 5 days to examine real-time momentary relationships between glucose and fatigue levels by week, day, and time of day. Additionally, we explored how these relationships differed by sex. METHOD Participants (N = 54, 51% male, 54% non-White) wore continuous glucose monitors and wrist actigraphy into which they inputted fatigue ratings 6-8 times daily during waking hours across 5 days. Generalized estimation equation models were used to explore the relationship between glucose and fatigue when averaged by week, day, and time of day. Differences by sex were also explored. RESULTS HbA1c and baseline and real-time fatigue were higher in women than in men. Baseline HbA1c and self-reported general fatigue were unrelated. Fatigue levels averaged by day and time of day were higher in women than in men (p < .05). Glucose and fatigue were significantly related at all levels of data (weekly, daily, and time of day) in women but not men. CONCLUSIONS Our findings suggest that, when measured concurrently, glucose excursions may affect fatigue levels in women.
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Affiliation(s)
- Cynthia Fritschi
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Chang Park
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Laurie Quinn
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Eileen G Collins
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA.,Research & Development, Edward Hines, Jr. VA Hospital, Hines, IL, USA
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Zare M, Tarighat-Esfanjani A, Rafraf M, Shaghaghi A, Asghari-Jafarabadi M, Shamshiri M. The Barriers and Facilitators of Self-Management Among Adults with Type 2 Diabetes Mellitus: A Trans Theoretical Model (TTM)-Based Mixed Method Study in Iran. Diabetes Metab Syndr Obes 2020; 13:2687-2699. [PMID: 32821141 PMCID: PMC7419615 DOI: 10.2147/dmso.s230083] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 06/25/2020] [Indexed: 11/28/2022] Open
Abstract
AIM This study planned to determine:( 1) the behavioral intention or profile of patients with type 2 diabetes mellitus (T2DM) based on the stages of the change model, and( 2) to explore the perceived facilitators and barriers of self-management (SM) in a sample of Iranian patients with T2DM. METHODS This was a mixed method study, accomplished in two phases. In the quantitative phase, 246 subjects with T2DM participated. They were classified according to items such as regular use of blood-glucose-lowering drugs, having a healthy diet and performing physical activity to pre-action and action groups. Socio-demographic and anthropometric information were collected, and a phenomenological qualitative study was conducted, and data collection continued until saturation achieved by 10 subjects in pre-action and 12 subjects in action groups. Four focus group discussions in the field of SM were accomplished. Analysis of quantitative and qualitative data was conducted by the SPSS and MAXQDA software, respectively. RESULTS The mean age and duration of illness among the subjects were 53.9±7.1 and 6.9±4.9 years, respectively. The barriers of SM in action and pre-action stages were as follows: lower socio-economic status, poor performance of treatment team, physical-intellectual factors and lack of planning to change. The facilitators stated in the pre-action and action stage in the field of SM were satisfaction from treatment, planning, belief in diabetes, treatment team's support, nutritional knowledge, and religious beliefs. CONCLUSION This study indicated facilitator and barrier factors in SM based on TTM in action and pre-action groups. Healthcare professionals should consider these findings to improve the patients' outcomes.
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Affiliation(s)
- Maryam Zare
- Department of Nutrition, Khalkhal University of Medical Sciences, Khalkhal, Iran
| | - Ali Tarighat-Esfanjani
- Nutrition Research Center, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
- Correspondence: Ali Tarighat-Esfanjani Nutrition Research Center, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, 5166614711, Iran Tel +98-41-33362117 Fax +98-41-33340634 Email
| | - Maryam Rafraf
- Nutrition Research Center, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abdolreza Shaghaghi
- Department of Health Education and Promotion, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Mahmood Shamshiri
- School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
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Groat D, Corrette K, Grando A, Vellore V, Bayuk M, Karway G, Boyle M, McCoy R, Grimm K, Thompson B. Data-Driven Diabetes Education Guided by a Personalized Report for Patients on Insulin Pump Therapy. ACI OPEN 2020; 4:e9-e21. [PMID: 34169229 DOI: 10.1055/s-0039-1701022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective It is difficult to assess self-management behaviors (SMBs) and incorporate them into a personalized self-care plan. We aimed to develop and apply SMB phenotyping algorithms from data collected by diabetes devices and a mobile health (mHealth) application to create patient-specific SMBs reports to guide individualized interventions. Follow-up interventions aimed to understand patient's reasoning behind discovered SMB choices. Methods This study deals with adults on continuous subcutaneous insulin infusion using a continuous glucose monitor (CGM) who self-tracked SMBs with an mHealth application for 1 month. Patient-generated data were quantified and an SMB report was designed and populated for each participant. A diabetes educator used the report to conduct personalized, data-driven educational interventions. Thematic analysis of the intervention was conducted. Results Twenty-two participants recorded 118 alcohol, 251 exercise, 2,661 meal events, and 1,900 photos. A patient-specific SMB report was created from this data and used to conduct the educational intervention. High variability of SMB was observed between patients. There was variability in the percentage of alcohol events accompanied by a blood glucose check, median 79% (38-100% range), and frequency of changing the bolus waveform, median 11 (7-95 range). Interventions confirmed variability of SMBs. Main emerging themes from thematic analysis were: challenges and barriers, motivators, current SMB techniques, and future plans to improve glycemic control. Conclusion The ability to quantify SMBs and understand patients' rationale may help improve diabetes self-care and related outcomes. This study describes our first steps in piloting a patient-specific diabetes educational intervention, as opposed to the current "one size fits all" approach.
