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Hemetek U, Aubram T, Grüblbauer J, Höld E. How to facilitate peer support - learnings from the development of a peer support program for people with T2DM via instant messaging service to improve diabetes self-management. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2025; 5:1491865. [PMID: 39834648 PMCID: PMC11743560 DOI: 10.3389/fcdhc.2024.1491865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Accepted: 12/03/2024] [Indexed: 01/22/2025]
Abstract
This study explores the use of Instant Messaging Services (IMS) for peer support among individuals with Type 2 Diabetes Mellitus (T2DM). Leveraging the popularity of IMS within the affected age group, the DiabPeerS study implemented a peer support intervention aimed at improving long-term blood glucose levels (HbA1c) in a randomized controlled trial (RCT). This article describes the development and acceptance of the IMS intervention used in the DiabPeerS study. The intervention included a communication strategy and content designed for lay moderators to facilitate group interaction among people with Type 2 Diabetes mellitus (PWT2D). The intervention's acceptance was determined by conducting participant interviews, moderator meetings, and analysis of IMS chat protocols. Results indicate that the intervention was well-received, with participants engaging in meaningful exchange about diabetes self-management (DSM). However, those less familiar with online communication may benefit from preparational training and initial face-to-face meetings could enhance group cohesion. This research offers insights into the practical application of IMS for diabetes peer support, highlighting both its benefits and room for improvement.
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Affiliation(s)
- Ursula Hemetek
- Institute of Health Sciences, Department of Health, University of Applied Sciences St. Pölten, St. Pölten, Austria
| | - Tatjana Aubram
- Institute for Innovation Systems, Department Digital Business and Innovation, University of Applied Sciences St. Pölten, St. Pölten, Austria
| | - Johanna Grüblbauer
- Institute for Creative\Media/Technologies, Department Media and Digital Technologies, University of Applied Sciences St. Pölten, St. Pölten, Austria
| | - Elisabeth Höld
- Institute of Health Sciences, Department of Health, University of Applied Sciences St. Pölten, St. Pölten, Austria
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Healy KV, Rähse T, Weise S, Fink A, Frese T, Knöchelmann A. Latent classes of learners in people with type 2 diabetes, stratified by educational status: A cross-sectional study. PATIENT EDUCATION AND COUNSELING 2024; 130:108466. [PMID: 39454546 DOI: 10.1016/j.pec.2024.108466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 08/15/2024] [Accepted: 10/06/2024] [Indexed: 10/28/2024]
Abstract
OBJECTIVE Research suggests that people with type 2 diabetes (PWT2D) exhibit different approaches to learning about disease-management. This study's aims to identify distinct learner groups among PWT2D and stratify them by educational status (ES). METHODS Cross-sectional data from 227 PWT2D, collected through 46 Likert-scale questions on learning behaviors, preferences, and attitudes, were analyzed using latent class analysis, to identify learner groups. Participants were recruited via healthcare practices in central Germany and a countrywide online survey. Group membership was displayed according to low, medium, and high ES, defined by years of schooling. RESULTS Four learner groups were identified: casual, versatile, insecure, and theorist learners. Insecure learners accounted for almost half of all respondents in the low ES group (46 %), casual learners were most prevalent among PWT2D with a medium (27 %), versatile (34 %) and theorist (29 %) learners among those with a high ES. CONCLUSION This study sheds light on learner groups among PWT2D, which differ by ES, suggesting social disparities in diabetes care. Further research is needed to validate these findings. PRACTICE IMPLICATIONS Understanding individual learning preferences and motivations is crucial for developing effective diabetes self-management trainings, which may involve providing additional background material for theorists and practical applications for insecure learners.
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Affiliation(s)
- Karl V Healy
- Institute of Medical Sociology, Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle, Saxony-Anhalt, Germany
| | - Tobias Rähse
- Institute of Medical Sociology, Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle, Saxony-Anhalt, Germany.
| | - Solveig Weise
- Institute of Medical Sociology, Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle, Saxony-Anhalt, Germany; Institute for General Medicine, Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle, Saxony-Anhalt, Germany
| | - Astrid Fink
- Institute of Medical Sociology, Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle, Saxony-Anhalt, Germany; District Administration Groß-Gerau, Germany, Department of Health, Germany
| | - Thomas Frese
- Institute for General Medicine, Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle, Saxony-Anhalt, Germany
| | - Anja Knöchelmann
- Institute of Medical Sociology, Interdisciplinary Centre for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle, Saxony-Anhalt, Germany
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Bransteter I, McVoy M, Miller DW, Gubitosi-Klug RA, Segall TL, Divan MK, Surdam J, Sajatovic M, Dusek JA. Barriers and Facilitators to Incorporating an Integrative Mind-Body Intervention in Youth With Type 2 Diabetes. JAACAP OPEN 2024; 2:208-216. [PMID: 39552817 PMCID: PMC11562543 DOI: 10.1016/j.jaacop.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 11/19/2024]
Abstract
Objective There has been little to no qualitative research done with adolescents and young adults (AYA) with type 2 diabetes (T2D) that can guide creation of interventions for this demographic. Using qualitative research methods, a novel mind-body intervention called Intervention for Early Onset Type 2 Diabetes (INTEND) has been developed for AYA aged 15 to 20 years, with the goal of improving self-management and coping skills, by enhancing routine care with augmented education coupled with mind-body skills. Method Qualitative interviews with AYA 15 to 20 years of age with T2D, their parents, and professionals caring specifically for this population were done through a focus group model. Transcripts were created, depersonalized, and coded using a Consensual Qualitative Research (CQR) method. Identified themes then guided the creation of course materials that included education about self-management of T2D and how to use the 4 mind-body technique toward self-care and regulation. Results The qualitative approach used in the development of this intervention revealed important findings in understanding key barriers faced by this group, key facilitators that improve their quality of life, and core components of an intervention that would be acceptable to them. Conclusion Results of this qualitative study helped craft an intervention tool that can subsequently be deployed and evaluated for effectiveness. Findings of the qualitative research model allow us to better understand the lived experience of AYA living with T2D. Clinical guidance •Stigma of type 2 diabetes in adolescents may interfere with patients' ability to adequately adhere to treatment recommendations•Clinicians need to identify social supports for adolescents with type 2 diabetes•Identifying family members and including them in treatment plans may help adolescents with type 2 diabetes.
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Affiliation(s)
- Irina Bransteter
- Case Western Reserve University School of Medicine, Cleveland, Ohio
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Molly McVoy
- Case Western Reserve University School of Medicine, Cleveland, Ohio
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
- Rainbow Babies and Children, UHCMC, Cleveland, Ohio
| | | | - Rose A. Gubitosi-Klug
- Case Western Reserve University School of Medicine, Cleveland, Ohio
- Rainbow Babies and Children, UHCMC, Cleveland, Ohio
| | | | - Mina K. Divan
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jessica Surdam
- University Hospitals Connor Whole Health, Cleveland, Ohio
| | - Martha Sajatovic
- Case Western Reserve University School of Medicine, Cleveland, Ohio
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
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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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Abdelhameed F, Pearson E, Parsons N, Barber TM, Panesar A, Summers C, de la Fosse M, Hanson P. Health Outcomes Following Engagement With a Digital Health Tool Among People With Prediabetes and Type 2 Diabetes: Prospective Evaluation Study. JMIR Diabetes 2023; 8:e47224. [PMID: 38016426 PMCID: PMC10784975 DOI: 10.2196/47224] [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: 03/12/2023] [Revised: 11/25/2023] [Accepted: 11/27/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Diabetes is a worldwide chronic condition causing morbidity and mortality, with a growing economic burden on health care systems. Complications from poorly controlled diabetes are associated with increased socioeconomic costs and reduced quality of life. Smartphones have become an influential platform, providing feasible tools such as health apps to deliver tailored support to enhance the ability of patients with diabetes for self-management. Gro Health is a National Health Service division X-certified digital health tool used to deliver educational and monitoring support to facilitate the development of skills and practices for maintaining good health. OBJECTIVE This study aims to assess self-reported outcomes of the Gro Health app among users with diabetes and prediabetes and identify the factors that determine engagement with the digital health tool. METHODS This was a service evaluation of self-reported data collected prospectively by the developers of the Gro Health app. The EQ-5D questionnaire is a standardized tool used to measure health status for clinical and economic appraisal. Gro Health users completed the EQ-5D at baseline and 6 months after using the app. Users provided informed consent for the use of their anonymized data for research purposes. EQ-5D index scores and visual analogue scale (VAS) scores were calculated at baseline and 6 months for individuals with prediabetes and type 2 diabetes. Descriptive statistics and multiple-regression models were used to assess changes in the outcome measures and determine factors that affected engagement with the digital tool. RESULTS A total of 84% (1767/2114) of Gro Health participants completed EQ-5D at baseline and 6 months. EQ-5D index scores are average values that reflect people's preferences about their health state (1=full health and 0=moribund). There was a significant and clinically meaningful increase in mean EQ-5D index scores among app users between baseline (0.746, SD 0.23) and follow-up (0.792, SD 0.22; P<.001). The greatest change was observed in the mean VAS score, with a percentage change of 18.3% improvement (61.7, SD 18.1 at baseline; 73.0, SD 18.8 at follow-up; P<.001). Baseline EQ-5D index scores, age, and completion of educational modules were associated with significant changes in the follow-up EQ-5D index scores, with baseline EQ-5D index scores, race and ethnicity, and completion of educational modules being significantly associated with app engagement (P<.001). CONCLUSIONS This study provides evidence of a significant positive effect on self-reported quality of life among people living with type 2 diabetes engaging with a digital health intervention. The improvements, as demonstrated by the EQ-5D questionnaire, are facilitated through access to education and monitoring support tools within the app. This provides an opportunity for health care professionals to incorporate National Health Service-certified digital tools, such as Gro Health, as part of the holistic management of people living with diabetes.
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Affiliation(s)
- Farah Abdelhameed
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Eilish Pearson
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Nick Parsons
- Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Thomas M Barber
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Arjun Panesar
- Diabetes Digital Media Health, Coventry, United Kingdom
| | | | | | - Petra Hanson
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
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Sabahi A, Jalali S, Ameri F, Garavand A, Negahban A. The effect of using mobile health on self-management of type 2 diabetic patients: A systematic review in Iran. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:358. [PMID: 38143998 PMCID: PMC10743845 DOI: 10.4103/jehp.jehp_910_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 12/06/2022] [Indexed: 12/26/2023]
Abstract
Type 2 diabetes, as one of the most common chronic diseases, requires ongoing management and support from the patient; therefore, patient participation and self-management play a pivotal role in controlling and preventing this disease. The increasing use of smartphones has provided a good opportunity for controlling and managing patients with type 2 diabetes. This study aimed to investigate the effect of mobile health on the self-management of patients with type 2 diabetes in Iran. A systematic review study was conducted from 2010 to 2021. Searches in Persian and English scientific databases, IranDoc, MagIran, SID Web of science, and PubMed, were performed using keywords such as diabetes and mobile health. The process of reviewing and selecting articles based on inclusion and exclusion criteria was performed by two researchers independently. The study evaluation was performed by using a standard tool. After selecting articles, data extraction was performed using a data extraction form. Data analysis was performed with a content analysis approach. Finally, 23 articles were included from the 7767 articles found in the initial search stage, which examined patients' self-care in 11 areas using mobile health. Fourteen studies (61%) considered mobile health to be effective in increasing hemoglobin control. Other studies also found the use of mobile health in increasing adherence to exercise (n = 10), increasing adherence to medication (n = 9), increasing adherence to diet (n = 11), increasing care for diabetic foot ulcers (n = 8), increasing self-efficacy and empowerment (n = 5), increasing cholesterol control (n = 4), increasing awareness and attitude (n = 4), increasing control of insulin dose (n = 2), increasing adherence to education (n = 1), and increasing control of blood urea (n = 1), which were considered effective. The use of m-health effectively controls the disease and promotes self-management in type 2 diabetic patients. Considering the high cost of diabetes treatment, policymakers should implement appropriate interventions and strategies in the field of using mobile health to improve adherence to self-management of the disease.
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Affiliation(s)
- Azam Sabahi
- Department of Health Information Technology, Ferdows School of Health and Allied Medical Sciences, Birjand University of Medical Sciences, Birjand, Iran
| | - Samaneh Jalali
- Ferdows School of Paramedical and Health, Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
| | - Fatemeh Ameri
- Ferdows School of Paramedical and Health, Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
| | - Ali Garavand
- Department of Health Information Technology, School of Allied Medical Sciences, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Ahmad Negahban
- Department of Health Information Technology, Ferdows School of Health and Allied Medical Sciences, Birjand University of Medical Sciences, Birjand, Iran
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Mohd ZW, Ahmad SR, Yaacob NA, Mohd Shariff N, Jaeb MZ, Hussin Z. Innovative Integrated Motivational Interviewing for Dual Management in Tuberculosis Patients with Diabetes (MID-DOT) in Malaysia. Healthcare (Basel) 2023; 11:1929. [PMID: 37444763 DOI: 10.3390/healthcare11131929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/23/2023] [Accepted: 05/31/2023] [Indexed: 07/15/2023] Open
Abstract
(1) Background: Achieving successful tuberculosis (TB) treatment outcomes among diabetic patients is a real challenge as TB complicates control of diabetes. This study aimed to evaluate the effectiveness of an integrated dual management educational module, MID-DOTS, which uses the mmotivational interviewing (MI) technique implemented within directly observed treatment as part of a short course (DOTS) program in TB patients with diabetes (TB/DM). A randomized controlled trial was conducted in the northeastern state of Malaysia. (2) Methods: One hundred and twenty-four TB patients with diabetes received educational intervention using a MID-DOT module that used the MI technique, which was repetitively applied by TB nurses throughout a 6-month DOTS program while another 122 patients were given standard health education. Study outcomes include the proportion of patients with successful TB treatment, and changes in HbA1c and diabetic self-care scores at 6 months. (3) Results: The successful TB treatment outcome was 88% in the intervention group versus 72% in the control group (RR = 1.24; 95%CI 1.16, 1.58). A significant reduction of HbA1c (mean difference 0.82%; 95%CI 0.66, 0.98) and significantly higher diabetes self-care score (mean difference 8.49; 95%CI 7.38, 9.59) were also shown in the intervention group. (4) Conclusions: A dual TB/DM educational strategy which integrates the MI technique applied repetitively within the DOTS program is effective in increasing successful TB treatment as well as improving diabetic outcomes.
