Patient Assessment of Family Function, Glycemic Control and Quality of Life in Adult Patients With Type 2 Diabetes and Incipient Complications

Understanding the role of family functioning, dietary adherence, and culture on glycemic control among adults with type 2 diabetes: A mediation and moderation analysis

BACKGROUND

Families and cultural contexts can impact dietary adherence and glycemic control of type 2 diabetes (T2D). Yet little is known about these relationships in Africa, where poor dietary adherence and glycemic control are prevalent. To address this gap, this study investigated whether dietary adherence mediates family functioning and glycemic control among T2D adults in Benin, West Africa. We also explored whether cultural identity affected the association between family functioning and dietary adherence.

METHODS

A cross-sectional study of 512 T2D patients from six health centers was conducted to assess: 1) family functioning with the 12-item McMaster Family Assessment Device-General Functioning Subscale (FAD-GF); 2) dietary adherence via the Perceived Dietary Adherence Questionnaire (PDAQ); and 3) cultural identity with the 12-item Multigroup Ethnic Identity Measure (MEIM). The three-month glycemic control was determined with Glycated Hemoglobin - HbA1c. Mediation and moderation analyses were conducted using Stata's structural equation model (SEM).

RESULTS

Healthy family functioning, good dietary adherence and good glycemic control rates were 56.8%, 33%, and 30.5% respectively. Path analysis showed that healthy family functioning was significantly associated with lower HbA1c levels (-0.34, 95% CI: [-0.72, -0.03]), and there was a significant indirect effect via greater dietary adherence (-0.12, 95% CI: [-0.22, -0.01]). However, cultural identity did not significantly impact the relationship between family functioning and dietary adherence.

CONCLUSIONS

Our study revealed that family functioning, adherence to dietary recommendations, and glycemic control are interconnected in adults with T2D. Interventions should target modifiable factors like dietary adherence and address relevant risk and resilience sources to improve glycemic control in urban African families.

Integrating literature and family insights: exploring the needs of families supporting adults with diabetes

Introduction

The considerable influence that family members can have on diabetes management is well recognized. Therefore, it is crucial for professionals to acknowledge the impact of the diagnosis on family members. This study aimed to comprehensively identify and understand the needs of family members with an adult diagnosed with diabetes using a two-phased research design.

Methods

Phase 1 was a scoping literature review using databases such as MEDLINE®, CINAHL®, SciELO, and PsycINFO, and gray literature from the Scientific Open Access Repository of Portugal and OpenGrey, focusing on studies from 2017 to 2023, adhering to the Joanna Briggs Institute and PRISMA guidelines. Phase 2 involved a focus group to gather qualitative data on family experiences, which was analyzed using content analysis and following the Consolidated Criteria for Reporting Qualitative Research.

Results from both phases revealed five themes

Communication and emotional expression within families, the impact of diabetes on the family, diabetes-specific knowledge, socio-cultural and environmental influences on diabetes management, and communication with healthcare providers. Integrating these findings highlighted the specific needs of families, suggesting that tailored interventions should be developed to enhance diabetes management support and promote overall family well-being.

Association Between Family Functioning and Health-related Quality of Life in Stroke Survivor-Informal Family Caregiver Dyads

PURPOSE

Stroke survivors and their informal family caregivers may share the impact of the disease, which may affect family functioning and quality of life (QoL) for both. This study compared the perceptions of stroke survivors and informal family caregivers regarding family functioning and QoL and examined the QoL of those reporting effective versus ineffective family functioning.

METHODS

A cross-sectional study design and convenience sampling were used. Stroke survivor-informal family caregiver dyads were recruited from a medical university hospital. We assessed participants' demographic and clinical variables, including disease severity, family functioning, and QoL. Independent t-test, paired t-test, Wilcoxon signed-rank test, and Mann-Whitney U test were used to analyze the data.

RESULTS

Seventy-one stroke survivor-informal family caregiver dyads participated in the current study. Most stroke survivors and informal family caregivers reported effective family functioning, with no significant differences. However, significant differences existed in the seven domains (physical functioning, role-physical, bodily pain, general health, vitality, social functioning, and role-emotional) of QoL, except emotional health. Stroke survivors reporting ineffective family functioning had a significantly lower mental component summary score, unlike informal family caregivers.