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Affiliation(s)
- Danielle Groat
- Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Krystal Corrette
- Department of Biomedical Informatics, Arizona State University, Tempe, Arizona, United States
| | - Adela Grando
- Department of Biomedical Informatics, Arizona State University, Tempe, Arizona, United States
| | - Vaishak Vellore
- Department of Biomedical Informatics, Arizona State University, Tempe, Arizona, United States
| | - Mike Bayuk
- Department of Biomedical Informatics, Arizona State University, Tempe, Arizona, United States
| | - George Karway
- Department of Biomedical Informatics, Arizona State University, Tempe, Arizona, United States
| | - Mary Boyle
- Department of Endocrinology, Mayo Clinic Arizona, Scottsdale, Arizona, United States
| | - Rozalina McCoy
- Division of Community Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Kevin Grimm
- Department of Psychology, Arizona State University, Tempe, Arizona, United States
| | - Bithika Thompson
- Department of Endocrinology, Mayo Clinic Arizona, Scottsdale, Arizona, United States
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Jalilian H, Pezeshki MZ, Janati A, Najafipour F, Sarbakhsh P, Zarnaq RK. Readiness for weight change and its association with diet knowledge and skills, diet decision making and diet and exercise barriers in patients with type 2 diabetes. Diabetes Metab Syndr 2019; 13:2889-2895. [PMID: 31425953 DOI: 10.1016/j.dsx.2019.07.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 07/29/2019] [Indexed: 12/30/2022]
Abstract
AIMS this study aimed to investigate stages of weight change in type 2 diabetics and its associations with diet knowledge and skills, diet decision making, diet and exercise barriers. MATERIALS AND METHODS This was a cross-sectional study of 1139 patients with type 2 diabetes aged>18 years in East Azerbaijan, Iran. Data were collected using the Personal Diabetes Questionnaire (PDQ) and were analyzed using SPSS software (version 22) and descriptive statistics, Chi-square and one-way ANOVA tests. RESULTS 48.1% of the patients were in the pre-contemplation stage. 7.5%, 14.6% and 29.8% of patients were in the stages of contemplation, preparation and action, respectively. Patients with a higher score in diet knowledge and skills and diet decision making were more likely to be involved in the action stage of weight loss process, while those who had more eating problems and exercise barriers were less likely to be involved in the action stage of weight loss. CONCLUSION The results of this study showed that a substantial percentage of patients are at the pre-contemplation stage, so proper measures are needed to inform patients about the consequences of obesity and overweight. It is also necessary to focus on people with poor incomes and education status and those living in rural areas. Improve diet knowledge and skills and diet decision making and the reduction of barriers to exercise can help patients to take action to lose weight.
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Affiliation(s)
- Habib Jalilian
- Iranian Center of Excellence in Health Management, Department of Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran; Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Mohammad Zakarya Pezeshki
- Social Determinants of Health Research Center, Department of Community and Family Medicine, Tabriz Medical School, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Ali Janati
- Iranian Center of Excellence in Health Management, Department of Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Farzad Najafipour
- Endocrine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Parvin Sarbakhsh
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Rahim Khodayari Zarnaq
- Iranian Center of Excellence in Health Management, Department of Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran; Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.
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Hushie M. Exploring the barriers and facilitators of dietary self-care for type 2 diabetes: a qualitative study in Ghana. Health Promot Perspect 2019; 9:223-232. [PMID: 31508343 PMCID: PMC6717922 DOI: 10.15171/hpp.2019.31] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/14/2019] [Indexed: 11/16/2022] Open
Abstract
Background: There is an increasing prevalence of type 2 diabetes (T2D) globally and countries in Sub Sahara Africa, such as Ghana are contending with the epidemic. The main objective ofthis study was to explore the barriers and facilitators of T2D self-care as perceived by patients and health providers (HPs) in Ghana. Methods: A maximum variation sample of 33 adult patients with a range of demographic features, diabetic conditions and self-care regimens and 3 providers were purposely selected from the specialist diabetes clinic of a private hospital in Accra, Ghana. Data were collected using in-depth interviews, which were recorded and transcribed; and non-participant observational field notes-that were analyzed thematically through directed content analysis. Results: The findings reveal that T2D adult patients face many inter-related challenges to diabetes self-care, than enabling factors that fell into four major domains:1) the counselling process and context (patients missing follow-up appointments, unacceptance of diagnosis); 2)recommended food and diet regimens (changing habitual diets, dislike and confusion about recommended diets); 3) social aspects (social functions interfering with dietary regimens, family members diverting patient from dietary goals) and 4) fears (non-disclosure to family member/pretense of being well). Conclusion: Integrated self-management interventions are needed to address these barriers, including tailoring dietary education to patients' specific needs, guiding patients on how tomanage diet during social occasions and among family members; and as well, providing mental health support. Future research should focus on T2D self-care behaviours and practices outside the clinic, including home, work and shopping environments.