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Affiliation(s)
- Zahiruddin Wan Mohd
- School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu 16150, Malaysia
| | | | - Nor Azwany Yaacob
- School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu 16150, Malaysia
| | | | - Mat Zuki Jaeb
- Hospital Raja Perempuan Zainab II, Kota Bharu 15586, Malaysia
| | - Zalmizy Hussin
- School of Applied Psychology, Social Work and Policy, Universiti Utara Malaysia, Sintok 06010, Malaysia
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Camargo-Plazas P, Robertson M, Paré GC, Costa IG, Alvarado B, Ross-White A, Duhn L. Diabetes self-management education for older adults in Western countries: a scoping review protocol. JBI Evid Synth 2023; 21:993-1000. [PMID: 36424871 DOI: 10.11124/jbies-22-00254] [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] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This scoping review will map the available evidence on diabetes self-management education programs for older adults in Western countries. INTRODUCTION Self-management and education are crucial for controlling diabetes and its associated complications. The successful uptake of diabetes self-management education programs is not straightforward, and little is known about diabetes programs for older adults. Within this context, a broad overview of diabetes self-management education for older adults, considering all types of related evidence, is needed. INCLUSION CRITERIA All studies in English concerning diabetes self-management education for older adults (aged 65 years and older) living with type 1 or 2 diabetes will be included. This review will not be specific to gender, sex, ethnicity, frailty, or other demographic variables. The review will be restricted to Western countries (North America, Western and Northern Europe, and Australasia), where approaches to diabetes self-management education will be similar. Studies including older adults with or without diabetes will not be considered unless they provide separate analyses for the 2 cohorts. METHODS This scoping review will follow the JBI methodology for scoping reviews. We will conduct searches of electronic databases, including CINAHL, MEDLINE, and PubMed, from January 1, 2000, to the present to capture eligible articles. The review will consider all study designs, including quantitative, qualitative, mixed methods designs, as well as text and opinion papers, and systematic reviews that meet the inclusion criteria. After duplicates are removed, titles and abstracts will be screened independently by 2 reviewers, and the full texts will be reviewed. The screening criteria and data extraction protocol will be pilot-tested by the research team. The results will be summarized in tables accompanied by narrative text.
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Affiliation(s)
- Pilar Camargo-Plazas
- School of Nursing, Queen's University, Kingston, ON, Canada
- Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Queen's University, Kingston, ON, Canada
| | | | | | | | - Beatriz Alvarado
- Department of Public Health Sciences, School of Medicine, Queen's University, Kingston, ON, Canada
| | - Amanda Ross-White
- School of Nursing, Queen's University, Kingston, ON, Canada
- Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Queen's University, Kingston, ON, Canada
| | - Lenora Duhn
- School of Nursing, Queen's University, Kingston, ON, Canada
- Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Queen's University, Kingston, ON, Canada
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Liu Y, Jiang J, You W, Gong D, Ma X, Wu M, Li F. Exploring facilitators and barriers to self-management engagement of Chinese people with type 2 diabetes mellitus and poor blood glucose control: a descriptive qualitative study. BMC Endocr Disord 2022; 22:294. [PMID: 36435767 PMCID: PMC9701421 DOI: 10.1186/s12902-022-01214-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 11/11/2022] [Indexed: 11/28/2022] Open
Abstract
AIMS To explore facilitators and barriers to self-management engagement of Chinese people with poorly controlled type 2 diabetes. METHODS Purposive sampling method was used for recruitment. Semi-structured interview and thematic analysis was used for data collection and analysis. RESULTS Twenty-six semi-structured interviews were conducted. Poor blood glucose control introduced awareness of susceptibility to complications, while mental disorders could be concomitant. General knowledge about healthy lifestyle and unhealthy habits impeded lifestyle management. Temporary remission of hyperglycemia and no perceived symptoms interfered engagement of medication therapy and regular blood glucose monitoring. Family and work environments could impact self-management engagement. Accessibility to reliable diabetes-related information influenced self-management engagement. CONCLUSIONS Awareness of susceptibility to complications motivated self-management engagement, while the awareness could cause mental disorders that need to be addressed. Customized lifestyle plans and behavior change technologies were crucial for lifestyle management. The progression of diabetes, importance of continuity of medication therapy, and the value of blood glucose monitoring should be clarified in diabetes education. Building diabetes-friendly social environments and providing reliable diabetes-related information were essential.
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Affiliation(s)
- Yuan Liu
- National Metabolic Management Center, Institute for Chronic Disease Management, Jining No. 1 People's Hospital, Jining, China.
| | - Jiajia Jiang
- National Metabolic Management Center, Institute for Chronic Disease Management, Jining No. 1 People's Hospital, Jining, China
| | - Wenjun You
- Department of Endocrinology, Jining No. 1 People's Hospital, Jining, China
| | - Dandan Gong
- Department of Endocrinology, Jining No. 1 People's Hospital, Jining, China
| | - Xiaoqing Ma
- Department of Endocrinology, Jining No. 1 People's Hospital, Jining, China
| | - Min Wu
- Department of Endocrinology, Jining No. 1 People's Hospital, Jining, China
| | - Feng Li
- Department of Endocrinology, Jining No. 1 People's Hospital, Jining, China
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Healy KV, Weise S, Fink A, Frese T, Richter M, Knöchelmann A. Learning Approaches as a Means to Understand Difficulties and Opportunities in Type 2 Diabetes Self-Management Training: A Qualitative Content Analysis of Two German Educational Curricula. AMERICAN JOURNAL OF HEALTH EDUCATION 2022. [DOI: 10.1080/19325037.2022.2120580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
| | | | - Astrid Fink
- Martin Luther University Halle-Wittenberg
- District Administration Groß-Gerau
| | | | - Matthias Richter
- Martin Luther University Halle-Wittenberg
- Technical University of Munich
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Beaudin J, Chouinard MC, Girard A, Houle J, Ellefsen É, Hudon C. Integrated self-management support provided by primary care nurses to persons with chronic diseases and common mental disorders: a scoping review. BMC Nurs 2022; 21:212. [PMID: 35918723 PMCID: PMC9344621 DOI: 10.1186/s12912-022-01000-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 07/28/2022] [Indexed: 11/10/2022] Open
Abstract
AIM To map integrated and non-integrated self-management support interventions provided by primary care nurses to persons with chronic diseases and common mental disorders and describe their characteristics. DESIGN A scoping review. DATA SOURCES In April 2020, we conducted searches in several databases (Academic Research Complete, AMED, CINAHL, ERIC, MEDLINE, PsycINFO, Scopus, Emcare, HealthSTAR, Proquest Central) using self-management support, nurse, primary care and their related terms. Of the resulting 4241 articles, 30 were included into the analysis. REVIEW METHODS We used the Rainbow Model of Integrated Care to identify integrated self-management interventions and to analyze the data and the PRISMS taxonomy for the description of interventions. Study selection and data synthesis were performed by the team. Self-management support interventions were considered integrated if they were consistent with the Rainbow model's definition of clinical integration and person-focused care. RESULTS The 30 selected articles related to 10 self-management support interventions. Among these, five interventions were considered integrated. The delivery of the interventions showed variability. Strategies used were education, problem-solving therapies, action planning, and goal setting. Integrated self-management support intervention characteristics were nurse-person relationship, engagement, and biopsychosocial approach. A framework for integrated self-management was proposed. The main characteristics of the non-integrated self-management support were disease-specific approach, protocol-driven, and lack of adaptability. CONCLUSION Our review synthesizes integrated and non-integrated self-management support interventions and their characteristics. We propose recommendations to improve its clinical integration. However, further theoretical clarification and qualitative research are needed. IMPLICATION FOR NURSING Self-management support is an important activity for primary care nurses and persons with chronic diseases and common mental disorders, who are increasingly present in primary care, and require an integrated approach. IMPACT This review addresses the paucity of details surrounding integrated self-management support for persons with chronic diseases and common mental disorders and provides a framework to better describe its characteristics. The findings could be used to design future research and improve the clinical integration of this activity by nurses.
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Affiliation(s)
- Jérémie Beaudin
- Faculté de Médecine Et Des Sciences de La Santé, Université de Sherbrooke, 12e Avenue Nord, Sherbrooke, Québec 3001J1H 5N4 Canada
| | - Maud-Christine Chouinard
- Faculté Des Sciences Infirmières, Université de Montréal, Pavillon Marguerite-d’Youville, C.P. 6128 succ. Centre-ville, Montréal, Québec H3C 3J7 Canada
| | - Ariane Girard
- Faculté de Médecine, Université Laval, VITAM Research Center On Sustainable Health, 2601, Chemin de La Canardière (G-2300), Québec, Québec G1J 2G3 Canada
| | - Janie Houle
- Département de Psychologie, Université du Québec À Montréal, case postale 8888, succ. Centre-ville, Montréal, Québec H3C 3P8 Canada
| | - Édith Ellefsen
- École des sciences infirmières, Faculté de Médecine Et Des Sciences de La Santé, Université de Sherbrooke, 12e Avenue Nord, Sherbrooke, Québec 3001J1H 5N4 Canada
| | - Catherine Hudon
- Faculté de Médecine Et Des Sciences de La Santé, Université de Sherbrooke, 12e Avenue Nord, Sherbrooke, Québec 3001J1H 5N4 Canada
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Höld E, Grüblbauer J, Wiesholzer M, Wewerka-Kreimel D, Stieger S, Kuschei W, Kisser P, Gützer E, Hemetek U, Ebner-Zarl A, Pripfl J. Improving glycemic control in patients with type 2 diabetes mellitus through a peer support instant messaging service intervention (DiabPeerS): study protocol for a randomized controlled trial. Trials 2022; 23:308. [PMID: 35422003 PMCID: PMC9009500 DOI: 10.1186/s13063-022-06202-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/26/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Diabetes mellitus is one of the four priority non-communicable diseases worldwide. It can lead to serious long-term complications and produces significant costs. Due to the chronicle character of the disease, it requires continuous medical treatment and good therapy adherence of those suffering. Therefore, diabetes self-management education (DSME) (and support DSMES) plays a significant role to increase patient's self-management capacity and improve diabetes therapy. Research indicates that these outcomes might be difficult to maintain. Consequently, effective strategies to preserve the positive effects of DSMES are needed. Preliminary results show that peer support, which means support from a person who has experiential knowledge of a specific behavior or stressor and similar characteristics as the target population, is associated with better outcomes in terms of HbA1c, cardiovascular disease risk factors or self-efficacy at a lower cost compared to standard therapy. Peer-supported instant messaging services (IMS) approaches have significant potential for diabetes management because support can be provided easily and prompt, is inexpensive, and needs less effort to attend compared to standard therapy. The major objective of the study is to analyze the impact of a peer-supported IMS intervention in addition to a standard diabetes therapy on the glycemic control of type 2 diabetic patients. METHODS A total of 205 participants with type 2 diabetes mellitus will be included and randomly assigned to an intervention or control group. Both groups will receive standard therapy, but the intervention group will participate in the peer-supported IMS intervention, additionally. The duration of the intervention will last for 7 months, followed by a follow-up of 7 months. Biochemical, behavioral, and psychosocial parameters will be measured before, in the middle, and after the intervention as well as after the follow-up. DISCUSSION Type 2 diabetes mellitus and other non-communicable diseases put healthcare systems worldwide to the test. Peer-supported IMS interventions in addition to standard therapy might be part of new and cost-effective approaches to support patients independent from time and place. TRIAL REGISTRATION ClinicalTrials.gov NCT04797429 . Registered on 15 March 2021.
