Reasons for non-participation in a self-care training program for diabetic patients: a qualitative study

Introduction

Self-care behaviors in diabetic patients is considered an important factor for controlling the diabetes. Therefore, diabetic patients need training the self-care behaviors to control this disease. This study aims to investigate the reasons for diabetic patients’ non-participation in a self-care training program.

Method

This qualitative study was carried out between 1 April to 1 July 2019. We used in-depth semi-structured interviews with 30 diabetic patients who did not participate in the self-care training program. Data analysis was conducted using content analysis with MAXQDA software.

Findings

The results of this study showed that there are 5 themes and 14 sub-themes for patients’ non-participation in self-care training program. Themes included access; individual, familial and social factors; attitude and awareness; motivator factors and need Factors. Also sub-themes were physical access, time access, physical abilities, social-familial responsibilities, attitude to disease, attitude to education, attitude to health, awareness, incentive, communication, teaching methods, perceived risk, access to other educational resources and self-efficacy.

Conclusion

According to the results of this study, simple physical and time access, offering high-quality education, providing virtual and distant training, organizing and designing modern training methods can lead to increase participation in self-care training programs.

Self-Care Management of Patients with diabetes: nurses' perspectives

PURPOSE

To explore nurses' experiences of providing education on self- care management to patients with diabetes.

METHODS

A qualitative phenomenological study using semi-structured interview on all nine certified diabetic nurse educators in the main hospital and health centres in Brunei. Prolonged engagement with participants and data, and member checking were employed to ensure thematic analysis was trustworthy.

RESULTS

Three main themes emerged; 1) Factors of effective teaching strategies that emphasizes on assessing patients' knowledge and education level to provide individualised instructional plan, which need to follow latest ministerial guidelines and effective pedagogy; 2) Barriers to provide effective education including psychological, financial, and lack of familial support, 3) Overcoming barriers through parallel health education and counselling, referring to medical social worker and non-governmental organizations, and inclusion of family members and carers in plan of care.

CONCLUSION

Diabetic nurse educator plays a crucial role to ensure patient with diabetes achieved competency and compliance with long term self-care management. Nurses' need to ensure psychological preparedness and patient literacy assessment when designing individualised health education session. While identifying and addressing key barriers for each patient to ensure effectiveness of management plan and improve quality of life. More research are still needed to explore experiences and innovation solutions from nurses in different parts of the world to better inform policymakers and improve organisational and national guidelines for management of patients with diabetes.

Evaluation of first-person storytelling on changing health-related attitudes, knowledge, behaviors, and outcomes: A scoping review

OBJECTIVES

First-person storytelling (FPS) has the potential to engage patients in changing behavior differently than didactic education. We assessed the prevalence of FPS in health education interventions; whether published FPS research has shown improvements in attitudinal, knowledge, behavioral, or clinical outcomes; and whether randomized controlled trials (RCTs) including FPS have shown more effectiveness than non-FPS interventions.

METHODS

A scoping review of FPS studies published before October 2019 in five medical databases was conducted.

RESULTS

22 out of 10,363 identified studies met eligibility criteria. FPS has been studied primarily in cancer, diabetes, and hypertension. Of the 12 RCTs, compared to controls, patients receiving FPS interventions improved attitudes (N = 6 studies) and knowledge (N = 1), improved health behaviors like quitting smoking (N = 6), and improved clinical outcomes like lowering A1C levels (N = 3). Of the 10 non-RCT studies, compared to baseline assessments, patients who received FPS interventions had improved knowledge (N = 1), attitudes (N = 3), clinical outcomes (N = 4), and improved health behaviors (N = 7).

CONCLUSION

While rarely used, FPS interventions can improve patient health attitudes and outcomes. Future research should expand FPS to new health areas and determine best practices for developing FPS interventions.

PRACTICE IMPLICATIONS

FPS may be particularly effective with low income patients and racial/ethnic minorities.

Diabetes Self-Management Education and Support: Referral and Attendance at a Patient-Centered Medical Home

BACKGROUND

Although evidence shows that diabetes self-management education and support (DSMES) is an effective tool to help individuals with type 2 diabetes (T2DM) improve their health outcomes, there remains a large number of individuals not attending DSMES. Understanding how frequently patients receive referrals to DSMES and the number of DSMES hours they receive is important to determine, as well as patients' health outcomes of utilizing DSMES. This will help us understand patterns of utilization and the outcomes that occur when such a valuable resource is utilized.

METHODS

Secondary data analysis was conducted of patient electronic medical records at a primary healthcare federally qualified clinic and 2 area hospitals. We identified 105 adult patients with a new T2DM diagnosis with at least 2 A1c lab results 3 to 12 months apart during the study period.

RESULTS

Only 53.5% were referred to DSMES. Out of those who were referred, 66% received no DSMES, 17% received 1-hour assessment, 4% received partial DSMES, and 13% received 8 or more hours. Linear regression of percent change in A1c and number of DSMES hours received, revealed that receiving 1 (P = .001) or 8 or more hours of DSMES (P = .022) had a significant negative relationship with the percent difference in A1c compared to the group who received no DSMES. Patients who had an hour of assessment had a similar percent reduction in A1c to those who had partial DSMES.

CONCLUSION

Referral rates and enrollment in DSMES remain low. Those who enrolled often dropped out after the one-hour assessment session. Results suggest making the one-hour assessment session more educationally comprehensive or longer to retain patients. Improving the DSMES referral process and further investing physicians' decisions on whether to refer or not refer patients to DSMES are key for future studies.