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Affiliation(s)
- Martin Hushie
- University for Development Studies, School of Allied Health Sciences Department of Behavioural Sciences, P. O. Box 1883, Tamale, N/R Ghana
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The Impact of a Community-Based Food Education Program on Nutrition-Related Knowledge in Middle-Aged and Older Patients with Type 2 Diabetes: Results of a Pilot Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16132403. [PMID: 31284568 PMCID: PMC6650826 DOI: 10.3390/ijerph16132403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/01/2019] [Accepted: 07/05/2019] [Indexed: 12/11/2022]
Abstract
The purpose of this study was to evaluate the impact of a community-based food education program on nutrition-related knowledge in middle-aged and older patients with type 2 diabetes (T2D). Participants (n = 36; 65.9 ± 6.0 years old) were recruited in primary health care to a 9-month community-based lifestyle intervention program for patients with T2D and randomly assigned to an exercise program (control group; n = 16) or an exercise program plus a food education program (experimental group; n = 20). Nutrition-related knowledge was assessed through a modified version of the General Nutrition Knowledge Questionnaire. The increase in total nutrition-related knowledge score and sources of nutrients area score was significantly higher in the experimental group compared to the control group. No significant changes in nutrition-related knowledge were found between groups in dietary recommendations and diet-disease relationship areas, although improvements were observed. This community-based food education program, with the use of easy to implement strategies (short-duration lectures and dual-task problem solving activities during exercise), had a positive and encouraging impact on nutrition-related knowledge in middle-aged and older patients with T2D.
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Fritschi C, Martyn-Nemeth P, Zhu B, Jung Kim M. Active Learning: Lessons From Women With Type 2 Diabetes in a Walking Program. DIABETES EDUCATOR 2019; 45:370-379. [PMID: 31072188 DOI: 10.1177/0145721719848437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this study was to explore the experiences and preferences of sedentary women with type 2 diabetes who had recently completed a pilot 12-week supervised treadmill walking study. METHODS A qualitative design was used. Content analysis was used to assess major themes and subthemes embedded within participants' responses to open-ended questions about their experiences of participating in a walking program. Women were recruited from a database of patients willing to be contacted for research studies. RESULTS Seven inner-city women with type 2 diabetes (71% African American, age 62 ± 4.2 years, A1C 6.8% ± 1.3, years since diagnosis 6.6 ± 3.4 years) completed the postprogram interview. Only 3 of the 7 women had ever received any diabetes education. Four major themes emerged: (1) supportive environment, (2) personal commitment: overcoming ambivalence, (3) learning, and (4) outcomes, and 8 subthemes emerged. A supportive environment (encouraging, person centered, social, and structured) in combination with actively learning about diabetes and self-monitoring the effects of exercise seemed to be associated with personal commitment and confidence in participating in a walking program. CONCLUSIONS Active/experiential learning in a supportive environment may enhance both personal diabetes knowledge and behaviors among women with little diabetes education and low activity levels.
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Affiliation(s)
- Cynthia Fritschi
- Department of Biobehavioral Health Science, University of Illinois at Chicago College of Nursing, Chicago, Illinois
| | - Pamela Martyn-Nemeth
- Department of Biobehavioral Health Science, University of Illinois at Chicago College of Nursing, Chicago, Illinois
| | - Bingqian Zhu
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Min Jung Kim
- Department of Biobehavioral Health Science, University of Illinois at Chicago College of Nursing, Chicago, Illinois
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Fink A, Fach EM, Schröder SL. 'Learning to shape life' - a qualitative study on the challenges posed by a diagnosis of diabetes mellitus type 2. Int J Equity Health 2019; 18:19. [PMID: 30678694 PMCID: PMC6346523 DOI: 10.1186/s12939-019-0924-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 01/17/2019] [Indexed: 01/19/2023] Open
Abstract
Background Diabetes mellitus type 2 is a central challenge for health policy and healthcare in all advanced countries. For the affected persons, living with a diagnosis of type 2 diabetes is difficult because the disease and its treatment have a considerable effect on daily life. The aim of this study was to investigate the challenges associated with a diagnosis of type 2 diabetes for those affected and the range, depth and complexities of the subjective perspectives of the patients under the conditions of the German healthcare system. Methods A cross-sectional qualitative study was conducted using a sample of 19 adult patients with type 2 diabetes mellitus. Patients were recruited successively from two specialized diabetological practices, three general practitioner’s offices, and two hospitals. The patients were interviewed once in person using semi-structured interviews. All interviews were recorded, transcribed, and analysed based on grounded theory. Results Persons affected by diabetes mellitus type 2 seem to feel responsible for managing their disease. Two strategies of action could be identified: 1) patients strictly followed the recommendations of the physicians, or 2) they showed that they are knowledgably managing their diabetes mellitus type 2. The action strategy to address the disease seemed to be influenced by patients’ confidence in themselves, the effectiveness of the interventions, or the patients’ locus of control. Minor differences in educational status could be discovered, and patients who were less educated tended to follow the recommendations of the physicians very strictly and seemed to place more emphasis on being compliant, which goes hand in hand with a life with prohibitions and restrictions. In contrast, being perceived as competent patients who make their own rules to manage the disease in daily life appeared to be more important for people with higher education levels. Conclusion Patient education and self-management programmes for diabetes mellitus type 2 should take different types of learners into account. Giving less-educated patients specific recommendations for successful diabetes self-management is particularly important. Trial registration German clinical trial register (DRKS-ID: DRKS00007847). Electronic supplementary material The online version of this article (10.1186/s12939-019-0924-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Astrid Fink
- Martin-Luther-University Halle-Wittenberg, Medical Faculty, Institute of Medical Sociology, Magdeburger Str. 8, 06112, Halle (Saale), Germany.