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Affiliation(s)
- Elisabeth Höld
- Institute of Health Sciences, St. Pölten University of Applied Sciences, St. Pölten, Austria.
| | - Johanna Grüblbauer
- Institute of Creative\Media/Technologies, St. Pölten University of Applied Sciences, St. Pölten, Austria
| | - Martin Wiesholzer
- Department of Internal Medicine I, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten, Austria
| | - Daniela Wewerka-Kreimel
- Bachelor Degree Program Dietetics, St. Pölten University of Applied Sciences, St. Pölten, Austria
| | - Stefan Stieger
- Department of Psychology and Psychodynamics, Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
| | - Werner Kuschei
- Department of Internal Medicine I, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten, Austria
| | - Philip Kisser
- Fachbereich Versorgungsmanagement 3, Austrian Health Insurance Fund, St. Pölten, Austria
| | - Elisabeth Gützer
- Fachbereich Versorgungsmanagement 3, Austrian Health Insurance Fund, St. Pölten, Austria
| | - Ursula Hemetek
- Bachelor Degree Program Dietetics, St. Pölten University of Applied Sciences, St. Pölten, Austria
| | - Astrid Ebner-Zarl
- Institute of Creative\Media/Technologies, St. Pölten University of Applied Sciences, St. Pölten, Austria
| | - Jürgen Pripfl
- Institute of Health Sciences, St. Pölten University of Applied Sciences, St. Pölten, Austria
- Christian Doppler Forschungsgesellschaft, Vienna, Austria
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13
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Carmienke S, Fink A, Baumert J, Heidemann C, Du Y, Frese T, Heise M. Participation in structured diabetes self-management education programs and its associations with self-management behaviour - a nationwide population-based study. PATIENT EDUCATION AND COUNSELING 2022; 105:843-850. [PMID: 34272129 DOI: 10.1016/j.pec.2021.07.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To evaluate the relationship between participation in structured diabetes self-management education programs (DSME) and self-management behaviour (SMB) in routine care. METHODS The study included 864 ever- and 515 never-DSME participants from the population-based survey German Health Update (GEDA) 2014/2015. SMB and clinical care variables were: Following a diet plan, keeping a diabetes diary, holding a diabetes pass, self-monitoring of blood glucose (SMBG), foot self-examination (FSE), retinopathy screening, haemoglobin A1c (HbA1c) measurement and examination of the feet by clinicians (FEC). We conducted logistic regression analyses for association of DSME-participation with SMB, adjusting for various variables. RESULTS DSME-participation was significantly associated with SMB including following a diet plan (OR 1.88 [95% CI 1.21-2.92]), keeping a diabetes journal (OR 3.83 [2.74-5.36]), holding a diabetes health passport (OR 6.11 [4.40-8.48]), SMBG (OR 2.96 [2.20-3.98]) and FSE (OR 2.64 [2.01-3.47]) as well as retinopathy screening (OR 3.30 [2.31-4.70]), HbA1c measurement (OR 2.58 [1.88-3.52]), and FEC (OR 3.68 [2.76-4.89]) after adjusting for confounders. CONCLUSION DSME-participation is associated with higher frequencies of various SMB and clinical care variables in routine care. Never-DSME attenders are more likely not to receive retinopathy screening, FEC and HbA1c measurements as recommended. PRACTICE IMPLICATIONS Clinicians should refer diabetes patients to a DSME and ensure a regular follow up for never-DSME attenders.
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Affiliation(s)
- Solveig Carmienke
- Institute of General Practice and Family Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Magdeburger Strasse 8, 06112 Halle, Saale, Germany
| | - Astrid Fink
- Institute of Medical Sociology, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle, Saale, Germany
| | - Jens Baumert
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Unit Physical Health, Berlin, Germany
| | - Christin Heidemann
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Unit Physical Health, Berlin, Germany
| | - Yong Du
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Unit Physical Health, Berlin, Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Magdeburger Strasse 8, 06112 Halle, Saale, Germany
| | - Marcus Heise
- Institute of General Practice and Family Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Magdeburger Strasse 8, 06112 Halle, Saale, Germany.
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14
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Ullmann S, Strauß B, Tiesler F, Schneider N, Gensichen J, Brenk-Franz K. Patient characteristics as predictors of sleep disturbances in multimorbid primary care patients - A secondary analysis. J Psychosom Res 2022; 153:110705. [PMID: 34998104 DOI: 10.1016/j.jpsychores.2021.110705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 12/14/2021] [Accepted: 12/14/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of the study was to identify patient characteristics (adult attachment, health status, number and severity of chronic conditions, social support) predictive sleep disturbances after 12 months. METHODS In a secondary analysis of a prospective longitudinal study dealing with adult attachment and self-management, attachment- and health-related characteristics, socio-demographic data at baseline and symptoms of insomnia at the follow up (12 month later) was recorded by 219 patients between the ages of 50 and 85 years with multimorbidity in primary care. Adult attachment was measured by the ECR-RD12. The overall health status was measured using a visual analogue scale (VAS) and a standardized list of chronic conditions. The number and severity of chronic diseases (CIRS-G) was assessed by general practitioners (GPs). Sleep disturbances was measured by the ISI 12 month later. RESULTS Approximately 19% of the respondents were found to have clinically relevant symptoms of insomnia, and a further 34% to be subclinical insomnia. Attachment-related anxiety, a poorer perceived social support, the number of chronic conditions and a better general health status could predict higher levels of sleep disturbance after 12 month. CONCLUSION Sleep disorders can play a major role in patients with multimorbidity. Attachment anxiety and lack of social support may also be possible risk factors for the development of sleep disturbances.
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Affiliation(s)
- Susanne Ullmann
- Jena University Hospital, Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Germany.
| | - Bernhard Strauß
- Jena University Hospital, Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Germany
| | - Fabian Tiesler
- Jena University Hospital, Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Germany
| | - Nico Schneider
- Jena University Hospital, Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Germany
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, University Hospital of Ludwig-Maximilians-University, Germany
| | - Katja Brenk-Franz
- Jena University Hospital, Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Germany
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15
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Padda J, Khalid K, Zubair U, Al Hennawi H, Khedr A, Patel V, Cooper AC, Jean-Charles G. Significance of Educational Literature and Diabetes Log Sheet on Hemoglobin A1c. Cureus 2022; 14:e21667. [PMID: 35233335 PMCID: PMC8882019 DOI: 10.7759/cureus.21667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2022] [Indexed: 11/09/2022] Open
Abstract
Diabetes mellitus (DM) is a major cause of morbidity worldwide. The prevalence of DM has doubled over the last 35 years and is escalating. Various complications and manifestations of diabetes have caused numerous deaths worldwide, with numbers increasing every year. There have been many advances and breakthroughs over the past decade in the management of DM. The major focus of many research studies has been to evaluate effective medication combinations, preventative measures, and the way to control such morbid conditions. Our focus in this review is to discuss specific secondary prevention techniques with the diabetes log sheet and educational literature on its effectiveness in controlling diabetes. Hemoglobin A1c (HbA1c) has been accepted as a diabetes control measure in many resources worldwide. Here, we have assessed articles on the effectiveness of the diabetes log sheet and educational literature on HbA1c levels. We will begin with a few key points to acknowledge diabetes initially, followed by discussing the effectiveness of the diabetes log sheet and literature on HbA1c.
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Mokaya M, Kyallo F, Vangoitsenhoven R, Matthys C. Clinical and patient-centered implementation outcomes of mHealth interventions for type 2 diabetes in low-and-middle income countries: a systematic review. Int J Behav Nutr Phys Act 2022; 19:1. [PMID: 34991593 PMCID: PMC8734304 DOI: 10.1186/s12966-021-01238-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 12/06/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The prevalence of Type 2 Diabetes is rising in Low- and Middle-Income Countries (LMICs), affecting all age categories and resulting in huge socioeconomic implications. Mobile health (mHealth) is a potential high-impact approach to improve clinical and patient-centered outcomes despite the barriers of cost, language, literacy, and internet connectivity. Therefore, it is valuable to examine the clinical and implementation outcomes of mHealth interventions for Type 2 Diabetes in LMICs. METHODS The Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines were applied in framing and reporting the review criteria. A systematic search of Cochrane Library, Web of Science, PubMed, Scopus, and Ovid databases was performed through a combination of search terms. Randomized Controlled Trials (RCTs) and cohort studies published in English between January 2010 and August 2021 were included. Risk of bias for missing results in the included studies was assessed using the Cochrane risk-of-bias tool for randomized trials (RoB 2). Quantitative and qualitative methods were used to synthesize the results. RESULTS The search identified a total of 1161 articles. Thirty studies from 14 LMICs met the eligibility criteria. On clinical outcomes, 12 and 9 studies reported on glycated hemoglobin (HbA1c )and fasting blood glucose (FBG) respectively. Text messages was the most commonly applied mHealth approach, used in 19 out of the 30 studies. Ten out of the 12 studies (83.3%) that reported on HbA1c had a percentage difference of <0.3% between the mHealth intervention and the comparison group. Additionally, studies with longer intervention periods had higher effect size and percentage difference on HbA1c (1.52 to 2.92%). Patient-centred implementation outcomes were reported variedly, where feasibility was reported in all studies. Acceptability was reported in nine studies, appropriateness in six studies and cost in four studies. mHealth evidence reporting and assessment (mERA) guidelines were not applied in all the studies in this review. CONCLUSION: mHealth interventions in LMICs are associated with clinically significant effectiveness on HbA1 but have low effectiveness on FBG. The application of mERA guidelines may standardize reporting of patient-centered implementation outcomes in LMICs. TRIAL REGISTRATION PROSPERO: Registration ID 154209.
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Affiliation(s)
- Moses Mokaya
- Department of Human Nutrition Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Florence Kyallo
- Department of Human Nutrition Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Roman Vangoitsenhoven
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - Christophe Matthys
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
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17
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Bosun-Arije SF. Commentary: Type 2 diabetes self-management: spirituality, coping and responsibility. J Res Nurs 2021; 26:761-762. [PMID: 35251283 PMCID: PMC8894746 DOI: 10.1177/17449871211030595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Widayanti AW, Heydon S, Green JA, Norris P. Effectiveness of an intensive community-based intervention for people with type 2 diabetes in Indonesia: A pilot study. Diabetes Res Clin Pract 2021; 181:109087. [PMID: 34637848 DOI: 10.1016/j.diabres.2021.109087] [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: 05/27/2020] [Revised: 09/03/2021] [Accepted: 10/07/2021] [Indexed: 11/30/2022]
Abstract
AIMS This pilot study aimed to assess the acceptability of an intensive community-based intervention, and to get a preliminary estimate of the effect size of the intervention for people with type 2 diabetes in Kupang, Indonesia. METHODS Pilot of a cluster randomised trial involving sixty-seven participants. The participants were recruited from four Primary Health Centres (PHCs), and were allocated into groups (intervention: 36; control: 31) based on the PHCs they were registered in. The 3-month intervention consisted of weekly group activities including physical activity and education. Control was usual care. The outcomes were change in HbA1c, medication adherence, and self-management behaviours. To test our intervention, we used a mixed linear model, with participants nested within cluster/health centre. RESULTS Participants were 60% female, mean age 57, and had diabetes for an average of 4.5 years. Groups did not differ at baseline. Counter to prediction, no effects of the intervention over usual care were observed on the outcomes measured. However, both groups made statistically significant improvements in HbA1c (intervention from 8.3% ± 1.9 to 7.8% ± 1.8; control from 8.4% ± 2.6 to 7.9% ± 2.5). CONCLUSIONS The effect of the intervention did not differ from usual care. However, both groups made improvements in HbA1c outcome, suggesting that the project might have indirectly triggered more intensive care for diabetes patients.
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Affiliation(s)
- Anna Wahyuni Widayanti
- School of Pharmacy, University of Otago, Dunedin, New Zealand; Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Susan Heydon
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - James A Green
- School of Pharmacy, University of Otago, Dunedin, New Zealand; School of Allied Health and Physical Activity for Health, Health Research Institute (HRI), University of Limerick, Limerick, Ireland.
| | - Pauline Norris
- School of Pharmacy, University of Otago, Dunedin, New Zealand
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19
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Effects of motivational interviewing on HbA1c and depression among cases with type 1 diabetes: a meta-analysis. Int J Diabetes Dev Ctries 2021. [DOI: 10.1007/s13410-021-01003-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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20
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Simonsmeier BA, Flaig M, Simacek T, Schneider M. What sixty years of research says about the effectiveness of patient education on health: a second order meta-analysis. Health Psychol Rev 2021; 16:450-474. [PMID: 34384337 DOI: 10.1080/17437199.2021.1967184] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Although meta-analyses have examined the association between patient education and health, the validity and quality of this evidence have not been comprehensively assessed. This second order meta-analysis combined previous meta-analyses that examined the effectiveness of patient education on health outcomes as an overall weighted grand mean d¯¯. Further, measures of methodological quality, meaningful variability across first order meta-analyses, and evidence for publication bias were examined. Forty meta-analyses were identified, investigating 156 associations between patient education and health summarizing data from over 776 studies including more than 74.947 patients. Quantitative analyses showed that patient education positively affects health outcomes with d¯¯ = 0.316 (95% CI [0.304, 0.329]). Summarizing data exclusively from randomized controlled trials indicated a causal effect. Patient education was effective for patients with neoplasms, diabetes, mental and behavioral disorders, diseases of the circulatory system, the respiratory system, and the musculoskeletal system. Patient education was effective in the reduction of medication use, pain, and visits to medical facilities, and significantly improved physiological, physical, psychological outcomes, and patients' general function. Overall, the findings reveal firm evidence for the effectiveness of patient education on health outcomes. However, theory-based interventions are lacking and need to be implemented to enable a successful transfer from theory to practice.
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Affiliation(s)
| | - Maja Flaig
- University of Tübingen, Tübingen, Germany
| | - Thomas Simacek
- Department of Educational Psychology, University of Trier, Trier, Germany
| | - Michael Schneider
- Department of Educational Psychology, University of Trier, Trier, Germany
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21
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Schwaab B, Bjarnason-Wehrens B, Meng K, Albus C, Salzwedel A, Schmid JP, Benzer W, Metz M, Jensen K, Rauch B, Bönner G, Brzoska P, Buhr-Schinner H, Charrier A, Cordes C, Dörr G, Eichler S, Exner AK, Fromm B, Gielen S, Glatz J, Gohlke H, Grilli M, Gysan D, Härtel U, Hahmann H, Herrmann-Lingen C, Karger G, Karoff M, Kiwus U, Knoglinger E, Krusch CW, Langheim E, Mann J, Max R, Metzendorf MI, Nebel R, Niebauer J, Predel HG, Preßler A, Razum O, Reiss N, Saure D, von Schacky C, Schütt M, Schultz K, Skoda EM, Steube D, Streibelt M, Stüttgen M, Stüttgen M, Teufel M, Tschanz H, Völler H, Vogel H, Westphal R. Cardiac Rehabilitation in German Speaking Countries of Europe-Evidence-Based Guidelines from Germany, Austria and Switzerland LLKardReha-DACH-Part 2. J Clin Med 2021; 10:jcm10143071. [PMID: 34300237 PMCID: PMC8306118 DOI: 10.3390/jcm10143071] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/29/2021] [Accepted: 07/05/2021] [Indexed: 02/08/2023] Open
Abstract
Background: Scientific guidelines have been developed to update and harmonize exercise based cardiac rehabilitation (ebCR) in German speaking countries. Key recommendations for ebCR indications have recently been published in part 1 of this journal. The present part 2 updates the evidence with respect to contents and delivery of ebCR in clinical practice, focusing on exercise training (ET), psychological interventions (PI), patient education (PE). In addition, special patients’ groups and new developments, such as telemedical (Tele) or home-based ebCR, are discussed as well. Methods: Generation of evidence and search of literature have been described in part 1. Results: Well documented evidence confirms the prognostic significance of ET in patients with coronary artery disease. Positive clinical effects of ET are described in patients with congestive heart failure, heart valve surgery or intervention, adults with congenital heart disease, and peripheral arterial disease. Specific recommendations for risk stratification and adequate exercise prescription for continuous-, interval-, and strength training are given in detail. PI when added to ebCR did not show significant positive effects in general. There was a positive trend towards reduction in depressive symptoms for “distress management” and “lifestyle changes”. PE is able to increase patients’ knowledge and motivation, as well as behavior changes, regarding physical activity, dietary habits, and smoking cessation. The evidence for distinct ebCR programs in special patients’ groups is less clear. Studies on Tele-CR predominantly included low-risk patients. Hence, it is questionable, whether clinical results derived from studies in conventional ebCR may be transferred to Tele-CR. Conclusions: ET is the cornerstone of ebCR. Additional PI should be included, adjusted to the needs of the individual patient. PE is able to promote patients self-management, empowerment, and motivation. Diversity-sensitive structures should be established to interact with the needs of special patient groups and gender issues. Tele-CR should be further investigated as a valuable tool to implement ebCR more widely and effectively.