CONCLUSIONS

Our findings suggest that family functioning is crucial to ensure stroke survivors' QoL, particularly regarding their mental health. Health professionals should prioritize mental health assessments and provide appropriate care interventions for stroke survivors in the first 1-6 months after stroke onset.

Effects of family support system on the self-management behaviour of patients with T2DM: a multi-centre cross-sectional study in community settings

BACKGROUND

The burden of type 2 diabetes mellitus (T2DM) in China continues to escalate.

OBJECTIVE

To investigate the impact of family support system on the self-management behaviour of patients with T2DM.

METHODS

In this cross-sectional study, 1,042 participants were sampled using a multistage stratified probability-proportionate-to-size method. On-site interviews were conducted using a structured questionnaire administered by 122 family doctors from 13 community health service centres in 8 administrative districts. A structural equation model was established to investigate the impact of individual factors and family support system on the self-management behaviour of T2DM patients. Statistical analysis was performed using the SPSS 25.0 software.

RESULTS

The self-management behaviour pass rate among individuals with T2DM was 40.9%. In terms of individual factors, those with a high school education level or above demonstrated higher self-management behaviour scores than those with a junior high school education level or lower. The structural equation model revealed a path of interactions among individual factors, family support system-related factors, and the self-management behaviour of patients with T2DM: Family function → Family support → Patients' self-management behaviour → Quality of life. The coefficient of the direct path from family function to family support was 0.74 (P < 0.001), while the coefficient of the direct path from family support to self-management behaviour was 0.68 (P = 0.001).

CONCLUSION

There is significant room for improvement in the self-management behaviour of T2DM patients in China. Family function can enhance the self-management behaviour of T2DM patients by promoting family support.

Measuring population health and quality of life: Developing and testing of the significant quality of life measure (SigQOLM)

Quality of life (QOL) should ideally be determined by a broader spectrum of measurable parameters. This study aims to develop and validate a study instrument that is designed to determine a holistic measure of health and non-health aspects of QOL, and it is called the 'Significant Quality of Life Measure' (SigQOLM). This study involves five phases which aim to (i) explore and understand the subject matter content, (ii) develop a questionnaire, (iii) assess its content validity and face validity, (iv) conduct a pilot study, and lastly (v) perform a field-test by using the questionnaire. For the field-testing phase, a cross-sectional study was conducted which elicited responses from healthcare workers via a self-administered survey for all the SigQOLM items. Based on the results, the overall framework of the SigQOLM consists of four elements, 18 domains with 69 items. The element of "Health" is measured by nine domains, while "Relationships", "Functional activities, and "Survival" are measured by three domains respectively. The SigQOLM has been developed successfully and then validated with a high level of reliability, validity, and overall model fit. Therefore, the SigQOLM will provide researchers and policymakers another viable option to elicit a more comprehensive outcome measure of QOL which shall then enable them to implement specific interventions for improving the QOL of all the people, both healthy or otherwise.

Exploring the relationship between self-management behaviour, family function and health information adoption behaviour in Chinese diabetic foot patients: a mixed-methods study protocol

INTRODUCTION

Diabetic foot is a major burden and threat to individuals, families and society, making it imperative to promote good self-management behaviour. However, although nurses have provided these patients with excellent health knowledge, their self-management remains unsatisfactory. Although researches have shown that self-management requires family involvement, no research has been conducted in China on family function, specifically in the diabetic foot. Therefore, this study aimed to explore the relationship between self-management, family functioning, and health information adoption behaviour and explain the formation's reason.

METHOD AND ANALYSIS

We will conduct a mixed-methods study using an exploratory sequential study design in Zhejiang, China. In the first phase, cross-section research will be conducted using a convenient sampling strategy on 225 diabetic foot patients. SPSS V.26 was used for correlation and multiple stepwise regression analyses. Structural equation modelling will be performed by using AMOS V.24. The researchers will conduct a semistructured interview to collect qualitative data and use NVivo to analyse. Ultimately, we will 'triangulate' to integrate quantitative and qualitative data.