| | - Eva-Maria Fach
- Martin-Luther-University Halle-Wittenberg, Medical Faculty, Institute of Medical Sociology, Magdeburger Str. 8, 06112, Halle (Saale), Germany
| | - Sara Lena Schröder
- Martin-Luther-University Halle-Wittenberg, Medical Faculty, Institute of Medical Sociology, Magdeburger Str. 8, 06112, Halle (Saale), Germany
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Rehling T, Bjørkman ASD, Andersen MB, Ekholm O, Molsted S. Diabetes Is Associated with Musculoskeletal Pain, Osteoarthritis, Osteoporosis, and Rheumatoid Arthritis. J Diabetes Res 2019; 2019:6324348. [PMID: 31886282 PMCID: PMC6925775 DOI: 10.1155/2019/6324348] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/04/2019] [Accepted: 11/19/2019] [Indexed: 12/14/2022] Open
Abstract
AIM To investigate the associations between diabetes and musculoskeletal pain, osteoarthritis, osteoporosis, and rheumatoid arthritis. METHODS Self-reported data were provided by the nationwide Danish National Health Survey 2013. Inclusion criteria were age ≥ 40 years and known diabetes status. The exposure variable was diabetes, and the outcome variables included musculoskeletal pain during the last 14 days in three body sites (back/lower back, limbs, and shoulder/neck), osteoarthritis, osteoporosis, and rheumatoid arthritis. Logistic regression analyses adjusted for age, gender, BMI, education, marital status, and physical activity were performed. RESULTS 9,238 participants with diabetes were 65.6 ± 11.0 (mean ± SD) years old; 55.6% were males. 99,980 participants without diabetes were 59.2 ± 11.8 years old; 46.7% were males. Diabetes was associated with back/lower back pain (OR 1.2 (CI 95% 1.1-1.2), p < 0.001), pain in the limbs (1.4 (1.3-1.4), p < 0.001), shoulder/neck pain (1.2 (1.1-1.3), p < 0.001), osteoarthritis (1.3 (1.2-1.4), p < 0.001), osteoporosis (1.2 (1.1-1.4), p = 0.010), and rheumatoid arthritis (1.6 (1.4-1.7), p < 0.001). In participants with diabetes, physical activity was associated with reduced pain (e.g., back/lower back pain (0.7 (0.6-0.7), p < 0.001)). CONCLUSION Diabetes was associated with elevated odds of having musculoskeletal pain. Diabetes was also associated with elevated odds of having osteoarthritis, osteoporosis, and rheumatoid arthritis. The most frequent disease in individuals with diabetes was osteoarthritis. The reported pain may have negative impacts on the level of physical activity. Health-care professionals should remember to inform patients with diabetes that musculoskeletal pain, osteoarthritis, osteoporosis, and rheumatoid arthritis are not contraindications to exercise training.
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Affiliation(s)
- Thomas Rehling
- Department of Clinical Research, Nordsjællands Hospital, Denmark
| | | | | | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Stig Molsted
- Department of Clinical Research, Nordsjællands Hospital, Denmark
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Mikhael EM, Hassali MA, Hussain SA, Shawky N. Self-management knowledge and practice of type 2 diabetes mellitus patients in Baghdad, Iraq: a qualitative study. Diabetes Metab Syndr Obes 2018; 12:1-17. [PMID: 30588052 PMCID: PMC6301727 DOI: 10.2147/dmso.s183776] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background and aim: Diabetes self-management behaviors are necessary to ensure optimum glycemic control. However, limited data were available regarding the practice of self-management by the Iraqi diabetic patients. This study aims to understand the knowledge, behaviors, and barriers of diabetes self-management among Iraqi type 2 diabetes mellitus (T2DM) patients in addition to their opinions and views toward the diabetes self-management educational program. METHODS A qualitative method approach was used to obtain the data from T2DM patients recruited from the National Diabetes Center, Baghdad, Iraq. Data were collected using a semi-structured interview guide, and a thematic analysis approach was used to process the data. RESULTS Most participants agreed to the importance of self-management practices especially healthy eating, exercise, taking medications, and healthy coping with stress to control DM and prevent its complications. Healthy eating and physical activity recommendations were inadequately practiced by most of the participants. Most participants reported irregular self-monitoring of blood glucose. Most of the participants properly adhered to the anti-diabetic medications. They generally lack proper information/knowledge about the importance of self-management practices of foot care and managing diabetes during sick days and how such practices should be implemented. Most participants have positive attitudes toward diabetes self-management practices. Face-to-face educational sessions are preferred by most patients. CONCLUSION The Iraqi diabetic patients have inadequate self-management behaviors. The main barrier to self-management practices was the lack of knowledge due to the absence of diabetes self-management educational programs in Iraq.