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Affiliation(s)
- Bernhard Schwaab
- Curschmann Klinik, D-23669 Timmendorfer Strand, Germany
- Medizinische Fakultät, Universität zu Lübeck, D-23562 Lübeck, Germany
- Correspondence:
| | - Birna Bjarnason-Wehrens
- Institute for Cardiology and Sports Medicine, Department of Preventive and Rehabilitative Sport- and Exercise Medicine, German Sportuniversity Cologne, D-50933 Köln, Germany; (B.B.-W.); (H.-G.P.)
| | - Karin Meng
- Institute for Clinical Epidemiology and Biometry (ICE-B), University of Würzburg, D-97080 Würzburg, Germany;
| | - Christian Albus
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine, University Hospital, D-50937 Köln, Germany;
| | - Annett Salzwedel
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany; (A.S.); (S.E.); or (H.V.)
| | | | | | - Matthes Metz
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany; (M.M.); (K.J.); (D.S.)
| | - Katrin Jensen
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany; (M.M.); (K.J.); (D.S.)
| | - Bernhard Rauch
- Institut für Herzinfarktforschung Ludwigshafen, IHF, D-67063 Ludwigshafen am Rhein, Germany;
- Zentrum für ambulante Rehabilitation, ZAR Trier GmbH, D-54292 Trier, Germany
| | - Gerd Bönner
- Medizinische Fakultät, Albert-Ludwigs-Universität zu Freiburg, D-79104 Freiburg, Germany;
| | - Patrick Brzoska
- Fakultät für Gesundheit, Universität Witten/Herdecke, Lehrstuhl für Versorgungsforschung, D-58448 Witten, Germany;
| | | | | | - Carsten Cordes
- Gollwitzer-Meier-Klinik, D-32545 Bad Oeynhausen, Germany;
| | - Gesine Dörr
- Alexianer St. Josefs-Krankenhaus Potsdam, D-14472 Potsdam, Germany;
| | - Sarah Eichler
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany; (A.S.); (S.E.); or (H.V.)
| | - Anne-Kathrin Exner
- Klinikum Lippe GmbH, Standort Detmold, D-32756 Detmold, Germany; (A.-K.E.); (S.G.)
| | - Bernd Fromm
- REHA-Klinik Sigmund Weil, D-76669 Bad Schönborn, Germany;
| | - Stephan Gielen
- Klinikum Lippe GmbH, Standort Detmold, D-32756 Detmold, Germany; (A.-K.E.); (S.G.)
| | - Johannes Glatz
- Reha-Zentrum Seehof der Deutschen Rentenversicherung Bund, D-14513 Teltow, Germany; (J.G.); (E.L.)
| | - Helmut Gohlke
- Private Practice, D-79282 Ballrechten-Dottingen, Germany;
| | - Maurizio Grilli
- Library Department, University Medical Centre Mannheim, D-68167 Mannheim, Germany;
| | - Detlef Gysan
- Department für Humanmedizin, Private Universität Witten/Herdecke GmbH, D-58455 Witten, Germany;
| | - Ursula Härtel
- LMU München, Institut für Medizinische Psychologie, D-80336 München, Germany;
| | | | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center and German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, D-37075 Göttingen, Germany;
| | | | | | | | | | | | - Eike Langheim
- Reha-Zentrum Seehof der Deutschen Rentenversicherung Bund, D-14513 Teltow, Germany; (J.G.); (E.L.)
| | | | - Regina Max
- Zentrum für Rheumatologie, Drs. Dornacher/Schmitt/Max/Lutz, D-69115 Heidelberg, Germany;
| | - Maria-Inti Metzendorf
- Cochrane Metabolic and Endocrine Disorders Group, Institute of General Practice, Medical Faculty of the Heinrich-Heine University, D-40225 Düsseldorf, Germany;
| | - Roland Nebel
- Hermann-Albrecht-Klinik METTNAU, Reha-Einrichtungen der Stadt Radolfzell, D-7385 Radolfzell, Germany;
| | - Josef Niebauer
- Universitätsinstitut für Präventive und Rehabilitative Sportmedizin, Uniklinikum Salzburg, Paracelsus Medizinische Privatuniversität, A-5020 Salzburg, Austria;
| | - Hans-Georg Predel
- Institute for Cardiology and Sports Medicine, Department of Preventive and Rehabilitative Sport- and Exercise Medicine, German Sportuniversity Cologne, D-50933 Köln, Germany; (B.B.-W.); (H.-G.P.)
| | - Axel Preßler
- Privatpraxis für Kardiologie, Sportmedizin, Prävention, Rehabilitation, D-81675 München, Germany;
| | - Oliver Razum
- Epidemiologie und International Public Health, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, D-33615 Bielefeld, Germany;
| | - Nils Reiss
- Schüchtermann-Schiller’sche Kliniken, D-49214 Bad Rothenfelde, Germany;
| | - Daniel Saure
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany; (M.M.); (K.J.); (D.S.)
| | | | - Morten Schütt
- Diabetologische Schwerpunktpraxis, D-23552 Lübeck, Germany;
| | - Konrad Schultz
- Klinik Bad Reichenhall, Zentrum für Rehabilitation, Pneumologie und Orthopädie, D-83435 Bad Reichenhall, Germany;
| | - Eva-Maria Skoda
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR University Hospital, University of Duisburg-Essen, D-45147 Essen, Germany; (E.-M.S.); (M.T.)
| | | | - Marco Streibelt
- Department for Rehabilitation Research, German Federal Pension Insurance, D-10704 Berlin, Germany;
| | | | | | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR University Hospital, University of Duisburg-Essen, D-45147 Essen, Germany; (E.-M.S.); (M.T.)
| | | | - Heinz Völler
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany; (A.S.); (S.E.); or (H.V.)
- Klinik am See, D-15562 Rüdersdorf, Germany
| | - Heiner Vogel
- Abteilung für Medizinische Psychologie und Psychotherapie, Medizinische Soziologie und Rehabilitationswissenschaften, Universität Würzburg, D-97070 Würzburg, Germany;
| | - Ronja Westphal
- Herzzentrum Segeberger Kliniken, D-23795 Bad Segeberg, Germany;
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Gupta SK, Lakshmi PVM, Rastogi A, Kaur M. Development and evaluation of self-care intervention to improve self-care practices among people living with type 2 diabetes mellitus: a mixed-methods study protocol. BMJ Open 2021; 11:e046825. [PMID: 34210727 PMCID: PMC8252870 DOI: 10.1136/bmjopen-2020-046825] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 06/02/2021] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The management of diabetes mellitus (DM) depends on medication adherence, self-care and regular follow-up to prevent complications and premature mortality. This study aims to develop and implement the behavioural change theory and model based diabetes self-care intervention package to improve self-care practices among people living with type 2 DM. METHODS AND ANALYSIS An exploratory sequential mixed-method study design wherein, quantitative follows qualitative will be used to develop, implement and evaluate the effect of diabetes self-care intervention package among people living with type 2 diabetes. The qualitative research method will be used to identify barriers and facilitators for self-care practices among people living with type 2 DM and will also provide the basis for the development of the diabetes self-care intervention package. The quasi-experimental with control study design will be used to evaluate the developed intervention package among 220 randomly selected people living with type 2 diabetes in both intervention and control arms. Baseline, follow-ups and endline data will be collected using same prevalidated and structured questionnaire for each self-care activity. Difference-in-difference analysis will be used to measure for changes in the proportion of people living with type 2 DM doing different component of self-care practices, preintervention and postintervention in both arms. ETHICS AND DISSEMINATION Permission for conducting the study has been taken from Institutional Ethical Committee of PGIMER, Chandigarh (Ref no. NK/4538/PhD/226, Dated 18.08.18). The findings of the trial will be disseminated through publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER CTRI/2018/10/016108; Pre-results.
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Affiliation(s)
- Saurabh Kumar Gupta
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, Chandigarh, India
| | - P V M Lakshmi
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, Chandigarh, India
| | - Ashu Rastogi
- Department of Endocrinology, PGIMER, Chandigarh, Chandigarh, India
| | - Manmeet Kaur
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, Chandigarh, India
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Thomsen S, Kristensen GDW, Jensen NWH, Agergaard S. Maintaining changes in physical activity among type 2 diabetics - A systematic review of rehabilitation interventions. Scand J Med Sci Sports 2021; 31:1582-1591. [PMID: 33735484 DOI: 10.1111/sms.13951] [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: 07/05/2019] [Revised: 08/27/2020] [Accepted: 03/02/2021] [Indexed: 10/21/2022]
Abstract
The prevalence of type 2 diabetes mellitus (T2DM) is increasing worldwide, and physical activity (PA) is a suitable way of preventing and managing the disease. However, improving long-term levels of PA in people with T2DM is a challenge and the best approach to rehabilitation in this regard is unknown. With the aim of outlining the existing knowledge regarding the maintenance of active lifestyles among people with T2DM after rehabilitation programs and gaining knowledge about options and challenges for their long-term engagement in PA, a systematic review of original research articles assessing PA after rehabilitation programs was conducted. Two thousand two hundred and forty-one articles were identified through PubMed or secondary sources and subjected to various inclusion criteria. Only articles published between the 1st of January 2000 and the 30th of June 2020 were considered. Additionally, the minimum time frame from intervention start to last PA assessment was 6 months and only articles based on interventions performed in Europe were included. The review was based on eighteen randomized controlled trials, four randomized trials without control, and four case studies. The 26 articles described 30 interventions that were categorized as personalized counseling, generalized teaching, supervised exercise, or a combination of personalized and generalized interventions. Statistical and narrative syntheses revealed no clear pattern regarding the effectiveness in eliciting maintained changes in PA. However, across categories, individual involvement, goal setting, social support, and the formation of habits are argued to be important components in sustaining PA and relieving challenges associated with the transition out of rehabilitation programs.
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Affiliation(s)
- Simon Thomsen
- Sport Sciences, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | | | | | - Sine Agergaard
- Sport Sciences, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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24
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Felix CMDM, Ghisi GLDM, Seixas MB, Batalha APDB, Ezequiel DGA, Trevizan PF, Pereira DAG, Silva LPD. Translation, cross-cultural adaptation, and psychometric properties of the Brazilian Portuguese version of the DiAbeTes Education Questionnaire (DATE-Q). Braz J Phys Ther 2021; 25:583-592. [PMID: 33824060 DOI: 10.1016/j.bjpt.2021.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 01/08/2021] [Accepted: 03/13/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The DiAbeTes Education Questionnaire (DATE-Q) is a self-administered tool developed to evaluate disease-related knowledge and to assess knowledge of five core components of rehabilitation programs: physical exercise, diet, psychosocial well-being, disease self-management, and complications. OBJECTIVE To translate and cross-culturally adapt into Brazilian Portuguese, and to test the psychometric properties of the DATE-Q for its use in Brazil. METHODS The process of translation and cross-cultural adaptation consisted of five steps: translation into Brazilian Portuguese, synthesis of translation, back translation, expert committee, and pilot test of pre-final version. The pre-final version was applied to a sample of 30 patients with diabetes. Psychometric properties (internal consistency, reliability, construct validity, and ceiling and floor effects) of the final version of the Brazilian Portuguese version of the DATE-Q were tested in a sample of 200 adults with diabetes. RESULTS There was no conceptual divergence between the original and the translated versions. Ten (50%) items of the DATE-Q were culturally adapted. Internal consistency (Cronbach's alpha coefficient = 0.6), reliability (intraclass correlation coefficient = 0.5), and construct validity (correlation between Diabetes Knowledge Scales and DATE-Q total scores: ρ = 0.7; P < 0.001) were confirmed. Ceiling or floor effects were not identified. The highest scoring item was about healthy eating. The average time for completion of the DATE-Q was 5 min and 51 s, and the completion rate was 100% for all items. CONCLUSION The Brazilian Portuguese version of the DATE-Q showed adequate psychometric properties, and results suggested that the tool can be used to assess disease-related knowledge in adults with diabetes in Brazil.