ETHICS AND DISSEMINATION

This study received ethical clearance from the Ethics Review Committee, the affiliated Sir Run Run Shaw Hospital of Medicine School, Zhejiang University (approval no: 2023-0145). All data collection processes will abide by health and safety measures required by the national government. Written informed consent will be obtained from all participants. The study will produce one paper that will be disseminated, to local stakeholders and participants, via local and international conferences and publications in peer-reviewed journals.

Diabetes Mellitus Family Assessment Instruments: A Systematic Review of Measurement Properties

Although many instruments are used to assess the families of people with diabetes, their measurement properties have not been systematically reviewed. We aimed to identify and evaluate the psychometric properties of the instruments used to assess family functioning in adults with diabetes.

METHODS

A systematic literature review, according to the JBI systematic reviews of measurement properties, was conducted using different databases, including gray literature. PROSPERO registration number: CRD42021239733. Two independent reviewers searched, screened, and assessed the risk of bias among the articles according to the COSMIN methodology. The quality of each included instrument was assessed using the updated criteria for good measurement properties.

RESULTS

Eighty-one studies were included, and thirty-one eligible instruments were identified. The psychometric properties frequently assessed were structural validity, internal consistency, and construct validity.

CONCLUSIONS

Although 31 instruments were included, none of their psychometric properties were scored as "very good". From the instruments scored as adequate on development and content validity, five stood out for their quality appraisal.. The development of new instruments is not recommended. More studies should be conducted on the existing instruments to assess the less commonly evaluated psychometric properties. Using valid instruments to develop and evaluate interventions is essential to promote health literacy and the effectiveness of diabetes management.

Proportion and risk factors of diabetic retinopathy by stage in less-developed rural areas of Hunan province of China: A multi-site cross-sectional study

Aims

To investigate the proportion and risk factors of diabetic retinopathy (DR) by stages in less-developed rural areas in Hunan Province of China.

Background

DR is common among people with diabetes but not well recognized in less-developed rural areas. There is insufficient evidence on the risk factors of DR by stages, making it challenging to develop targeted prevention and intervention programs for DR in primary care settings.

Methods

A multi-site cross-sectional survey was conducted among people with type 2 diabetes mellitus (T2DM) from four less-developed counties in Hunan Province of China. All participants underwent the screening of DR via digital fundus photography and completed self-reported questionnaires on their socio-demographic and clinical characteristics, diabetes self-efficacy, diabetes self-care behaviors, social support, family function, and health service accessibility. The multinomial logistic regression models were employed to explore the risk factors of DR by stage, which were selected based on the socio-ecological model, literature, and clinical experience.

Results

A total of 196 participants were included in this study with an average age of 57.43 ± 10.26. 59.6% (117/196) of the participants were identified as DR, including 37.2% (73/196) non-proliferative DR and 22.4% (44/196) proliferative DR. Compared to the non-DR group, the risk factors of non-proliferative DR and proliferative DR were diabetes duration (OR: 1.10, 95 CI%: 1.04–1.17; OR: 1.14, 95 CI% 1.06–1.22) and self-monitoring of blood glucose (OR: 1.09, 95 CI% 1.01–1.17; OR: 1.11, 95 CI%: 1.02–1.20); the protective factors of non-proliferative DR was accessible complication prevention and management education (OR: 0.37, 95 CI% 0.14–0.94) while the protective factors of proliferative DR were physical activities (OR: 0.89, 95 CI%: 0.80–0.98). Compared to the non-proliferative DR group, the protective factors of proliferative DR were physical activities (OR: 0.89, 95 CI% 0.02–0.89) and family function (OR: 0.84, 95 CI%: 0.04–0.84).

Conclusion

DR was prevalent among people with T2DM in less-developed rural areas, indicating the need of strengthening DR screening. Risk factors of DR varied by stage while sharing some common factors. Future DR prevention and intervention programs may benefit from improving these factors to reduce the risk of DR by stage.

Perceived Family Function and Associated Predictors in Nurses: A Cross-Sectional Study

Background

Nurses play a key role in the health care system. However, clinical nurses experience different kinds of stressors that might impact the nurses' quality of life or quality of care. Family is one of the main social support resources, and quality family function might improve the quality of care provided by nurses. However, evidence on family function in Chinese clinical nurses is quite limited.

Objectives

The current study was to evaluate the family function of the Chinese clinical nurses, and to explore associated predicting factors.