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Affiliation(s)
- Ehab Mudher Mikhael
- Department of Clinical Pharmacy, College of Pharmacy, University of Baghdad, Baghdad, Iraq,
- Department of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia,
| | - Mohamed Azmi Hassali
- Department of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia,
| | - Saad Abdulrahman Hussain
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Al-Rafidain University College, Baghdad, Iraq
| | - Nizar Shawky
- Internal Medicine Department, National Diabetes Center, Al-Mustansiriyah University, Baghdad, Iraq
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Substitution of red meat with poultry or fish and risk of type 2 diabetes: a Danish cohort study. Eur J Nutr 2018; 58:2705-2712. [PMID: 30225630 DOI: 10.1007/s00394-018-1820-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 09/11/2018] [Indexed: 01/28/2023]
Abstract
PURPOSE We examined associations between substitution of red meat (total, processed and unprocessed, low fat and high fat) with poultry or fish and substitution of processed red meat with unprocessed red meat and the risk of type 2 diabetes. METHODS A cohort of 53,163 participants from the Danish Diet, Cancer and Health study were followed for incident type 2 diabetes (6879 cases; median follow-up time 15.4 years). Diet was assessed by a validated 192-item food frequency questionnaire at baseline. Adjusted Cox proportional hazard models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for type 2 diabetes associated with specified food substitutions of 150 g/week. RESULTS Replacing total red meat with fish was associated with a lower risk of type 2 diabetes [HR 0.96 (95% CI 0.94, 0.99)] as was replacement of processed red meat with poultry or fish [HR poultry 0.96 (95% CI 0.93, 0.99)]; HR fish 0.94 [(95% CI 0.91, 0.97)]. Replacing low fat red meat or high fat red meat with fish was associated with a lower risk of type 2 diabetes whereas similar substitutions, with poultry, were not. Replacing processed red meat with unprocessed red meat was also associated with a lower risk of type 2 diabetes [HR 0.96 (95% CI 0.93, 0.99)]. CONCLUSIONS Replacing processed red meat with poultry, replacing total or processed red meat with fish, and replacing processed red meat with unprocessed red meat were all associated with a lower risk of type 2 diabetes.
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Olivan-Blázquez B, Montero-Marin J, García-Toro M, Vicens-Pons E, Serrano-Ripoll MJ, Castro-Gracia A, Sarasa-Bosque MC, Mendive-Arbeloa JM, López-del-Hoyo Y, Garcia-Campayo J. Facilitators and barriers to modifying dietary and hygiene behaviours as adjuvant treatment in patients with depression in primary care: a qualitative study. BMC Psychiatry 2018; 18:205. [PMID: 29921245 PMCID: PMC6008925 DOI: 10.1186/s12888-018-1779-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 06/07/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Major depression is a highly prevalent condition. Its pathogenesis is related to a wide variety of biological and psychosocial factors and among these is factors related to lifestyle. Lifestyle-based interventions seem to be appropriate strategies as coadjutant treatment. The objective of this study is to explore and identify expectations and experiences of both patients and healthcare professionals that can point to the main barriers and facilitators with regard to the promotion of healthy dietary and hygiene behaviours in patients suffering from major depression. METHODS A qualitative design was used to collect information from a wide range of purposefully and theoretically guided samples of depressed patients and health professionals from Primary Care (PC). Both in-depth interviews and discussion groups were used. A standardized protocol was designed to guide the interviews and groups, including the preparation of a topic list to be addressed, with previously tested, open suggestions that could be of interest. A thematic analysis was performed from grounded theory in order to explore, develop and define until saturation the emergent categories of analysis derived from the individual interview and group data. RESULTS Both patients as well as PC professionals noted a series of central aspects with respect to the implementation of a programme for the acquisition of healthy dietary and hygiene habits for depressive patients, which may be organized around 'personal', 'programmatic', and 'transversal' aspects. As for the personal aspects, categories regarding 'patient history', and 'disposition' were found; the programmatic aspects included categories such as 'presentation and monitoring', and modification of 'cognitive' and 'behavioural' habits; whereas the transversal aspects comprised the possibilities of 'social support' and defining categories of 'objectives'. CONCLUSION The implementation of intervention programmes that combine dietary and hygiene-related factors in patients with depression is complex, given the nature of the disorder itself, and its symptoms such as apathy and feelings of guilt or incompetence. Key issues exist for the success of the intervention, such as the simplicity of guidelines, tailoring through motivational interviewing, prolonged and intense monitoring throughout the different stages of the disorder, and the provision of adequate feedback and social support. PC could be an appropriate level in which to implement these interventions.