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Affiliation(s)
| | - Gabriela Lima de Melo Ghisi
- Cardiac Rehabilitation and Prevention Program, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Mariana Balbi Seixas
- Faculty of Physical Therapy, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil; Cardiovascular Research Unit and Exercise Physiology, University Hospital, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil
| | | | | | - Patrícia Fernandes Trevizan
- Cardiovascular Research Unit and Exercise Physiology, University Hospital, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil
| | | | - Lilian Pinto da Silva
- Faculty of Physical Therapy, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil; Cardiovascular Research Unit and Exercise Physiology, University Hospital, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil.
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Hersson-Edery F, Reoch J, Gagnon J. The Quebec Diabetes Empowerment Group Program: Program Description and Considerations Regarding Feasibility and Acceptability of Implementation in Primary Health Care Settings. Front Nutr 2021; 8:621238. [PMID: 33816538 PMCID: PMC8014038 DOI: 10.3389/fnut.2021.621238] [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: 10/25/2020] [Accepted: 02/19/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Diabetes is a highly prevalent chronic disease that frequently coexists with other medical conditions and implies a high burden for patients and the healthcare system. Clinicians currently are challenged to provide effective interventions that are both multidisciplinary and empower patient self-care. The Diabetes Empowerment Group Program (DEGP) was developed with the aims of fostering patient engagement in diabetes self-care through the lens of empowerment and to support the empowerment of patients with diabetes by providing multidisciplinary group-based care. This research's objectives were to: (1) develop a comprehensive description of the DEGP for potential adopters, and (2) explore the factors influencing the feasibility and acceptability of implementing it in other healthcare settings in Montreal. Methods: A qualitative descriptive study was conducted, following a participatory approach. Data were obtained from: (1) semi-structured interviews with 14 patients who participated in the pilot program; (2) from semi-structured group interviews with patient partners, healthcare professionals, and other stakeholders from 4 Montreal family medicine groups, and (3) discussions among the participatory research team during various knowledge translation activities. Inductive content analysis of the data was performed. Results: The DEGP identified seven key elements: medical visit, continuity of care, group-based dynamics, multi-disciplinarity, clinician facilitation, patient-centered agenda, and a theoretical framework of empowerment. The content and organization of the group visits were conceived to address each of these four domains. The empowerment framework comprises four domains of self-care: emotional (attitude), cognitive (knowledge), behavioral (skills), and relational (relatedness). Factors impacting the feasibility and acceptability of implementing the DEGP in other primary care settings were identified. Discussion: The DEGP fits within the discourse around the need for more patient-centered programs for people living with diabetes, following a more comprehensive empowerment model. This research could facilitate the development or adaptation of similar programs in other settings.
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Affiliation(s)
| | | | - Justin Gagnon
- Department of Family Medicine, McGill University, Montreal, QC, Canada
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26
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Spanbauer C, Sparapani R. Nonparametric machine learning for precision medicine with longitudinal clinical trials and Bayesian additive regression trees with mixed models. Stat Med 2021; 40:2665-2691. [PMID: 33751659 DOI: 10.1002/sim.8924] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 12/14/2020] [Accepted: 02/07/2021] [Indexed: 11/11/2022]
Abstract
Precision medicine is an active area of research that could offer an analytic paradigm shift for clinical trials and the subsequent treatment decisions based on them. Clinical trials are typically analyzed with the intent of discovering beneficial treatments if the same treatment is applied to the entire population under study. But, such a treatment strategy could be suboptimal if subsets of the population exhibit varying treatment effects. Identifying subsets of the population experiencing differential treatment effect and forming individualized treatment rules is a task well-suited to modern machine learning methods such as tree-based ensemble predictive models. Specifically, Bayesian additive regression trees (BART) has shown promise in this regard because of its exceptional performance in out-of-sample prediction. Due to the unique inferential needs of precision medicine for clinical trials, we have proposed the BART extensions explicated here. We incorporate random effects for longitudinal repeated measures and subject clustering within medical centers. The addition of a novel interaction detection prior to identify treatment heterogeneity among clinical trial patients and its association with patient characteristics. These extensions are unified under a framework that we call mixedBART. Simulation studies and applications of precision medicine based on real randomized clinical trials data examples are presented.
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Affiliation(s)
- Charles Spanbauer
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Rodney Sparapani
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Kumah E, Afriyie EK, Abuosi AA, Ankomah SE, Fusheini A, Otchere G. Influence of the Model of Care on the Outcomes of Diabetes Self-Management Education Program: A Scoping Review. J Diabetes Res 2021; 2021:2969243. [PMID: 33688505 PMCID: PMC7914106 DOI: 10.1155/2021/2969243] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 01/14/2021] [Accepted: 02/11/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) accounts for approximately 95% of all diabetes cases, making the disease a global public health concern. The increasing prevalence of T2DM has highlighted the importance of evidence-based guidelines for effective prevention, management, and treatment. Diabetes self-management education (DSME) can produce positive effects on patient behaviors and health status. Study objective. We synthesized findings from the existing studies to find out whether or not the impact of DSME on patient health behaviors and outcomes differ by the different models of diabetes care. That is, we determined whether there are differences in DSME outcomes when patient's care provider is a general practitioner, a specialist, a nurse, or a combination of these health professionals. METHODS Searches were made of six electronic databases to identify relevant English language publications on DSME from 2000 through 2019. Titles and abstracts of the search results were screened to select eligible papers for full-text screening. All eligible papers were retrieved, and full-text screening was done by three independent reviewers to select studies for inclusion in the final analysis. Twenty-one studies were included in the final analysis. The main outcome measures assessed were glycated hemoglobin (HbA1c), body mass index (BMI), diet, and physical activity. RESULTS The majority of the patients with diabetes were seen by primary care physicians. In general, the studies reported significant improvements in patient health behaviors and outcomes. Some differences in outcomes between the different models of care were observed. CONCLUSION Our findings suggest that the effects of DSME on patients' health behaviors and outcomes could differ by the different models of diabetes care. However, considering the limited sample of publications reviewed, and because none of the reviewed studies directly measured the impact of the DSME program on patient behaviors and outcomes, significant conclusions could not be reached.
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Affiliation(s)
- Emmanuel Kumah
- Policy, Planning, Monitoring, & Evaluation Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Emmanuel K. Afriyie
- Laboratory Services Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Aaron A. Abuosi
- Department of Public Administration and Health Services Management, University of Ghana Business School, Ghana
| | - Samuel E. Ankomah
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Adam Fusheini
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Center for Health Literacy and Rural Health Promotion, P.O. Box GP1563, Accra, Ghana
| | - Godfred Otchere
- Policy, Planning, Monitoring, & Evaluation Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
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Mogueo A, Oga‐Omenka C, Hatem M, Kuate Defo B. Effectiveness of interventions based on patient empowerment in the control of type 2 diabetes in sub-Saharan Africa: A review of randomized controlled trials. Endocrinol Diabetes Metab 2021; 4:e00174. [PMID: 33532614 PMCID: PMC7831206 DOI: 10.1002/edm2.174] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 07/02/2020] [Accepted: 07/04/2020] [Indexed: 12/20/2022] Open
Abstract
Background It is estimated that 1.6 million deaths worldwide were directly caused by diabetes in 2016, and the burden of diabetes has been increasing rapidly in low- and middle-income countries. This study reviews existing interventions based on patient empowerment and their effectiveness in controlling diabetes in sub-Saharan Africa. Method PubMed, MEDLINE, EMBASE, CINAHL, Web of Science, PsycINFO and Global Health were searched through August 2018, for randomized controlled trials of educational interventions on adherence to the medication plan and lifestyle changes among adults aged 18 years and over with type 2 diabetes. Random-effects meta-analysis was used. Results Eleven publications from nine studies involving 2743 participants met the inclusion criteria. The duration of interventions with group education and individual education ranged from 3 to 12 months. For six studies comprising 1549 participants with meta-analysable data on glycaemic control (HbA1c), there were statistically significant differences between intervention and control groups: mean difference was -0.57 [95% confidence interval (CI) -0.75, -0.40] (P < .00001, I2 = 27%). Seven studies with meta-analysable data on blood pressure showed statistically significant differences between groups in favour of interventions. Subgroup analyses on glycaemic control showed that long-term interventions were more effective than short-term interventions and lifestyle interventions were more effective than diabetes self-management education. Conclusion This review supports the findings that interventions based on patient empowerment may improve glycaemia (HbA1c) and blood pressure in patients with diabetes. The long-term and lifestyle interventions appear to be the most effective interventions for glycaemic control.
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Affiliation(s)
- Amélie Mogueo
- School of Public Health of the University of MontrealMontrealQCCanada
- Public Health Research Institute of the University of MontrealMontrealQCCanada
| | - Charity Oga‐Omenka
- School of Public Health of the University of MontrealMontrealQCCanada
- Public Health Research Institute of the University of MontrealMontrealQCCanada
| | - Marie Hatem
- School of Public Health of the University of MontrealMontrealQCCanada
- Sainte‐Justine University Hospital CentreMontrealQCCanada
| | - Barthelemy Kuate Defo
- School of Public Health of the University of MontrealMontrealQCCanada
- Public Health Research Institute of the University of MontrealMontrealQCCanada
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Gagnon J, Hersson-Edery F, Reoch J, Zhang H, Schuster T, Pluye P. Development and Validation of the McGill Empowerment Assessment-Diabetes (MEA-D). Diabetes Spectr 2020; 33:307-314. [PMID: 33223768 PMCID: PMC7666606 DOI: 10.2337/ds19-0075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Diabetes is a prevalent chronic condition that poses a major burden for patients and the health care system. Evidence suggests that patient engagement in self-care improves diabetes control and reduces the risk of complications. To provide effective interventions that aim to improve empowerment processes relating to diabetes, a comprehensive and valid measure of empowerment is needed. This article details the development and validation of the McGill Empowerment Assessment-Diabetes (MEA-D). METHODS The development and validation of the MEA-D questionnaire comprised three steps: item generation, qualitative face validation, and factorial content validation. An initial version was created by combining existing items and inductively generated items. Items were mapped to an empowerment framework with four domains: attitude, knowledge, behavior, and relatedness. Semi-structured interviews were conducted with 21 adults living with diabetes to assess face validity. The questionnaire was revised by a team of clinicians, researchers, and patient-partners. Factorial content validation was then performed using responses from 300 adult Canadians living with type 1 or type 2 diabetes. RESULTS The final version of the MEA-D contained 28 items. A moderately good item-domain correlation was found between the individual items within the four domains. Cronbach's α was 0.81 (95% CI 0.78-0.85) for attitude, 0.73 (95% CI 0.67-0.79) for knowledge, 0.84 (95% CI 0.81-0.87) for behavior, and 0.81 (95% CI 0.77-0.84) for relatedness. CONCLUSION The evaluation of diabetes programs demands a validated measure of empowerment. We developed the MEA-D to address this need. The MEA-D may be adapted to measure patients' empowerment regarding other chronic health conditions.
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Affiliation(s)
- Justin Gagnon
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | | | | | - Hao Zhang
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Tibor Schuster
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Pierre Pluye
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
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Tanaka R, Shibayama T, Sugimoto K, Hidaka K. Diabetes self-management education and support for adults with newly diagnosed type 2 diabetes mellitus: A systematic review and meta-analysis of randomized controlled trials. Diabetes Res Clin Pract 2020; 169:108480. [PMID: 33002545 DOI: 10.1016/j.diabres.2020.108480] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 09/09/2020] [Accepted: 09/21/2020] [Indexed: 02/07/2023]
Abstract
This systematic review aimed to identify the effectiveness of diabetes self-management education and support (DSMES) among adults within 12 months of diagnosis of type 2 diabetes mellitus (T2DM). We searched the Cochrane Library, MEDLINE, CINAHL, PsycINFO, ERIC, and other sources up to March 2019 to detect randomized controlled trials in the last decade based on the global guidelines' definition of DSMES. Data were categorized into biomedical, psychosocial, and behavioral outcomes and synthesized using a random-effects model. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation system. We scrutinized 12 studies that enrolled 2,386 adults with newly diagnosed T2DM. Biomedical outcomes presented the pooled effects of HbA1c -0.21% (95% confidence interval, -0.38, -0.04), body weight -2.36 kg (-5.77, 1.05), and waist circumference -1.8 cm (-5.63, 2.04) when the data from the two studies with low risk of bias were combined (N = 1,082). Psychosocial and behavioral effects were inconclusive owing to mixed results from various scales and reporting. The quality of the body of evidence was low. DSMES within 12 months of T2DM diagnosis might affect patient-centered outcomes. Further studies with higher precision using standardized measurement methods are required.
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Affiliation(s)
- Rie Tanaka
- Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan.
| | - Taiga Shibayama
- Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Keiko Sugimoto
- Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Kikue Hidaka
- Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
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Woolley A, Li L, Solomon J, Li J, Huang K, Chahal P, Chahal P, Tu G, Chahal P, Chattopadhyay K. What are the development priorities for management of type 2 diabetes by general practitioners in Ningbo, China: a qualitative study of patients' and practitioners' perspectives. BMJ Open 2020; 10:e037215. [PMID: 32912986 PMCID: PMC7485253 DOI: 10.1136/bmjopen-2020-037215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES To explore patients' and general practitioners' (GPs') perspectives on primary care management of patients with type 2 diabetes mellitus (T2DM) in Ningbo, China. We aimed to understand the current benefits and challenges and to identify development priorities. DESIGN Exploratory qualitative descriptive study using face-to-face interviews and analysed by thematic, inductive analysis. SETTING 11 primary care facilities spread across the city of Ningbo, China. PARTICIPANTS 23 patients with T2DM and 20 GPs involved in caring for patients with T2DM. RESULTS GPs were considered the first point of contact and providers of information. However, the care varied, and many GPs lacked confidence and felt overworked. The medication was a particularly weak area. The diagnostic screening commenced late, leading to crisis presentations. Patients were variably informed about their condition, contributing to poor adherence. CONCLUSIONS Future developments of primary care for T2DM in Ningbo should centre around improving GP confidence and workload and patient education and adherence.
