Everyday life of a family with diabetes as described by adults with type 1 diabetes

Testing proximal, intermediate, and health outcomes of patient centered communication among non-pregnant women of childbearing age with diabetes mellitus: Findings from the Medical Expenditure Panel Survey 2012-2018

Objective

To determine associations between patient-centered communication (PCC) and overall healthcare ratings, self-efficacy, and management adherence among reproductive-age women with diabetes within the framework of Epstein and Street's conceptual model.

Methods

We analyzed longitudinal data from the 2012-2018 Medical Expenditure Panel Survey. The sample included 493 non-pregnant women of childbearing age (18-45 years) with diabetes. Independent variables were domains of PCC (listening, explaining, respecting, spending time, giving instructions, among others). Dependent variables were overall healthcare ratings, self-efficacy, and management adherence. Crude and adjusted associations were evaluated.

Results

Non-pregnant women of childbearing age who reported that their provider always listened to them, explained things, showed respect, and spent enough time with them had greater odds of reporting high overall healthcare ratings. Those who reported their provider always listened to them and spent enough time with them had greater odds of reporting better diabetes care adherence than those whose health care providers did not.

Conclusion

Findings demonstrate that non-pregnant women of childbearing age who report having optimal PCC are more likely to adhere to their diabetes care regimen.

Innovation

This is the first known study using a nationally representative sample of non-pregnant women of childbearing age to examine multiple layers of PCC.

Lived Experience of People with Type 1 Diabetes in North East Ethiopia; Psycho-Social and Economical Perspective, a Phenomenological Study

Objective

To explore lived experience of people with type 1 diabetes in North East Ethiopia; psycho-social and economical perspective.

Methods

A descriptive phenomenological study was conducted to explore the lived experience of people with type 1 diabetes in North East Ethiopia; psycho-social and economical perspective from March 02 to March 25, 2020. A heterogeneous purposive sample method was used to choose the participants. The lead investigator used an in-depth interview to collect data, using an audio recorder and an interview guide. The data were analysed using the thematic analysis method. Atlas. ti software version 7 was used to facilitate the data analysis process.

Results

A total of 13 participants were enrolled in this study. The participants age range were 14 to 70 years and their duration of diabetes since diagnosis were from 8 months to 16 years. The three interconnected themes that emerged from the analysis are: (1) psychological experience with two sub-themes (psychological problems due to diabetes including fear and coping strategies for psychological problems), (2) social experience, which has five categories (influence on intimate relationships, influence on social participation, disclosure status, social isolation and stigma, social support, and influence on education); and (3) economic experience.

Conclusion

Fear was one of the psychological experiences felt by people with type 1 diabetes. Although type 1 diabetes is a biomedical problem, it is also accompanied by other psychological and socio-economic issues, that require a holistic approach to address it. So, health professionals should strengthen health information dissemination programs.

Understanding the Roles of Romantic Partners and Parents in the Management of Type 1 Diabetes in Emerging Adults

During the emerging adulthood of people with type 1 diabetes, long-term romantic partners may be involved in diabetes management in ways that supplant parental involvement. We examined the perspectives of involvement in diabetes management of the parents and romantic partners of 29 emerging adults with type 1 diabetes, using qualitative interviews and an online survey. When the individuals with diabetes were in long-term romantic relationships, their partners were heavily involved in managing diabetes and providing support; however, when the individuals with diabetes were in short-term relationships or not in a relationship, their parents were described as having the biggest positive impact on their diabetes management. Emerging adults described the involvement of their parents and romantic partners in both positive and negative ways. Romantic relationship status is an important but understudied variable in understanding social involvement and its effects on type 1 diabetes management during emerging adulthood.

Perspectives of Parents With Type 1 Diabetes: Role of Children in Self-Management and Support

PURPOSE

The purpose of this study was to examine parents' perceptions of the role children play in their type 1 diabetes (T1DM) care. Family members are a resource to support T1DM self-management, but how children are involved in their parents' diabetes has not been well explored.

METHODS

Parents with T1DM (n = 85) and a subset of their romantic partners (n = 55) participated in interviews during which they described their children's knowledge of and involvement in diabetes care. Interviews were transcribed, responses coded/tallied, and themes identified.

