A Canadian Cross-Sectional Survey on Psychosocial Supports for Adults Living With Type 1 or 2 Diabetes: Health-Care Providers' Awareness, Capacity and Motivation

Helping providers address psychological aspects of obesity in routine care: Development of the obesity adjustment dialogue tool (OADT)

Background

This study developed and validated a dialogue tool (Obesity Adjustment Dialogue Tool) to efficiently assess QoL and drive to eat for use in routine clinical care.

Methods

A 13-question interview was created, assessing the impact of living with obesity on quality of life and drive to eat. In a counter-balanced order, PwO were interviewed and completed the Obesity Adjustment Survey (OAS), the Impact of Obesity on Quality of Life-Lite scale (IWQoL), the Three Factor Eating Questionnaire (TREQ), and the Control of Eating Questionnaire (COEQ). Questionnaire results were used to validate the interview using correlational and concordance measures.

Results

101 PwO consented and 98 completed all measures (mean BMI = 37.8; 30.7% Class III obesity). Correlations between the QoL dialogue tool and validated instruments (OAS, IWQOL) were moderate to high. Correlations between cravings questions and validated measures (TFEQ, COEQ) were high except for attempts to control eating. Correspondence based on categorizing both the dialogue tool and scales into high/low impact was high except for attempts to control eating (which was dropped from the final tool).

Conclusion

The Obesity Adjustment Dialogue Tool is a brief clinician-led structured interview which closely matches information derived from validated scales. This tool offers an efficient approach to incorporating QoL factors into obesity management.

Behaviour Change to Promote Diabetes Outcomes: Getting More From What We Have Through Dissemination and Scalability

The potential benefits of advanced medical treatments (pharmacotherapies) and technologies (diagnostics, devices and apps) are unrealized due to lack of sustained behaviour change in individuals living with type 2 diabetes. The lack of scale-up of effective health behaviour change interventions limits health improvement. Identification of mediators of behaviour change (adherence, self-efficacy, intrinsic motivation) can address this limitation by shifting the focus of behaviour change from input (which behaviour change strategy to choose) to output (what can the person adhere to and sustain). Technology and accessing the workplace environment to promote change offer scalable opportunities for facilitating health behaviour change in populations.

Moving beyond 'don't ask, don't tell': Mental health needs of adults with type 1 diabetes in rural and remote regions of British Columbia

AIMS

To investigate the mental health needs of adults with type 1 diabetes living in rural and remote regions of Interior, British Columbia (BC) and identify factors associated with accessing support. We also explored perspectives around using peer support and digital health strategies for delivering mental health support.

METHODS

This study recruited 38 adults with type 1 diabetes to complete a self-report survey and participate in focus groups. We conducted six 90-min focus groups that addressed the following: current and past mental health needs, social media use for type 1 diabetes support, peer supporter recruitment and training, and support delivery features for virtual care platforms. Focus groups were recorded, transcribed, quality checked, coded and analysed to develop themes and subthemes.

RESULTS

Four core themes emerged: (1) emotional challenges linked to type 1 diabetes management, (2) unique type 1 diabetes-related concerns in rural and remote communities, (3) previous support experiences and future support needs and (4) diabetes-related mental health support interventions involving peer support and digital health strategies. Existing support services are inadequate in meeting the needs of type 1 diabetes adults in Interior BC. Some have turned towards social media as a way to connect with the type 1 diabetes community for support.

CONCLUSIONS

Though type 1 diabetes adults living in rural and remote settings experience distress associated with the ongoing burdens, frustrations and fears of managing a complex chronic condition, many have not been offered support and do not know how to seek services in the present/future. Peer support and digital health strategies are two potential solutions to address this care gap.

Exploring the perceptions of emotional distress among couples living with Type 2 diabetes and among diabetes healthcare providers, and consideration of support needs

AIMS

To compare the emotional distress experienced by people with Type 2 diabetes with the perceptions of their partners, and to explore the perceptions of healthcare providers and how these differ from the perceptions and experiences of couples living with Type 2 diabetes regarding their support needs.

METHODS

A purposive sample of people with Type 2 diabetes and their partners was recruited through Diabetes UK media outlets and support groups, while healthcare providers were recruited through hospital and diabetes education teams. Inductive thematic analysis was conducted.