Methods

A multi-center cross-sectional anonymous online survey was carried out. Chinese Family Function Scale was used in the study. Spearman's rank correlation analysis, Mann-Whitney U test, or Kruskal-Wallis H test was performed in the univariate analysis. The pairwise comparison method was used to determine whether the difference was significant between pair groups. Categorical regression (optimal scaling regression) was the main method to analyze factors that had been confirmed to be statistically significant in the univariate analysis.

Results

Nineteen thousand four hundred and twenty-two nurses completed the online questionnaires. The median of the nurse's perceived family function score was three (Inter-quartile Range: IQR 2-5). The multivariate analysis showed that the highest education level (P <0.001), the hospital level (P <0 .001), rotation shift status (P <0.001), working department (P < 0.001), number of children (P < 0.001), monthly income per family member (P < 0.001) were significantly associated with family function. Moreover, the importance of the factors was the number of children (49.1%), monthly income per family member (20.7%), rotation shift status (12.4%), the highest education level (8.0%), the hospital level (7.6%), and working department (2.4%) in turn.

Conclusions

The family function was associated with multiple factors, which hints that managers, leaders, and government could make strategies to improve nurses' family function in order to lead nurses to make a balance between family and work. Policymakers, nursing managers, and employers should make strategies such as promoting children-care services, increasing nurses' income, educating and training enough nurses, and building a well-established system of career development to help clinical nurses improve their family function so that to improve the quality of care.

Factors associated with self-management behaviors of patients with chronic obstructive pulmonary disease

AIMS

To examine self-management behaviors level and discuss the associated factors among chronic obstructive pulmonary disease (COPD) patients.

METHODS

A descriptive study design was used. A convenience sample of 124 COPD patients was recruited from three hospitals in Fuzhou. Self-management Behaviors, Social Support Rating Scale and The Family APGAR Score were used to collect data. Descriptive statistics, one-way analysis of variance (ANOVA), Pearson correlation and multiple linear regression were used for data analysis.

RESULTS

The overall score of self-management behaviors ranged 4-41, with a mean score of 21.26 ± 7.72. Pearson correlation analyses and ANOVA revealed that age, course of disease, education, marital status, family function, subjective support, objective support, and availability of support were positively correlated with overall self-management behaviors (p < .05). Multiple linear regression analyses revealed that subjective support and availability of support significantly predicted self-management behaviors.

CONCLUSIONS

The level of self-management behaviors of COPD patients was suboptimal. We suggest that people in the patients' social network should provide support for them, and help them use available resources to improve the level of self-management behaviors.

Family Functioning Assessment Instruments in Adults with a Non-Psychiatric Chronic Disease: A Systematic Review

There is little information on the evaluation of family functioning in adult patients with chronic non-psychiatric illness. The objective of this systematic review was to identify family functioning assessment instruments of known validity and reliability that have been used in health research on patients with a chronic non-psychiatric illness. We conducted a search in three biomedical databases (PubMed, Science Direct, and Web of Science), for original articles available in English or Spanish published between 2000 and 2019. The review was conducted in accordance with PRISMA guidelines. Fourteen articles were included in the review. The instruments Family Assessment Device, Family Adaptability and Cohesion Evaluation Scales, Family Functioning Health and Social Support, Family APGAR, Assessment of Strategies in Families-Effectiveness, Iceland Expressive Family Functioning, Brief Family Assessment Measure-III, and Family Relationship Index were identified. All of them are reliable instruments to evaluate family functioning in chronic patients and could be very valuable to help nurses identify families in need of a psychosocial intervention. The availability and clinical application of these instruments will allow nurses to generate knowledge on family health and care for non-psychiatric chronic conditions, and will eventually contribute to the health and wellbeing of adults with a non-psychiatric chronic disease and their families.

Psychosocial distress, clinical variables and self-management activities associated with type 2 diabetes: a study in Ghana

Aim

Psychosocial distress can act as a barrier to diabetes self-care management and thus compromise diabetes control. Yet in Ghana, healthcare centres mainly focus on the medical aspect of diabetes to the neglect of psychosocial care. This study determined the relationship amongst psychosocial distress, clinical variables, and self-management activities associated with type 2 diabetes management.