RESULTS

All parents reported that children knew of their diabetes, which they learned about progressively from a young age. Most parents reported children to be accepting and understanding of the ways that diabetes affected their family experiences (eg, pause to treat low blood glucose). When asked about specific support, parents rated "making parent feel better about diabetes" as the most frequently occurring behavior. Some parents felt that children, particularly younger ones, occasionally detracted from T1DM management, but this was usually expected and considered transient. Regardless of child age, many parents did not want diabetes to burden children and limited their involvement. Both parents with T1DM and partners requested resources to enhance child awareness and preparedness to support diabetes. Respondents, particularly partners, were also interested in learning how to communicate better as a family and share perspectives on how diabetes affects individual family members.

CONCLUSIONS

Diabetes care and education specialists should consider developmentally and relationally appropriate ways to engage children of parents with T1DM in education and self-management.

Patient Work and Their Contexts: Scoping Review

Background

Having patients self-manage their health conditions is a widely promoted concept, but many patients struggle to practice it effectively. Moreover, few studies have analyzed the nature of work required from patients and how such work fits into the context of their daily life.

Objective

This study aimed to review the characteristics of patient work in adult patients. Patient work refers to tasks that health conditions impose on patients (eg, taking medications) within a system of contextual factors.

Methods

A systematic scoping review was conducted using narrative synthesis. Data were extracted from PubMed, Excerpta Medica database (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO, including studies from August 2013 to August 2018. The included studies focused on adult patients and assessed one or more of the following: (1) physical health–related tasks, (2) cognitive health–related tasks, or (3) contextual factors affecting these tasks. Tasks were categorized according to the themes that emerged: (1) if the task is always visible to others or can be cognitive, (2) if the task must be conducted collaboratively or can be conducted alone, and (3) if the task was done with the purpose of creating resources. Contextual factors were grouped according to the level at which they exert influence (micro, meso, or macro) and where they fit in the patient work system (the macroergonomic layer of physical, social, and organizational factors; the mesoergonomic layer of household and community; and the microergonomic triad of person-task-tools).

Results

In total, 67 publications were included, with 58 original research articles and 9 review articles. A variety of patient work tasks were observed, ranging from physical and tangible tasks (such as taking medications and visiting health care professionals) to psychological and social tasks (such as creating coping strategies). Patient work was affected by a range of contextual factors on the micro, meso, or macro levels. Our results indicate that most patient work was done alone, in private, and often imposing cognitive burden with low amounts of support.

Conclusions

This review sought to provide insight into the work burden of health management from a patient perspective and how patient context influences such work. For many patients, health-related work is ever present, invisible, and overwhelming. When researchers and clinicians design and implement patient-facing interventions, it is important to understand how the extra work impacts one’s internal state and coping strategy, how such work fits into daily routines, and if these changes could be maintained in the long term.

Occupational patterns of families living with a health condition: A scoping review

BACKGROUND

A family's health is sustained by its occupational patterns. While it is commonly accepted that a health condition places extra demands on a family's time or can limit daily occupations, few studies have reported on the occupational patterns of these families.

AIMS/OBJECTIVES

This scoping review provides an overview of the current state of research exploring occupational patterns of families living with a health condition.

MATERIAL AND METHOD

Publications between 2000 and 2018 indexed in CINAHL, PsycInfo, Medline and Scopus databases were searched.

RESULTS

Seventy-seven studies were included in the final content analysis. Findings suggest that families' occupational patterns are more complex than simply the sum of individual and shared occupational patterns, but consist of interconnected relational aspects of occupations, rarely highlighted in studies. Moreover, testimonies tend to be predominantly from the mother's perspectives, thereby limiting the scope of understanding of the interdependent nature of families' occupational patterns.

CONCLUSION

To better understand the complexity and interdependence of families' occupational patterns, future studies should examine multiple perspectives (parents and children) when studying occupations in a family setting. This can be enabled by the use of a variety of data collection methodologies.

Living Well With Type 1 Diabetes for 40 Years or More

Background

Although many studies explore the experiences of persons with type 1 diabetes, most examine the experience of children, adolescents, or persons in transition to adulthood. Few studies focus on the person living long term with type 1 diabetes.

Purpose

The purpose of this study was to explore the facilitators and barriers for people living well with type 1 diabetes over the long term.