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Affiliation(s)
- B. Olivan-Blázquez
- Department of Psychology and Sociology, University of Zaragoza, Violante de Hungria 23, 50009 Zaragoza, Spain
- Research Network on Preventive Activities and Health Promotion (Red de Investigación en Actividades Preventivas y Promoción de la Salud - RedIAPP), Barcelona, Spain
- Promosam Network, Red de Excelencia PSI2014-56303-REDT PROMOSAM: (Investigación en procesos, mecanismos y tratamientos psicológicos para la promoción de la salud mental), Economy and Competitiveness Ministry, Madrid, Spain
| | - J. Montero-Marin
- Research Network on Preventive Activities and Health Promotion (Red de Investigación en Actividades Preventivas y Promoción de la Salud - RedIAPP), Barcelona, Spain
- Promosam Network, Red de Excelencia PSI2014-56303-REDT PROMOSAM: (Investigación en procesos, mecanismos y tratamientos psicológicos para la promoción de la salud mental), Economy and Competitiveness Ministry, Madrid, Spain
| | - M. García-Toro
- Research Network on Preventive Activities and Health Promotion (Red de Investigación en Actividades Preventivas y Promoción de la Salud - RedIAPP), Barcelona, Spain
- Institut Universitari d’Investigació en Ciències de la Salut (IUNICS), Universitat de les Illes Balears (UIB), Palma de Mallorca, Spain
| | - E. Vicens-Pons
- Research Network on Preventive Activities and Health Promotion (Red de Investigación en Actividades Preventivas y Promoción de la Salud - RedIAPP), Barcelona, Spain
- Departamento de Psiquiatría, Parc Sanitari San Joan de Déu, Sant Boi de Llobregat, Spain
| | - M. J. Serrano-Ripoll
- Institut Universitari d’Investigació en Ciències de la Salut (IUNICS), Universitat de les Illes Balears (UIB), Palma de Mallorca, Spain
| | - A. Castro-Gracia
- Institut Universitari d’Investigació en Ciències de la Salut (IUNICS), Universitat de les Illes Balears (UIB), Palma de Mallorca, Spain
| | | | | | - Y. López-del-Hoyo
- Department of Psychology and Sociology, University of Zaragoza, Violante de Hungria 23, 50009 Zaragoza, Spain
- Research Network on Preventive Activities and Health Promotion (Red de Investigación en Actividades Preventivas y Promoción de la Salud - RedIAPP), Barcelona, Spain
- Promosam Network, Red de Excelencia PSI2014-56303-REDT PROMOSAM: (Investigación en procesos, mecanismos y tratamientos psicológicos para la promoción de la salud mental), Economy and Competitiveness Ministry, Madrid, Spain
| | - J. Garcia-Campayo
- Research Network on Preventive Activities and Health Promotion (Red de Investigación en Actividades Preventivas y Promoción de la Salud - RedIAPP), Barcelona, Spain
- Promosam Network, Red de Excelencia PSI2014-56303-REDT PROMOSAM: (Investigación en procesos, mecanismos y tratamientos psicológicos para la promoción de la salud mental), Economy and Competitiveness Ministry, Madrid, Spain
- Aragones Health Service, Zaragoza, Spain
- Department of Medicine and Psychiatry, University of Zaragoza, Zaragoza, Spain
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45
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Lewinski AA, Anderson RA, Vorderstrasse AA, Fisher EB, Pan W, Johnson CM. Type 2 Diabetes Education and Support in a Virtual Environment: A Secondary Analysis of Synchronously Exchanged Social Interaction and Support. J Med Internet Res 2018; 20:e61. [PMID: 29467118 PMCID: PMC5842323 DOI: 10.2196/jmir.9390] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 12/15/2017] [Accepted: 12/16/2017] [Indexed: 11/18/2022] Open
Abstract
Background Virtual environments (VEs) facilitate interaction and support among individuals with chronic illness, yet the characteristics of these VE interactions remain unknown. Objective The objective of this study was to describe social interaction and support among individuals with type 2 diabetes (T2D) who interacted in a VE. Methods Data included VE-mediated synchronous conversations and text-chat and asynchronous emails and discussion board posts from a study that facilitated interaction among individuals with T2D and diabetes educators (N=24) in 2 types of sessions: education and support. Results VE interactions consisted of communication techniques (how individuals interact in the VE), expressions of self-management (T2D-related topics), depth (personalization of topics), and breadth (number of topics discussed). Individuals exchanged support more often in the education (723/1170, 61.79%) than in the support (406/1170, 34.70%) sessions or outside session time (41/1170, 3.50%). Of all support exchanges, 535/1170 (45.73%) were informational, 377/1170 (32.22%) were emotional, 217/1170 (18.55%) were appraisal, and 41/1170 (3.50%) were instrumental. When comparing session types, education sessions predominately provided informational support (357/723, 49.4%), and the support sessions predominately provided emotional (159/406, 39.2%) and informational (159/406, 39.2%) support. Conclusions VE-mediated interactions resemble those in face-to-face environments, as individuals in VEs engage in bidirectional exchanges with others to obtain self-management education and support. Similar to face-to-face environments, individuals in the VE revealed personal information, sought information, and exchanged support during the moderated education sessions and unstructured support sessions. With this versatility, VEs are able to contribute substantially to support for those with diabetes and, very likely, other chronic diseases.
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Affiliation(s)
- Allison A Lewinski
- Durham Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC, United States
| | - Ruth A Anderson
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | - Edwin B Fisher
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Peers for Progress, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Wei Pan
- School of Nursing, Duke University, Durham, NC, United States
| | - Constance M Johnson
- School of Nursing, Duke University, Durham, NC, United States.,Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, TX, United States
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Vongmany J, Luckett T, Lam L, Phillips JL. Family behaviours that have an impact on the self-management activities of adults living with Type 2 diabetes: a systematic review and meta-synthesis. Diabet Med 2018; 35:184-194. [PMID: 29150863 DOI: 10.1111/dme.13547] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2017] [Indexed: 12/27/2022]
Abstract
AIMS To identify family behaviours that adults with Type 2 diabetes' perceive as having an impact on their diabetes self-management. BACKGROUND Research suggests that adults with Type 2 diabetes perceive that family members have an important impact on their self-management; however, it is unclear which family behaviours are perceived to influence self-management practices. METHODS This meta-synthesis identified and synthesized qualitative studies from the databases EMBASE, Medline and CINAHL published between the year 2000 and October 2016. Studies were eligible if they provided direct quotations from adults with Type 2 diabetes, describing the influence of families on their self-management. This meta-synthesis adheres to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. RESULTS Of the 2606 studies screened, 40 were included. This meta-synthesis identified that adults with Type 2 diabetes perceive family behaviours to be either: 1) facilitators of diabetes self-management; 2) barriers to diabetes self-management; or 3) equivocal behaviours with the potential to both support and/or impede diabetes self-management. Seven sub-themes were identified within these themes, including: four facilitator sub-themes ('positive care partnerships'; 'family watchfulness'; 'families as extrinsic motivator' and 'independence from family'); two barrier sub-themes ('obstructive behaviours' and 'limited capacity for family support'); and one equivocal behaviours subtheme ('regular reminders and/or nagging'). CONCLUSION While most family behaviours are unambiguously perceived by adults with Type 2 diabetes to act as facilitators of or barriers to self-management, some behaviours were perceived as being neither clear facilitators nor barriers; these were termed 'equivocal behaviours'. If the concept of 'equivocal behaviours' is confirmed, it may be possible to encourage the adult living with Type 2 diabetes to reframe these behaviours so that they are perceived as enabling their diabetes self-management.