RESULTS

Seven people with Type 2 diabetes and six partners took part in separate semi-structured interviews and seven healthcare providers took part in focus groups. Themes emerged regarding unique psychological struggles for people with Type 2 diabetes: 'sense of restriction'; 'disempowerment'; and 'acceptance of diabetes'. For partners the themes of 'feeling responsible' and 'need for greater involvement' emerged. Common themes arising from people with Type 2 diabetes, partners and healthcare providers highlighted diabetes-related stresses: 'self-care struggles' and 'perceived need for appropriate psychological support'. A key theme drawn from healthcare providers was 'perceived professional barriers to psychological support', which captures concerns related to providing emotional support in clinical practice.

CONCLUSIONS

People with Type 2 diabetes, partners, and healthcare providers share a common understanding of the emotional stresses of living with Type 2 diabetes, but also experience diabetes differently depending on their role and responsibilities. All face barriers that need to be considered to ensure that emotional support in diabetes is meaningful and feasible in routine practice.

Diabetes management experience of middle-aged persons with type 1 diabetes

AIM

For middle-aged persons with type 1 diabetes, diabetes management is essential due to the natural effects of middle age. However, studies investigating how such individuals manage their diabetes are lacking. This study aimed to explore diabetes management experiences of middle-aged individuals with type 1 diabetes.

METHODS

Data were collected through in-depth interviews with six middle-aged persons with diabetes. An interpretative phenomenological analysis was used for the analysis of the data.

RESULTS

The following four themes emerged: "familiarity with but no control over type 1 diabetes", "embodiment of one's unique management of type 1 diabetes", "control of one's mindset regarding diabetes management despite a limited scope of activity", and "accepting ownership of self-management and continued management to the best of one's ability." A core theme was "living silently like robots dreaming of true freedom from type 1 diabetes."

CONCLUSIONS

The findings indicate that nurses should provide education, embracing the experience in diabetes management through trial and error among persons with type 1 diabetes.

Addressing a Care Gap in Type 1 Diabetes Management: Using the Diabetes Distress Scale in a Community Care Setting to Address Diabetes-Related Treatment Challenges

OBJECTIVES

To bridge the gap between existing clinical evidence and recommendations around screening for diabetes-related distress (DD) and the observation of a low level of adoption of these suggestions in everyday clinical practice. We focused on the use of the Diabetes Distress Scale (DDS) by adult diabetes care specialists.

METHODS

We conducted a survey of endocrinologists and diabetes educators in our clinics, examining the use of DD screening and assessment tools, including DDS-2, DDS-17 and T1-DDS-28.

RESULTS

Our results indicated that very few practitioners surveyed are currently using the DD questionnaires, and highlighted their perceptions of the primary barriers to doing so.

CONCLUSIONS

We discuss the results of our survey of colleagues' use of the DDS and provide suggestions about how to incorporate this tool, and tips about how to address the various facets of DD. We argue that integrating the assessment of DD in clinical practice, with the use of standardized and validated self-report questionnaires, is a necessary and very feasible step towards achieving further improvements in the health and quality of life of people living with type 1 diabetes.

Integrating psychosocial support into routine diabetes care: perspectives from participants at the Self-Management Alliance meeting 2016

AIMS

To identify challenges and solutions to integrating psychosocial support into routine diabetes care from the perspective of stakeholders with expertise in diabetes self-management education and support.

METHODS

Ninety-four people attended the annual international Diabetes Self-Management Alliance meeting in 2016, which included plenary sessions and workshops on self-management education, support and prevention. One workshop focused on how to integrate psychosocial support into routine diabetes care; this was run four times consecutively, allowing all conference participants to attend the workshops in groups of 20-25 people.

RESULTS

Challenges and solutions associated with integrating psychosocial support into routine diabetes care concern the patient-provider relationship, the healthcare system and the community. Challenges identified were: lack of time, skills and resources to deal with psychological well-being; a culture of patient blame and care expectations; the complexity of person-centred assessment of psychological issues; and the substantial healthcare system focus on productivity and biomedical indicators. Lack of involvement of local communities and of inclusion of social determinants of health were also highlighted as challenging. Solutions identified were more patient-provider dialogue; more training and better skills among care providers; system incentives for psychosocial outcomes; and targeting social determinants of health and involvement of family and peers.

CONCLUSIONS

From the perspective of international stakeholders with an expertise in diabetes self-management and support attending the conference in Denmark, substantial new incentives and systematic cultural changes are needed in healthcare systems to integrate psychosocial support into routine diabetes care, as recommended in international guidelines.