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Affiliation(s)
- Angharad Woolley
- Department of Research and Knowledge Exchange, University of Nottingham, Ningbo, China
- Department of Research and Innovation, University of Nottingham, Nottingham, United Kingdom
| | - Li Li
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, China
| | - Josie Solomon
- School of Pharmacy, University of Lincoln, Brayford Campus, Lincoln, United Kingdom
| | - Jialin Li
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, China
| | - Kai Huang
- Department of General Practice, Ningbo First Hospital, Ningbo, China
| | - Punam Chahal
- Department of Research and Knowledge Exchange, University of Nottingham, Ningbo, China
- Department of Research and Innovation, University of Nottingham, Nottingham, United Kingdom
| | - Priya Chahal
- Department of Research and Knowledge Exchange, University of Nottingham, Ningbo, China
- Department of Research and Innovation, University of Nottingham, Nottingham, United Kingdom
| | - Gloria Tu
- Department of Research and Knowledge Exchange, University of Nottingham, Ningbo, China
- Department of Research and Innovation, University of Nottingham, Nottingham, United Kingdom
| | - Pritpal Chahal
- Health Education England, Leeds, United Kingdom
- Division of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Kaushik Chattopadhyay
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
- The Nottingham Centre for Evidence-Based Healthcare: a Joanna Briggs Institute Centre of Excellence, University of Nottingham, Nottingham, United Kingdom
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Javanmardifard S, Heidari S, Sanjari M, Yazdanmehr M, Shirazi F. The relationship between spiritual well-being and hope, and adherence to treatment regimen in patients with diabetes. J Diabetes Metab Disord 2020; 19:941-950. [PMID: 33520814 DOI: 10.1007/s40200-020-00586-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 07/09/2020] [Indexed: 12/16/2022]
Abstract
Background Adherence to treatment regimen is one of the behaviors related to diabetes, which has predicted successful control of the disease and reduced its intensity as well as negative consequences. This study aimed to determine the relationship between spiritual well-being and hope, and adherence to treatment regimen in patients with type II diabetes referred to diabetes clinics. Methods In this descriptive-correlational study, 227 diabetic patients referred to healthcare centers and diabetes clinics affiliated to Shiraz University of Medical Sciences were selected via cluster sampling (clinics) followed by convenience sampling (patients). The study data were collected using a demographic information form, spiritual well-being scale developed by Ellison and Paloutzian, Herth hope scale, and adherence to treatment regimen questionnaire. Then, the data were entered into the statistical software and were analyzed using descriptive and inferential statistics. Results The results indicated that most participants had moderate spiritual well-being, high hope, and low adherence to treatment regimen. Additionally, spiritual well-being was directly associated with hope and reversely related to adherence to treatment. A significant reverse correlation was also observed between hope and adherence to treatment. Conclusion Considering the fact that spiritual well-being and hope were reversely associated with adherence to treatment regimen, further studies should be done in this field. Also patients' image of God and their interpretations of being sick might not be appropriate and need correction.
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Affiliation(s)
- Sorur Javanmardifard
- Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shiva Heidari
- Department of Nursing, Urmia branch, Islamic Azad University, Urmia, Iran
| | - Mahnaz Sanjari
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Yazdanmehr
- Department of Ophthalmology, Shahid Motahari Specialty and Sub-specialty Complex, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Shirazi
- Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
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Wong MK, Cheng SYR, Chu TK, Lam FY, Lai SK, Wong KC, Liang J. Impact of Motivational Interviewing on Self-Management in Patients With Type 2 Diabetes: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e15709. [PMID: 32229475 PMCID: PMC7157490 DOI: 10.2196/15709] [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: 07/31/2019] [Revised: 10/28/2019] [Accepted: 02/03/2020] [Indexed: 11/22/2022] Open
Abstract
Background The nonpharmacological approach to diabetic control in patients with diabetes focuses on a healthy diet, physical activity, and self-management. Therefore, to help patients change their habits, it is essential to identify the most effective approach. Many efforts have been devoted to explain changes in or adherence to specific health behaviors. Such efforts have resulted in the development of theories that have been applied in prevention campaigns and include brief advice and counseling services. Within this context, motivational interviewing (MI) has proven to be effective in changing health behaviors for specific cases. However, stronger evidence is needed on the effectiveness of MI in treating chronic pathologies such as diabetes. Objective This study will obtain preliminary data on the impact of a nurse-led MI intervention in improving glycemic control, as well as clinical, psychosocial, and self-care outcomes for individuals with type 2 diabetes mellitus when compared with usual care, with the aim of improving diabetic control in patients with diabetes. Methods An open, two-arm, parallel, randomized controlled, pilot exploratory trial will be performed. Two government outpatient clinics in the New Territories West Cluster in Hong Kong will be involved. In total, 20 to 25 participants will be invited in each arm. Intervention participants will receive face-to-face MI interventions in addition to their usual care from the clinic. Control participants will only receive usual care. Outcomes are assessed at baseline, 6 months, and 12 months. The primary outcome measure is glycated hemoglobin levels. Secondary outcomes include blood pressure, BMI, hip and waist circumference, fasting blood, and psychosocial and self-care measures. Results This study is currently underway with funding support from the Hong Kong College of Family Physician Research Seed Fund 2017. Conclusions MI skills constitute the main strategies primary care nurses use on their patients. Having economical, simple, effective, and applicable techniques is essential for primary care professionals to help their patients change their lifestyle and improve their health. This study will provide scientific evidence on the effectiveness of MI. It will be performed with strict control over the data collection, ensuring the maintenance of therapeutic integrity. Trial Registration Centre for Clinical Research and Biostatistics CUHK_CCRB00614; https://tinyurl.com/v9awzk6 International Registered Report Identifier (IRRID) DERR1-10.2196/15709
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Affiliation(s)
- Man Kin Wong
- Department of Family Medicine and Primary Health Care, Tuen Mun Hospital, New Territories West Cluster, New Territories, Hong Kong
| | - Sai Yip Ronald Cheng
- Department of Family Medicine and Primary Health Care, Tuen Mun Hospital, New Territories West Cluster, New Territories, Hong Kong
| | - Tsun Kit Chu
- Department of Family Medicine and Primary Health Care, Tuen Mun Hospital, New Territories West Cluster, New Territories, Hong Kong
| | - Fung Yee Lam
- Department of Family Medicine and Primary Health Care, Tuen Mun Hospital, New Territories West Cluster, New Territories, Hong Kong
| | - Shiu Kee Lai
- Department of Family Medicine and Primary Health Care, Tuen Mun Hospital, New Territories West Cluster, New Territories, Hong Kong
| | - Kai Chung Wong
- Department of Family Medicine and Primary Health Care, Tuen Mun Hospital, New Territories West Cluster, New Territories, Hong Kong
| | - Jun Liang
- Department of Family Medicine and Primary Health Care, Tuen Mun Hospital, New Territories West Cluster, New Territories, Hong Kong
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Dobson R, Whittaker R, Jiang Y, McNamara C, Shepherd M, Maddison R, Cutfield R, Khanolkar M, Murphy R. Long-term follow-up of a randomized controlled trial of a text-message diabetes self-management support programme, SMS4BG. Diabet Med 2020; 37:311-318. [PMID: 31722130 PMCID: PMC7004024 DOI: 10.1111/dme.14182] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2019] [Indexed: 01/03/2023]
Abstract
AIMS To determine the long-term effectiveness of an individually tailored text-message diabetes self-management support programme, SMS4BG, on glycaemic control at 2 years in adults with diabetes with an HbA1c concentration > 64 mmol/mol (8%). METHODS We conducted a 2-year follow-up of a two-arm, parallel, randomized controlled trial across health services in New Zealand. Participants were English-speaking adults with type 1 or 2 diabetes and with an HbA1c >64 mmol/mol (8%). In the main trial participants randomized to the intervention group (N=183) received up to 9 months of an automated tailored text-message programme in addition to usual care. Participants in the control group (N=183) received usual care for 9 months. In this follow-up study, 293 (80%) of 366 randomized participants in the main trial were included. The primary outcome measure was change in glycaemic control (HbA1c ) from baseline to 2 years. Mixed-effect models were used to compare the group differences at 3, 6, 9 and 24 months, adjusted for baseline HbA1c and stratification factors (health district category, diabetes type and ethnicity). RESULTS The decrease in HbA1c at 2 years was significantly greater in the intervention group [mean (sd) -10 (18) mmol/mol or -0.9 (1.6)%] compared with the control group [mean (sd) -1 (20) mmol/mol or -0.1 (1.8)%], with an adjusted mean difference of -9 mmol/mol (95% CI -14, -5) or -0.8% (95% CI -1.2, -0.4; P<0.0001). CONCLUSIONS Improvements in glycaemic control resulting from a text-message diabetes self-management support programme were sustained at 2 years after randomization. These findings support the implementation of SMS4BG in current practice.
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Affiliation(s)
- R. Dobson
- National Institute for Health InnovationSchool of Population HealthUniversity of AucklandAucklandNew Zealand
| | - R. Whittaker
- National Institute for Health InnovationSchool of Population HealthUniversity of AucklandAucklandNew Zealand
- Waitematā District Health BoardAucklandNew Zealand
| | - Y. Jiang
- National Institute for Health InnovationSchool of Population HealthUniversity of AucklandAucklandNew Zealand
| | - C. McNamara
- Waitematā District Health BoardAucklandNew Zealand
| | - M. Shepherd
- School of PsychologyMassey UniversityAucklandNew Zealand
| | - R. Maddison
- Institute for Physical Activity and NutritionDeakin UniversityBurwoodVic.Australia
| | - R. Cutfield
- Waitematā District Health BoardAucklandNew Zealand
| | - M. Khanolkar
- Auckland District Health BoardAucklandNew Zealand
| | - R. Murphy
- Auckland District Health BoardAucklandNew Zealand
- School of MedicineFaculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
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Paudyal V, MacLure K, Forbes-McKay K, McKenzie M, MacLeod J, Smith A, Stewart D. 'If I die, I die, I don't care about my health': Perspectives on self-care of people experiencing homelessness. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:160-172. [PMID: 31490598 DOI: 10.1111/hsc.12850] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/25/2019] [Accepted: 08/16/2019] [Indexed: 06/10/2023]
Abstract
Self-care, which refers to what people do to prevent disease and maintain good health, can alleviate negative health consequences of people experiencing homelessness. The aim of the study was to apply a theoretically informed approach in exploring engagement of people experiencing homelessness in self-care and to identify factors that can be targeted in future health and social care interventions. Qualitative semi-structured interviews were conducted with 28 participants opportunistically recruited from a specialist homelessness healthcare centre of North East Scotland, the United Kingdom (UK). An interview schedule was developed based on the theoretical domains framework (TDF). Interviews were audio-recorded and transcribed verbatim. Six aspects of self-care were explored, including (a) self-awareness of physical and mental health, (b) health literacy, including health seeking behaviour, (c) healthy eating, (d) risk avoidance or mitigation, (v) physical activity and sleep and (e) maintaining personal hygiene. Thematic analysis was conducted by two independent researchers following the Framework Approach. Participants described low engagement in self-care. Most of the barriers to engagement in self-care by participants were related to 'environmental context and resources' domain of TDF. Participants often resorted to stealing or begging for food. Many perceived having low health literacy to interpret health-related information. Visits to churches and charities to get a shower or to obtain free meals were commonplace. Participants expressed pessimism that there was 'nothing' they could do to improve their health and described perceived barriers often too big for them to overcome. Alienation, lack of social support and the perception that they had done irreversible damage to their health prevented their involvement in self-care. The theme of 'social circle' held examples of both enabler and barriers in participants' uptake of risky behaviours. Health and social services should work with persons experiencing homelessness in designing and delivering targeted interventions that address contextual barriers, multi-morbidity, health literacy and self-efficacy.
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Affiliation(s)
- Vibhu Paudyal
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Katie MacLure
- Faculty of Health and Social Care, Robert Gordon University, Aberdeen, UK
| | | | - Myra McKenzie
- Faculty of Health and Social Care, Robert Gordon University, Aberdeen, UK
| | - Joan MacLeod
- NHS Grampian (South Cluster), Aberdeen City Community Health Partnership, Aberdeen, UK
| | - Ann Smith
- NHS Grampian (North Cluster), Aberdeen City Community Health Partnership, Aberdeen, UK
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da Rocha RB, Silva CS, Cardoso VS. Self-Care in Adults with Type 2 Diabetes Mellitus: A Systematic Review. Curr Diabetes Rev 2020; 16:598-607. [PMID: 31267873 DOI: 10.2174/1573399815666190702161849] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/17/2019] [Accepted: 06/20/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Self-care is essential for the prevention of complications in patients with diabetes, but several authors report that even with health education programs, the incidence of complications in patients with diabetes continues to increase. OBJECTIVE We aimed to examine adherence to self-care strategies and the repercussions of adherence on the clinical profiles of individuals with type 2 diabetes. METHODS We performed a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. We searched for related studies in 4 databases: PubMed, Web of Science, Scopus, and Latin American and Caribbean Health Science Literature (LILACS). We included observational studies in English and Portuguese that evaluated the effects of selfcare in individuals with type 2 diabetes. RESULTS The search resulted in the identification of 615 articles, of which 34 met all the inclusion criteria. General self-care was considered unsatisfactory. Physical exercise was classified as the self-care activity that was performed less frequently by individuals with type 2 diabetes mellitus; adherence to medication was the most frequent behavior among volunteers. CONCLUSION The studies indicated poor adherence of the population to good self-care practices, reflected by the increase in complications related to DM.