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Affiliation(s)
- J Vongmany
- Centre for Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - T Luckett
- Centre for Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - L Lam
- Centre for Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - J L Phillips
- Centre for Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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Vanstone M, Rewegan A, Brundisini F, Giacomini M, Kandasamy S, DeJean D. Diet modification challenges faced by marginalized and nonmarginalized adults with type 2 diabetes: A systematic review and qualitative meta-synthesis. Chronic Illn 2017; 13:217-235. [PMID: 27884930 DOI: 10.1177/1742395316675024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Diet modification is an important part of the prevention and treatment of type 2 diabetes, but sustained dietary change remains elusive for many individuals. This paper describes and interprets the barriers to diet modification from the perspective of people with type 2 diabetes, paying particular attention to the experiences of people who experience social marginalization. Methods A systematic review of primary, empirical qualitative research was performed, capturing 120 relevant studies published between 2002 and 2015. Qualitative meta-synthesis was used to provide an integrative analysis of this knowledge. Results Due to the central role of food in social life, dietary change affects all aspects of a person's life, and barriers related to self-discipline, emotions, family and social support, social significance of food, and knowledge were identified. These barriers are inter-linked and overlapping. Social marginalization magnifies barriers; people who face social marginalization are trying to make the same changes as other people with diabetes with fewer socio-material resources in the face of greater challenges. Discussion A social-ecological model of behavior supports our findings of challenges at all levels, and highlights the need for interventions and counseling strategies that address the social and environmental factors that shape and sustain dietary change.
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Affiliation(s)
- Meredith Vanstone
- 1 Department of Family Medicine, McMaster University, Hamilton, ON, Canada.,2 Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Alex Rewegan
- 3 MA Program in Social Anthropology, York University, Hamilton, ON, Canada
| | - Francesca Brundisini
- 2 Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.,4 Health Policy PhD Program, McMaster University, Hamilton, ON, Canada
| | - Mita Giacomini
- 2 Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.,5 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Sujane Kandasamy
- 5 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Deirdre DeJean
- 2 Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.,5 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
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48
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Lo C, Teede H, Fulcher G, Gallagher M, Kerr PG, Ranasinha S, Russell G, Walker R, Zoungas S. Gaps and barriers in health-care provision for co-morbid diabetes and chronic kidney disease: a cross-sectional study. BMC Nephrol 2017; 18:80. [PMID: 28245800 PMCID: PMC5331625 DOI: 10.1186/s12882-017-0493-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 02/21/2017] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Patients with diabetes and chronic kidney disease (CKD) are a complex subset of the growing number of patients with diabetes, due to multi-morbidity. Gaps between recommended and received care for diabetes and chronic kidney disease (CKD) are evident despite promulgation of guidelines. Here, we document gaps in tertiary health-care, and the commonest patient-reported barriers to health-care, before exploring the association between these gaps and barriers. METHODS This cross-sectional study recruited patients with diabetes and CKD (eGFR < 60 mL/min/1.73 m2) across 4 large hospitals. For each patient, questionnaires were completed examining clinical data, recommended care, and patient-reported barriers limiting health-care. Descriptive statistics, subgroup analyses by CKD stage and hospital, and analyses examining the relationship between health-care gaps and barriers were performed. RESULTS 308 patients, of mean age 66.9 (SD 11.0) years, and mostly male (69.5%) and having type 2 diabetes (88.0%), participated. 49.1% had stage 3, 24.7% stage 4 and 26.3% stage 5 CKD. Gaps between recommended versus received care were evident: 31.9% of patients had an HbA1c ≥ 8%, and 39.3% had a measured blood pressure ≥ 140/90 mmHg. The commonest barriers were poor continuity of care (49.3%), inadequate understanding/education about CKD (43.5%), and feeling unwell (42.6%). However, barriers associated with a failure to receive items of recommended care were inadequate support from family and friends, conflicting advice from and poor communication amongst specialists, the effect of co-morbidities on self-management and feeling unmotivated (all p < 0.05). CONCLUSIONS Barriers to health-care varied across CKD stages and hospitals. Barriers associated with a deviation from recommended care were different for different items of care, suggesting that specific interventions targeting each item of care are required.