Methods

An inductive interpretive description approach was used to explore living with type 1 diabetes for a duration of 40 years or more. Qualitative semistructured interviews with a convenience sample (n = 8) were conducted.

Results

Four dialectic themes were identified: accommodating and battling the disease, convenience and constraint of technology and treatment, self-reliance and reliance on others, and external and personal knowledge.

Conclusions

Recommendations for the health-care team emphasize person-centered care with acknowledgment of the person as expert and as more than their condition. Further research with this population would strengthen the implications for practice. Specifically, research is needed on diabetes distress, losses experienced due to diabetes, how to meet their educational needs, and how to tap into their expertise for the benefit of those with type 1 following them.

Close relationships and diabetes management across the lifespan: The good, the bad, and autonomy

Relationships are linked with positive and negative self-management and illness outcomes for individuals with type 1 diabetes. Explanations for these mixed associations have remained separated in psychosocial research in type 1 diabetes by relationship type (e.g. parent vs spouse) and individual's age (e.g. adolescence vs older adulthood). In this conceptual review, we present a novel perspective that close relationships across the lifespan may be beneficial for illness self-management when they support individuals' sense of autonomy, defined from a Basic Psychological Needs perspective. Processes of autonomy support are crucial for promoting illness management across all ages and relationship types.

Hypoglycaemic unawareness: A systematic review of qualitative studies of significant others' (SO) supportive interventions for patients with diabetes mellitus

BACKGROUND

Hypoglycemia unawareness (HU) has been attributed to both a downward shift in central nervous system (CNS)-triggered sympatho-adrenal responses to low glycaemic thresholds and a subsequent loss of adrenergic symptoms, which, in addition, to cerebral cortex adaptations permit normal function under hypoglycaemic conditions. Both of these mechanisms are brought about by recurring hypoglycemic events (hypoglycemia-associate autonomic failure, HAAF). This can contribute to repetitive cycles of increasingly severe hypoglycaemia, the consequences of which have considerable impact on relatives and significant others (SO) when providing care to patients with diabetes.

METHODS

A Systematic Review (SR) of 639 qualitative studies was carried out in accordance with the Preferred Reporting Items for Systematic Review (PRISMA) principles. The search strategy was developed using MeSH terms for a range of electronic databases: CINAHL, Pubmed, EMBASE, Medline, AMED and ASSIA were systematically searched in order to identify a variety of literature relevant to the review topic. Four duplicate studies were removed and a further 630 studies were excluded due to being irrelevant. Five qualitative studies were retained and analysed.

RESULTS

The three resultant findings from the literature appraised were i) Experiences and views of Significant Others' (SO) with adult relatives that have HU ii) Support needs of SO and iii) Health professionals interventions to address SO support needs and improve overall HU care. A clear finding was that SO experience difficulties managing HU and this can impact on the relationships that SO and HU patients have. Support needs of SO highlighted were both educational and psychological in nature, with there being a requirement for additional raised awareness within the wider community.

CONCLUSION

It is essential that healthcare professionals offer support, such as teaching and support groups. In addition, providing interventions into improving family knowledge of diabetes and support with regard to psychosocial, behavioural and practical support for the person with diabetes. Moreover, improving resources for families to improve diabetes care. However, as the literature was of a qualitative nature, future recommendations would be quantitative research into these suggested nursing implementations to quantitatively assess their usefulness in practice.

Experiences of being a family member to an older person with diabetes receiving home care services

AIM

To describe family members' experiences of attending to an old person with diabetes receiving home care services, including their interaction with the formal caregivers.

METHODS AND RESULTS

The study has a qualitative descriptive design. From May to August 2015, eight family members were interviewed. Interviews were analysed using qualitative content analysis. To describe family members' experiences, the following four themes were identified: Security through patients' self-management skills and diabetes knowledge; Perceived burden due to the old persons' deteriorated health; Security through competent home care services; and Doubt due to personnel's inadequate approach and interaction.

CONCLUSION

It is important for personnel in home care services to consider patients' self-management skills and the family members' diabetes knowledge as key aspects in order to limit experiences of burden when the older person with diabetes has deteriorating health. The findings underscore that interaction with home care personnel skilled in managing diabetes helps family members feel secure.