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Affiliation(s)
- Rebeca Barbosa da Rocha
- Center of Medical Specialties, Parnaíba, Piauí, Brazil
- Biosignal Laboratory, Parnaíba, Piauí, Brazil
| | - Cristiano Sales Silva
- Center of Medical Specialties, Parnaíba, Piauí, Brazil
- Biosignal Laboratory, Parnaíba, Piauí, Brazil
- School of Physical Therapy, Federal University of Piauí, Parnaíba, Piauí, Brazil
| | - Vinícius Saura Cardoso
- Center of Medical Specialties, Parnaíba, Piauí, Brazil
- Biosignal Laboratory, Parnaíba, Piauí, Brazil
- School of Physical Therapy, Federal University of Piauí, Parnaíba, Piauí, Brazil
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Mikhael EM, Hassali MA, Hussain SA. Effectiveness of Diabetes Self-Management Educational Programs For Type 2 Diabetes Mellitus Patients In Middle East Countries: A Systematic Review. Diabetes Metab Syndr Obes 2020; 13:117-138. [PMID: 32021358 PMCID: PMC6968799 DOI: 10.2147/dmso.s232958] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 10/22/2019] [Indexed: 12/17/2022] Open
Abstract
AIM This review study aimed to determine the effectiveness and factors affecting the success of DSME programs in T2DM patients living in ME countries. METHODS An extensive manual literature search was conducted using PubMed and Google Scholar for clinical trials assessing the effect of diabetes self-management education (DSME) for type 2 diabetes mellitus patients in Middle East countries. Information from the included studies was summarized in relation to study population, sample size, duration of follow-up, characteristics of DSME program, and follow-up time, besides in addition to parameters used in assessment, results, and conclusions. The risk of bias in the included studies was assessed using the Cochrane risk of bias tool. The effect of DSME on clinical and patient-reported outcomes was measured by calculation of the percentage of DSME studies that produce a significant improvement in these outcomes for patients in intervention group as compared to those in control group. Additionally, the effect of DSME on each clinical outcome was assessed by calculating the mean for the absolute effect of DSME on that outcome. RESULTS Twelve studies were included in this review. Heterogeneity was found among included studies in terms of DSME program characteristics, the enrolled patients, duration of follow-up, assessment methods, and obtained outcomes. All clinical glycemic outcomes (glycosylated hemoglobin, fasting, and non-fasting blood glucose), lipid profile (total cholesterol and triglycerides), and body mass index were significantly improved for patients in intervention group as compared to those in control group in at least 60% of the included studies. All patients' reported outcomes (medication adherence, self-management behavior, knowledge, self-efficacy, health belief and quality of life) were significantly improved by the DSME program. CONCLUSION DSME programs are highly effective in improving glycemic control, lipid profile and BMI, and modestly effective in improving BP. Thus, they can reduce the risks of developing diabetes complications. Patient diabetes knowledge, DSM behaviors, adherence to medications, self-efficacy, and quality of life can also be significantly improved by DSME.
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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
- Correspondence: Ehab Mudher Mikhael Email
| | - 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
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Azzi JL, Azzi S, Lavigne-Robichaud M, Vermeer A, Barresi T, Blaine S, Giroux I. Participant Evaluation of a Prediabetes Intervention Program Designed for Rural Adults. CAN J DIET PRACT RES 2019; 81:80-85. [PMID: 31736334 DOI: 10.3148/cjdpr-2019-033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The type 2 diabetes epidemic is a global crisis threatening the health and economies of many nations. This study aimed to evaluate a prediabetes intervention program designed for rural adults in southwestern Ontario based on the feedback of participants. Rural adults with prediabetes were referred by physicians to an intervention program developed to assist with unique barriers rural adults face related to the built environment and socioeconomic status when adopting a healthy lifestyle. After 6 monthly education sessions offered by a dietitian and a nurse, participants completed a questionnaire to share their program experience. In addition, 6 focus groups consisting of 5-9 participants were conducted to assess program acceptability, feasibility, and practicality. Of 49 enrolled, 35 participants aged 60.8 ± 7.1 (mean ± SD) evaluated the program. Participants reported finding the program to be acceptable, feasible, and practical due to the interactive nature of the sessions, the group setting and the availability of health professionals. This prediabetes lifestyle intervention program was perceived as successfully addressing rural adults' needs in terms of adopting a healthy lifestyle. Feedback received through program evaluation, which included a participant experience survey and focus groups has helped improve this program and may benefit other prediabetes education intervention programs.
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Affiliation(s)
- Jayson L Azzi
- Faculty of Medicine, University of Ottawa, Ottawa, ON
| | - Sarita Azzi
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON
| | | | | | | | | | - Isabelle Giroux
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON
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Rasoul AM, Jalali R, Abdi A, Salari N, Rahimi M, Mohammadi M. The effect of self-management education through weblogs on the quality of life of diabetic patients. BMC Med Inform Decis Mak 2019; 19:205. [PMID: 31665001 PMCID: PMC6819410 DOI: 10.1186/s12911-019-0941-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 10/16/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Self-management education of diabetes which is one of the most important noncommunicable diseases worldwide involves facilitating knowledge, skills, and ability required for self-care in these patients. Concerning the progressive growth of use of Internet for educating patients and absence of different studies about education through use of weblogs in patients with diabetes in Iran, the present study was conducted with the aim of determining the effect of self-management education through weblogs on the quality of life of affect the patients. METHODS This study was performed as intervention on patients referring to diabetes clinic of Talghani hospital in Kermanshah in winter 2018 and spring 2019. The samples consisted of 98 patients with diabetes chosen through available sampling and randomly assigned into study and control groups. For data collection, diabetes quality of life (DQOL) short form clinical questionnaire, Persian version, was used. The intervention involved training self-management conducted through 60 sessions via a designed weblog. The obtained information was introduced into SPSS 21, and analyzed through Mann-Whitney, t-test, and paired t-test. RESULTS According to the results of this study, the mean age of the examined patients was 32.1 ± 4.9 years, where the major participants were male (n = 52 in the test group, 52.5%). The results showed that after the intervention, the test and control groups were different in terms of anthropometric variables and metabolic indicators; the mean waist circumference in the test and control groups was 98.6 ± 9.8 and 101.5 ± 7.8, respectively; the mean FBS following the intervention in the test and control groups was 131.08 ± 16.04 and 238.2 ± 40, respectively; and the mean BMI postintervention in the test and control groups was obtained as 27.3 ± 3.4 and 30.1 ± 3.8 respectively, where these differences were significant according to independent t-test (p < 0.05). The mean score of quality of life postintervention in the test and control groups was obtained as 56.1 and 49.9 respectively; according to Mann-Whitney test, the difference between the two groups was significant (p < 0.05). CONCLUSION The results of the present study revealed the positive effect of weblog based self-management on the quality of life of patients with diabetes following the intervention. Further, reduced levels of FBS, BMI, as well as systolic and diastolic blood pressure were also observed, which could be due to increased awareness of patients about their abilities, its risks, as well as the ways to control and treat it.
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Affiliation(s)
- Amal Mohammad Rasoul
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Rostam Jalali
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Abdi
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nader Salari
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mehrali Rahimi
- Diabetes Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Mohammadi
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Yaghoubi M, Mansell K, Vatanparast H, Steeves M, Zeng W, Farag M. Prevalence of Type 1 and Type 2 Diabetes-Related Complications and Their Association With Determinants Identified in Canada's Survey on Living With Chronic Diseases-Diabetes Component. Can J Diabetes 2019; 44:304-311.e3. [PMID: 31866239 DOI: 10.1016/j.jcjd.2019.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 09/07/2019] [Accepted: 09/09/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES In this study, we estimated the prevalence of diabetes-related complications and the factors associated with them in Canadian patients with diabetes. METHODS Data from the 2011 Survey on Living with Chronic Diseases in Canada---Diabetes Component (SLCDC-DM-2011) were used to calculate the weighted prevalence of 16 diabetes-related complications. A multivariable, sex-stratified logistic regression model was used to examine the association between each diabetes-related complication and select determinants. RESULTS Among Canadian patients who self-reported having diabetes, 80.26% reported having at least 1 type of diabetes-related complication. The most frequently reported complications were high blood pressure (54.65%), cataracts (29.52%) and poor circulation (21.68%). Male patients were more associated to have at least 1 complication if they had an inappropriate body mass index (odds ratio [OR], 2.94; 95% confidence interval [CI], 1.39 to 6.23) and had a high level of glycated hemoglobin (OR, 2.32; 95% CI, 1.05 to 5.13), were older (OR, 6.92; 95% CI, 1.82 to 24.74) and had diabetes for a longer period of time (OR, 3.42; 95% CI, 1.71 to 6.85). Among the female patients, a longer duration diabetes was found to have a significant association with complications (OR, 2.00; 95% CI, 1.05 to 3.81). CONCLUSIONS Our findings suggest that socioeconomic factors, including marital status, income and education, have a significant association with most types of complications. Our findings also confirm that low levels of physical activity and high levels of glycated hemoglobin were major determinants in many diabetes-related complications.
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Affiliation(s)
- Mohsen Yaghoubi
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
| | - Kerry Mansell
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Hassanali Vatanparast
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Megan Steeves
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Wu Zeng
- The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, United States
| | - Marwa Farag
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Kloos C, Burghardt K, Müller UA, Kramer G, Müller N, Wolf G, Kuniss N. Reduction of Severe Hypoglycaemia in People with Type 2 Diabetes after a Structured Inpatient Intervention. Exp Clin Endocrinol Diabetes 2019; 129:587-592. [PMID: 31487750 DOI: 10.1055/a-0983-1559] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of this longitudinal study was to assess outcomes before and one year after participation in a structured inpatient intervention including participation in an education programme for people with type 2 diabetes. METHODS In 2014, 81 individuals, who were admitted to optimise insulin therapy, participated in a structured inpatient intervention and were invited to participate in a follow-up visit after one year. RESULTS Seventy participants (46.9% female, age 68.3 y, diabetes duration 17.9 y, HbA1c 9.7%/82.5 mmol/mol) were followed-up after 1.2 y (3 died by non-diabetic causes, 8 declined/were not available). HbA1c decreased by 1.1% (p<0.001) without change of insulin dose (79.7 vs. 79.3 IU, n.s.) or BMI (33.6 vs. 33.8 kg/m2, n.s.). 5 people admitted because of severe hypoglycaemia (one person with 5 episodes and 4 with one episode in the year prior to participation) did not experience another event in the evaluation period, nor did anyone in the rest of the cohort (frequency of severe hypoglycaemia 0.12 events/year before and 0.0 after intervention). CONCLUSIONS In people admitted for optimising insulin therapy or severe hypoglycaemia, metabolic control improved substantially and frequency of severe hypoglycaemia was significantly reduced after participation in a structured inpatient intervention. Reasons could be motivational and better adapted eating habits, tailoring individual therapy solutions and deescalating diabetes therapy in people after severe hypoglycaemia.
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Affiliation(s)
- Christof Kloos
- Division of Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Jena, Germany
| | - Katharina Burghardt
- Division of Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Jena, Germany
| | - Ulrich Alfons Müller
- Division of Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Jena, Germany
| | - Guido Kramer
- Division of Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Jena, Germany
| | - Nicolle Müller
- Division of Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Jena, Germany
| | - Gunter Wolf
- Division of Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Jena, Germany
| | - Nadine Kuniss
- Division of Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Jena, Germany
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Saidi S, Milnes LJ, Griffiths J. Are we doing it right? Self-care support for patients with type 2 diabetes in urban areas in Malaysia. ENFERMERIA CLINICA 2019. [DOI: 10.1016/j.enfcli.2019.04.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Morro T, Fink A, Carmienke S, Frese T, Guenther S. Learning types and learning success in a structured diabetes education programme for patients with type 2 diabetes: study protocol of a prospective, longitudinal study. BMJ Open 2019; 9:e030611. [PMID: 31444191 PMCID: PMC6707680 DOI: 10.1136/bmjopen-2019-030611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Diabetes mellitus (DM) has had a wide-ranging impact on healthcare politics. Secondary diseases and complications caused by diabetes are relevant cost and utilisation factors in the healthcare system. For decades, diabetes self-management education (DSME) has played a major role in the treatment of patients with type 2 DM (T2DM). The aim of this training is to empower patients to actively influence their diabetes process by gaining knowledge about health-related behaviours, such as healthy nutrition and exercise, and cardiovascular risks. The aim of the project is to analyse the practice of structured diabetes education and the effects of different learning types of participants. This project focuses on the needs of socioeconomically deprived patients and aims to improve DSME for this group. This patient group has a higher prevalence of T2DM, more complications and worse therapy-relevant parameters. METHODS AND ANALYSIS The study will be conducted as a prospective longitudinal study. Patients will be recruited in outpatient physician offices over a period of 12 months. Patients will be included if they are 18 years and older, have T2DM and are scheduled to participate in DSME for the first time. A pseudonymised, written survey with standardised questionnaires will be administered. The data will be analysed using inferential statistical methods, such as correlation analysis, regression models and variance analytical designs. ETHICS AND DISSEMINATION The study will be carried out following the principles of the Declaration of Helsinki and good scientific standards. Ethical approval of the Ethics Review Committee of the Medical Faculty at Martin-Luther-University, Halle-Wittenberg, was obtained. All participants in the study will receive comprehensive information and will be included after written informed consent is obtained. The results will be published in international peer-reviewed journals and presented at several congresses. TRIAL REGISTRATION NUMBER DRKS00016630.