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Affiliation(s)
- C. Lo
- Diabetes and Vascular Research Program, Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria Australia
- Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Victoria Australia
| | - H. Teede
- Diabetes and Vascular Research Program, Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria Australia
- Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Victoria Australia
| | - G. Fulcher
- Department of Diabetes and Endocrinology, Royal North Shore Hospital, St Leonards, New South Wales Australia
| | - M. Gallagher
- Department of Nephrology, Concord Hospital, Concord, New South Wales Australia
- The George Institute for Global Health, Sydney, New South Wales Australia
| | - P. G. Kerr
- Department of Nephrology, Monash Health, Clayton, Victoria Australia
| | - S. Ranasinha
- Diabetes and Vascular Research Program, Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria Australia
| | - G. Russell
- School of Primary Health Care, Monash University, Notting Hill, Victoria Australia
| | - R. Walker
- Department of Renal Medicine, Alfred Health, Prahran, Victoria Australia
| | - S. Zoungas
- Diabetes and Vascular Research Program, Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria Australia
- Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Victoria Australia
- Department of Diabetes and Endocrinology, Royal North Shore Hospital, St Leonards, New South Wales Australia
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Bennich BB, Røder ME, Overgaard D, Egerod I, Munch L, Knop FK, Vilsbøll T, Konradsen H. Supportive and non-supportive interactions in families with a type 2 diabetes patient: an integrative review. Diabetol Metab Syndr 2017; 9:57. [PMID: 28736580 PMCID: PMC5521150 DOI: 10.1186/s13098-017-0256-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/15/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Type 2 diabetes and its management affect the patient and the close family potentially causing either psychological distress or increased sense of responsibility and collaboration in these families. Interactions between patient and family play an important role in maintaining lifestyle changes and diabetes self-management. The purpose of this integrative review was to summarise and assess published studies on the intra-family perspective of supportive and non-supportive interactions in families with a type 2 diabetes patient. METHODS Included in the review were published qualitative and quantitative studies that examined the intra-family perspective on supportive and non-supportive interactions. We searched the literature from 2000 to 2016 and the search strategy comprised the following databases: Cochrane, PubMed, CINAHL, Web of Science, PsycINFO and Psyc-ARTICLES as well as hand searching of reference lists. Quality assessment, data extraction and analysis were undertaken on all included studies. RESULTS We identified five eligible research papers. Employing content analysis three categories describing interactions were refined: Impact of practical action, impact of emotional involvement, and impact of communication content. Supportive interactions included encouraging communication and family collaboration in managing diet, medications, and blood glucose checking. Non-supportive interactions were visible irritation, nagging behaviour and refusing to share the burden of living with diabetes. CONCLUSION The findings stress the importance of including both patient and family in clinical practice to target diabetes self-management adherence and well-being of the whole family. The majority of self-management occurs within the family environment. Therefore, the intra-family perspective of supportive and non-supportive interactions should be understood and addressed as the family members are interdependent and affected by each other. Future research assessing the impact of professional support and the family function will have the potential to improve the daily life and well-being of patients with type 2 diabetes as well as the whole family.
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Affiliation(s)
- Birgitte B. Bennich
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Institute of Nursing, Metropolitan University College, Copenhagen N, Denmark
| | - Michael E. Røder
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Dorthe Overgaard
- Institute of Nursing, Metropolitan University College, Copenhagen N, Denmark
| | - Ingrid Egerod
- Intensive Care Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Faculty of Health & Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lene Munch
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Institute of Nursing, Metropolitan University College, Copenhagen N, Denmark
| | - Filip K. Knop
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- NNF Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tina Vilsbøll
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Konradsen
- Department of Neurobiology, Care Sciences and Society, NVS, Karolinska Instituttet, Alfred Nobels Allé 23, 141 52 Hundinge, Sweden
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50
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Lidegaard LP, Schwennesen N, Willaing I, Faerch K. Barriers to and motivators for physical activity among people with Type 2 diabetes: patients' perspectives. Diabet Med 2016; 33:1677-1685. [PMID: 27279343 DOI: 10.1111/dme.13167] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2016] [Indexed: 11/30/2022]
Abstract
AIM To explore barriers to and motivators for physical activity in a group of overweight and obese individuals with dysregulated Type 2 diabetes. METHODS Data were collected from the Steno Diabetes Center's outpatient clinic in Denmark. Four focus groups were conducted including 28 individuals with Type 2 diabetes aged 39-71 years. The facilitators used open-ended questions and probes such as images, statements and quotations about physical activity to foster active participation and interaction among participants. Focus groups were recorded on video and the discussions were transcribed and analysed thematically. RESULTS We identified four main themes: 1) the body as a barrier to physical activity because of functional limitations; 2) logistical challenges, including lack of time and awareness of where to exercise in the local area; 3) being physically active with others, providing a sense of mutual commitment and enjoyment; and 4) goal-setting and self-tracking, which was seen as an opportunity to track physical improvement over time. CONCLUSIONS The findings suggest that, once people are active, a high level of social interaction may help maintain their activity levels. Further research is needed to investigate the effect of combining individually tailored exercise plans with the establishment of customized and locally based exercise communities that offer enjoyment and support. Additionally, it is relevant to explore experiences of using self-tracking technologies to review short- and long-term goals.
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Affiliation(s)
| | - N Schwennesen
- Steno Diabetes Center, Gentofte, Denmark
- Centre for Healthy Ageing, Department of Anthropology and Public Health, University of Copenhagen, Copenhagen, Denmark
| | - I Willaing
- Steno Diabetes Center, Gentofte, Denmark
| | - K Faerch
- Steno Diabetes Center, Gentofte, Denmark
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