Method

Questionnaires were administered to 162 patients from four hospitals in Accra, Ghana, to assess psychosocial distress (e.g. diabetes distress), clinical variables (e.g. glycaemic control), and self- management activities (e.g. medication intake) related to diabetes. In assessing diabetes distress, the use of the PAID allowed evaluation of broader range of emotional concerns (diabetes-related emotional distress), while the DDS allowed evaluation of factors more closely related to diabetes self-management (diabetes distress).

Results

Diabetes-related emotional distress, diabetes distress and depressive symptoms were reciprocally positively correlated, while non-supportive family behaviour correlated negatively with these psychological variables. Diabetes-related emotional distress correlated positively with systolic and diastolic blood pressure, and correlated negatively with exercise regimen. On the other hand, diabetes distress correlated negatively with dietary and exercise regimen and correlated positively with glycaemic levels, while depressive symptoms correlated positively with glycaemic levels, diabetes complication and systolic blood pressure. Contrary to the literature, non-supportive family behaviour correlated positively with diet, exercise and medication regimen.

Conclusion

The positive association of psychological variables with glycaemic levels and blood pressure levels, and the positive association of non-supportive family behaviour with self-management activities suggests the need for psychosocial care to be incorporate in the management of type 2 diabetes in Ghana. Patients can be screened for diabetes-related distress and symptoms of depression and provided psychosocial care where necessary.

Factors associated with poor-to-moderate quality of life among pregnant women with gestational diabetes mellitus: a cross-sectional study in Malaysia

PURPOSE

This study aimed to identify factors associated with poor-to-moderate quality of life (QOL) among women with gestational diabetes mellitus (GDM) in two tertiary hospitals in Malaysia.

METHODS

A cross-sectional study was conducted among 526 pregnant women with GDM in two tertiary hospitals in Malaysia. Diabetes-related QOL was assessed using the Asian Diabetes Quality of Life Scale (AsianDQoL). Socio-demographic characteristics, glucose monitoring treatments for GDM, past obstetric history, concurrent medical problems and a family history of diseases were captured from patient records. A multiple logistic regression was used for analysis.

RESULTS

A total of 526 respondents with GDM entered the analysis. The median age of the respondents was 32 (interquartile range = 7) while 82.3% were Malay women. More than half of the respondents (69.5%) received an oral hypoglycaemic agent (OHA), and/or diet modification in controlling their GDM. The study reported that 23.2% of the respondents had poor-to-moderate QOL. Those with a family history of depression and/or anxiety (adjusted Odds ratio [AOR] 6.934, 95% confidence interval [CI] 2.280-21.081), and a family history of GDM (AOR 1.814, 95% CI 1.185-2.778) were at higher odds of suffering from poor-to-moderate QOL compared to those without a family history. Similarly, those who received insulin, with or without OHA, and/or are on diet modification (AOR 1.955, 95% CI 1.243-3.074) were at higher odds of suffering from poor-to-moderate QOL compared to those receiving OHA and/or diet modification.

CONCLUSION

Nearly one-quarter of Malaysian women with GDM have poor-to-moderate QOL. GDM women with a family history of depression and/or anxiety, family history of GDM, and those who received insulin, with or without OHA, and/or are on diet modification were associated with poor-to-moderate QOL.

TRIAL REGISTRATION

NMRR-17-2264-37814.

Well-being mediates the effects of social support and family function on self-management in elderly patients with hypertension

Previous studies have linked self-management with social support and family function. However, little is known about the mechanisms underlying these relationships. This study aimed to explore the underlying relationships between social support (family function) and self-management and to examine whether well-being mediated these relationships in elderly patients with hypertension. A cross-sectional design was used to study 517 elderly patients with hypertension. Demographics, self-management behaviors, social support, family function and well-being were collected by questionnaires. Results showed that social support, family function and well-being were separately associated with self-management behaviors. When social support, family function and well-being were included in the regression model simultaneously, social support and family function were no longer the significant predictors of self-management, demonstrating mediation. Using bootstrapping approach, 89.9% of the relationship between social support and self-management was explained by well-being, and 66.3% of the relationship between family function and self-management was explained by well-being. Improving self-management in patients with hypertension should be a comprehensive approach which should take social support, family function and well-being into account. Health providers should realize the importance of focusing on the promotion of well-being, especially among elderly hypertensive patients with low social support and low family function.