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Affiliation(s)
- Thimo Morro
- Institute of Medical Sociology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Astrid Fink
- Institute of Medical Sociology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Solveig Carmienke
- Institute of General Practice and Family Medicine of the Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine of the Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Sebastian Guenther
- Institute of Medical Sociology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
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Swanson V, Maltinsky W. Motivational and behaviour change approaches for improving diabetes management. PRACTICAL DIABETES 2019. [DOI: 10.1002/pdi.2229] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Vivien Swanson
- Centre for Health and Behaviour Change, Psychology DivisionUniversity of Stirling Stirling UK
| | - Wendy Maltinsky
- Centre for Health and Behaviour Change, Psychology DivisionUniversity of Stirling Stirling UK
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Alomar MJ, Al-Ansari KR, Hassan NA. Comparison of awareness of diabetes mellitus type II with treatment's outcome in term of direct cost in a hospital in Saudi Arabia. World J Diabetes 2019; 10:463-472. [PMID: 31523382 PMCID: PMC6715573 DOI: 10.4239/wjd.v10.i8.463] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/08/2015] [Accepted: 07/20/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Saudi Arabia is among the top 10 countries with the highest prevalence of diabetes. Cost of prevention and the indirect cost must be calculated to increase the awareness of society and to emphasize disease prevention and limit further complications. AIM To understand the importance of awareness and the impact on the expenditure of diabetes mellitus and treatments outcomes. METHODS A prospective descriptive and comparative survey was carried out among patients with diabetes mellitus in Saudi Arabia. RESULTS One hundred and one participants were included in the study of which 40% were female and one third were above the age of 50. The mean of the first HbA1c reading was 6.95, and the median was 7. The mean of the second reading of HbA1c was 7.26, and the median was 7. The mean body mass index was 32.1, and the median was 30.9. The average yearly cost of the medication was 995.14 SR. Comparing participants who think that a healthy low-sugar diet can affect blood sugar with those who do not, showed a statistically significant difference when cost was considered (P value = 0.03). Also, when comparing the group of participants who know when to take their oral hyperglycemic medicine and their yearly direct cost and those who do not know when to take it, by using independent sample T test, showed significant statistical difference (P value = 0.046). CONCLUSION It is essential for the governments to invest in ways to prevent and help in the early detection of such an expensive disease by performing national screening and education programs. Many pharmaco-economic studies can be done to help the decision-maker in our hospitals think about strategies to help the patient to be physically fit by offering gymnasium or places to walk or contract.
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Affiliation(s)
- Muaed Jamal Alomar
- Clinical Pharmacy Department, College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates
| | - Khadeja Rashed Al-Ansari
- Clinical Pharmacy Department, College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates
| | - Najeeb A Hassan
- Clinical Pharmacy Department, College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates
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Dineen-Griffin S, Garcia-Cardenas V, Williams K, Benrimoj SI. Helping patients help themselves: A systematic review of self-management support strategies in primary health care practice. PLoS One 2019; 14:e0220116. [PMID: 31369582 PMCID: PMC6675068 DOI: 10.1371/journal.pone.0220116] [Citation(s) in RCA: 274] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 07/09/2019] [Indexed: 12/11/2022] Open
Abstract
Background Primary health professionals are well positioned to support the delivery of patient self-management in an evidence-based, structured capacity. A need exists to better understand the active components required for effective self-management support, how these might be delivered within primary care, and the training and system changes that would subsequently be needed. Objectives (1) To examine self-management support interventions in primary care on health outcomes for a wide range of diseases compared to usual standard of care; and (2) To identify the effective strategies that facilitate positive clinical and humanistic outcomes in this setting. Method A systematic review of randomized controlled trials evaluating self-management support interventions was conducted following the Cochrane handbook & PRISMA guidelines. Published literature was systematically searched from inception to June 2019 in PubMed, Scopus and Web of Science. Eligible studies assessed the effectiveness of individualized interventions with follow-up, delivered face-to-face to adult patients with any condition in primary care, compared with usual standard of care. Matrices were developed that mapped the evidence and components for each intervention. The methodological quality of included studies were appraised. Results 6,510 records were retrieved. 58 studies were included in the final qualitative synthesis. Findings reveal a structured patient-provider exchange is required in primary care (including a one-on-one patient-provider consultation, ongoing follow up and provision of self-help materials). Interventions should be tailored to patient needs and may include combinations of strategies to improve a patient’s disease or treatment knowledge; independent monitoring of symptoms, encouraging self-treatment through a personalized action plan in response worsening symptoms or exacerbations, psychological coping and stress management strategies, and enhancing responsibility in medication adherence and lifestyle choices. Follow-up may include tailored feedback, monitoring of progress with respect to patient set healthcare goals, or honing problem-solving and decision-making skills. Theoretical models provided a strong base for effective SMS interventions. Positive outcomes for effective SMS included improvements in clinical indicators, health-related quality of life, self-efficacy (confidence to self-manage), disease knowledge or control. An SMS model has been developed which sets the foundation for the design and evaluation of practical strategies for the construct of self-management support interventions in primary healthcare practice. Conclusions These findings provide primary care professionals with evidence-based strategies and structure to deliver SMS in practice. For this collaborative partnership approach to be more widely applied, future research should build on these findings for optimal SMS service design and upskilling healthcare providers to effectively support patients in this collaborative process.
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Affiliation(s)
- Sarah Dineen-Griffin
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
- * E-mail:
| | | | - Kylie Williams
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
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Vos RC, van Heusden L, Eikelenboom NWD, Rutten GEHM. Theory-based diabetes self-management education with pre-selection of participants: a randomized controlled trial with 2.5 years' follow-up (ELDES Study). Diabet Med 2019; 36:827-835. [PMID: 30677175 PMCID: PMC6618028 DOI: 10.1111/dme.13907] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2019] [Indexed: 12/22/2022]
Abstract
AIMS To evaluate the (cost-)effectiveness of Beyond Good Intentions (BGI), a 12-week group-based, nurse-led self-management programme, in terms of cardiovascular risk factors, self-management and quality of life, after 2.5 years of follow-up in pre-selected individuals with known Type 2 diabetes of up to 5 years' duration. METHODS A parallel randomized controlled trial comparing BGI with usual care, based on a self-management screening questionnaire, was conducted in 43 general practices after pre-selection of participants. After 2.5 years of follow-up, the between-group changes in the abovementioned variables were assessed using analysis of covariance. RESULTS A total of 108 participants (BGI group, n =56; control group, n =52) were included. Changes over time in BMI (-0.4 vs -0.5 kg/m2 ) were similar in the two groups. Median HbA1c [BGI group 47 mmol/mol (6.5%); control group: 49 mmol/mol (6.6%)] and mean systolic blood pressure (BGI group: 132±13 mmHg; control group: 133±14 mmHg) were well controlled at baseline and no intervention effect was found. LDL cholesterol levels decreased from 2.4 to 2.2 mmol/l in the control group and remained stable at 2.6 mmol/l in the intervention group (P=0.032). No intervention effect was found for self-management or quality of life. CONCLUSION In contrast to the first BGI study, we did not observe significant effects of the BGI intervention, despite pre-selection of individuals. In diabetes populations with target levels for HbA1c , systolic blood pressure and LDL cholesterol, no further beneficial effects can be expected from self-management programmes with regard to biomedical factors and quality of life.
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Affiliation(s)
- R. C. Vos
- Julius Centre for Health Sciences and Primary Care, Department of General PracticeUniversity Medical Centre UtrechtUtrecht UniversityUtrechtThe Netherlands
- Leiden University Medical Centre, Department of Public Health and Primary Care/LUMC‐Campus The HagueEindhovenThe Netherlands
| | - L. van Heusden
- Julius Centre for Health Sciences and Primary Care, Department of General PracticeUniversity Medical Centre UtrechtUtrecht UniversityUtrechtThe Netherlands
| | | | - G. E. H. M. Rutten
- Julius Centre for Health Sciences and Primary Care, Department of General PracticeUniversity Medical Centre UtrechtUtrecht UniversityUtrechtThe Netherlands
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Horikawa Y, Suzuki A, Hashimoto KI, Enya M, Nishida S, Kobayashi R, Ohashi T, Yamazaki F, Totani R, Kobayashi H, Yamamoto M, Itoh Y, Takeda J. Evaluation of the Diabetes Regional Coordination Path using the Diabetes Coordination Notebook in community-based diabetes care. Diabetol Int 2019; 10:188-197. [PMID: 31275785 PMCID: PMC6592995 DOI: 10.1007/s13340-018-0379-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/12/2018] [Indexed: 10/28/2022]
Abstract
AIMS A number of epidemiologic surveys have demonstrated that improving lifestyle habits, providing patient education, and regular screening of patients for early diabetic symptoms and complications through multidisciplinary collaboration are crucial for the management of diabetes. METHODS To evaluate the Diabetes Coordination Notebook and the Diabetes Regional Coordination Path in management of diabetes, 217 community pharmacies conducted a survey by questionnaire in Gifu Prefecture, Japan. RESULTS A reply to the questionnaire was obtained from 27,016 individuals, of whom 5,572 claimed to have diabetes or prediabetes. The rate of usage of the Diabetes Coordination Notebook and the Diabetes Regional Coordination Path was 40% and 7%, respectively. Interestingly, patients using the Diabetes Regional Coordination Path more frequently visited an ophthalmic clinic (p < 0.001) and a dental clinic (p < 0.05) than those not using it. Furthermore, multivariate logistic regression analysis revealed that use of the Diabetes Regional Coordination Path was the only factor associated with control of HbA1c < 7.0% (OR: 0.613, 95% CI: 0.395-0.951, p = 0.029). CONCLUSIONS The usage of the Diabetes Regional Coordination Path together with the Diabetes Coordination Notebook is associated not only with regular visits to both an ophthalmic clinic and a dental clinic but also with the maintenance of appropriate HbA1c.
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Affiliation(s)
- Yukio Horikawa
- Department of Diabetes and Endocrinology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Akio Suzuki
- Department of Pharmacy, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Ken-ichi Hashimoto
- Department of Diabetes and Endocrinology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Mayumi Enya
- Department of Diabetes and Endocrinology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Shohei Nishida
- Department of Pharmacy, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Ryo Kobayashi
- Department of Pharmacy, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Tetsuya Ohashi
- Gifu Pharmaceutical Association, 4-5 Kokonoecho, Gifu, 500-8146 Japan
| | - Futoshi Yamazaki
- Gifu Pharmaceutical Association, 4-5 Kokonoecho, Gifu, 500-8146 Japan
| | - Rieko Totani
- Gifu Prefecture Medical Association, 3-5-1 Yabutaminami, Gifu, 500-8510 Japan
| | - Hiroshi Kobayashi
- Gifu Prefecture Medical Association, 3-5-1 Yabutaminami, Gifu, 500-8510 Japan
| | - Mayumi Yamamoto
- Health Administration Center, Gifu University, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Yoshinori Itoh
- Department of Pharmacy, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Jun Takeda
- Department of Diabetes and Endocrinology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194 Japan
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Bene BA, O'Connor S, Mastellos N, Majeed A, Fadahunsi KP, O'Donoghue J. Impact of mobile health applications on self-management in patients with type 2 diabetes mellitus: protocol of a systematic review. BMJ Open 2019; 9:e025714. [PMID: 31243029 PMCID: PMC6597642 DOI: 10.1136/bmjopen-2018-025714] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 04/03/2019] [Accepted: 05/15/2019] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The emergence of mobile health (mHealth) solutions, particularly mHealth applications (apps), has shown promise in self-management of chronic diseases including type 2 diabetes mellitus (T2DM). While majority of the previous systematic reviews have focused on the effectiveness of mHealth apps in improving treatment outcomes in patients with T2DM, there is a need to also understand how mHealth apps influence self-management of T2DM. This is crucial to ensure improvement in the design and use of mHealth apps for T2DM. This protocol describes how a systematic review will be conducted to determine in which way(s) mHealth apps might impact on self-management of T2DM. METHODS The following electronic databases will be searched from inception to April 2019: PubMed, MEDLINE, EMBASE, Global Health, PsycINFO, CINAHL, The Cochrane Central Register of Controlled Trials, Scopus, Web of Science, ProQuest Dissertations & Theses Global, Health Management Information Consortium database, Google Scholar and ClinicalTrials.gov. The Cochrane risk of bias tool will be used to assess methodological quality. The primary outcome measures to be assessed will be 'change in blood glucose'. The secondary outcomes measures will be 'changes in cardiovascular risk markers' (including blood pressure, body mass index and blood lipids), and self-management practices. Others will include: health-related quality of life, economic data, social support, harms (eg, death or complications leading to hospital admissions or emergency unit attendances), death from any cause, anxiety or depression and adverse events (eg, hypoglycaemic episodes). ETHICS AND DISSEMINATION This study will not involve the collection of primary data and will not require ethical approval. The review will be published in a peer-reviewed journal and a one-page summary of the findings will be shared with relevant organisations. Presentation of findings will be made at appropriate conferences. TRIAL REGISTRATION NUMBER CRD42017071106.
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Affiliation(s)
- Benard Ayaka Bene
- Department of Primary Care & Public Health, School of Public Health, Imperial College London, London, UK
- Department of Public Health, Federal Ministry of Health, Abuja, Nigeria
| | - Siobhan O'Connor
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Nikolaos Mastellos
- Department of Primary Care & Public Health, School of Public Health, Imperial College London, London, UK
| | - Azeem Majeed
- Department of Primary Care & Public Health, School of Public Health, Imperial College London, London, UK
| | - Kayode Philip Fadahunsi
- Department of Primary Care & Public Health, School of Public Health, Imperial College London, London, UK
- Department of Hospital Services, Federal Ministry of Health, Abuja, Nigeria
| | - John O'Donoghue
- Malawi eHealth Research Centre, University College Cork, Cork, Ireland
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Selçuk‐Tosun A, Zincir H. The effect of a transtheoretical model–based motivational interview on self‐efficacy, metabolic control, and health behaviour in adults with type 2 diabetes mellitus: A randomized controlled trial. Int J Nurs Pract 2019; 25:e12742. [DOI: 10.1111/ijn.12742] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/31/2018] [Accepted: 04/14/2019] [Indexed: 11/28/2022]
Affiliation(s)
| | - Handan Zincir
- Faculty of Health SciencesErciyes University Kayseri Turkey
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