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Becker J, Emmert-Fees KMF, Greiner GG, Rathmann W, Thorand B, Peters A, Karl FM, Laxy M, Schwettmann L. Associations between self-management behavior and sociodemographic and disease-related characteristics in elderly people with type 2 diabetes - New results from the population-based KORA studies in Germany. Prim Care Diabetes 2020; 14:508-514. [PMID: 32088161 DOI: 10.1016/j.pcd.2020.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/18/2019] [Accepted: 01/17/2020] [Indexed: 12/14/2022]
Abstract
AIMS Self-management behavior (SMB) is an important aspect in the management of diabetes. This study aimed to identify sociodemographic and disease-related factors associated with good SMB in people with type 2 diabetes (T2D). METHODS We used data from 479 people with T2D aged 65 or older from the population-based KORA (Cooperative Health Research in the Area of Augsburg) Health Survey 2016 in Southern Germany. We estimated Poisson and logistic regression models testing the cross-sectional relationship between individual or disease-related characteristics and an established SMB sum index comprising six SMB dimensions stratified according to insulin treatment status. RESULTS Mean age in the sample was 75 and mean diabetes duration was 13 years. The overall level of SMB was low. Higher SMB index scores were associated with higher age, treatment with insulin, participation in a diabetes education program, and, for people with insulin treatment, with a BMI below 30 kg/m2. Single item analyses generally supported these findings. CONCLUSIONS SMB in people with T2D needs to be improved with efficient interventions. Targeting obese individuals and those at an early stage of the disease with low-barrier, regular education or self-management programs may be a preferred strategy.
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Affiliation(s)
- Jana Becker
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany; Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital Munich, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Karl M F Emmert-Fees
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
| | - Gregory Gordon Greiner
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany; Institute for Health Services Research and Health Economics, German Diabetes Center, Auf'm Hennekamp 65, 40225 Duesseldorf, Germany; Institute for Health Services Research and Health Economics, Center for Health and Society, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225 Duesseldorf, Germany
| | - Wolfgang Rathmann
- Institute for Biometrics and Epidemiology, German Diabetes Center, Auf'm Hennekamp 65, 40225 Duesseldorf, Germany; German Centre for Diabetes Research (DZD), Ingolstädter Landstraße 1, 85764 München-Neuherberg, Germany
| | - Barbara Thorand
- German Centre for Diabetes Research (DZD), Ingolstädter Landstraße 1, 85764 München-Neuherberg, Germany; Institute of Epidemiology, Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
| | - Annette Peters
- German Centre for Diabetes Research (DZD), Ingolstädter Landstraße 1, 85764 München-Neuherberg, Germany; Institute of Epidemiology, Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
| | - Florian M Karl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany; German Centre for Diabetes Research (DZD), Ingolstädter Landstraße 1, 85764 München-Neuherberg, Germany
| | - Michael Laxy
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany; German Centre for Diabetes Research (DZD), Ingolstädter Landstraße 1, 85764 München-Neuherberg, Germany; Global Diabetes Research Center, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE Atlanta, GA 30322 USA
| | - Lars Schwettmann
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany; Department of Economics, Martin Luther University Halle-Wittenberg, 06099 Halle an der Saale, Germany.
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du Pon E, Kleefstra N, Cleveringa F, van Dooren A, Heerdink ER, van Dulmen S. Effects of the Proactive Interdisciplinary Self-Management (PRISMA) Program on Online Care Platform Usage in Patients with Type 2 Diabetes in Primary Care: A Randomized Controlled Trial. J Diabetes Res 2020; 2020:5013142. [PMID: 32016122 PMCID: PMC6982360 DOI: 10.1155/2020/5013142] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 12/06/2019] [Accepted: 12/16/2019] [Indexed: 01/03/2023] Open
Abstract
Online care platforms can support patients with type 2 diabetes (T2DM) in managing their health. However, in the use of eHealth, a low participation rate is common. The Proactive Interdisciplinary Self-Management (PRISMA) program, aimed at improving patients' self-management skills, was expected to encourage patients to manage their disease through the use of an online platform. Therefore, the objective of the current study was to investigate whether a group education program can improve the use of an online care platform in patients with T2DM treated by primary care providers in the Netherlands. In a randomized controlled trial, patients with T2DM received either PRISMA with usual care or usual care only. During a six-month follow-up period in 2014-2015, usage (number of log-ons and time spent per session) of an online care platform (e-Vita) aimed at improving T2DM self-management was assessed. A training about the functionalities of e-Vita was offered. The sample consisted of 203 patients. No differences were found between the intervention and control groups in the number of patients who attended the platform training (interested patients) (X 2(1) = 0.58; p = 0.45), and the number of patients who logged on at least once (platform users) (X 2(1) = 0.46; p = 0.50). In addition, no differences were found between the groups in the type of users-patients who logged on twice or more (active users) or patients who logged on once (nonactive users) (X 2(1) = 0.56; p = 0.45). The PRISMA program did not change platform usage in patients with T2DM. In addition, only a small proportion of the patients logged on twice or more. Patients probably need other encouragements to manage their condition using an online platform.
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Affiliation(s)
- Esther du Pon
- Research Group Process Innovations in Pharmaceutical Care, Utrecht University of Applied Sciences, PO Box 12011, 3501 AA Utrecht, Netherlands
- Diabetes Centre, Isala, Zwolle, Netherlands
| | - Nanne Kleefstra
- Medical Research Group, Langerhans, Ommen, 7731 MX, Netherlands
- Department of GGZ Drenthe Research and High Intensive Care, GGZ Drenthe Mental Health Services, Assen, 9404 LA, Netherlands
- Department of Internal Medicine, University of Groningen and University Medical Center Groningen, Groningen, 9713 GZ, Netherlands
| | - Frits Cleveringa
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, 3584 CX, Netherlands
| | - Ad van Dooren
- Research Group Process Innovations in Pharmaceutical Care, Utrecht University of Applied Sciences, PO Box 12011, 3501 AA Utrecht, Netherlands
| | - Eibert R. Heerdink
- Research Group Process Innovations in Pharmaceutical Care, Utrecht University of Applied Sciences, PO Box 12011, 3501 AA Utrecht, Netherlands
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Sandra van Dulmen
- Nivel (Netherlands Institute for Health Services Research), Utrecht, 3513 CR, Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, 6525 GA, Netherlands
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen 3045, Norway
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Wolever RQ, Dreusicke MH. Integrative health coaching: a behavior skills approach that improves HbA1c and pharmacy claims-derived medication adherence. BMJ Open Diabetes Res Care 2016; 4:e000201. [PMID: 27239318 PMCID: PMC4873948 DOI: 10.1136/bmjdrc-2016-000201] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/23/2016] [Accepted: 03/29/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Medication adherence requires underlying behavior skills and a supporting mindset that may not be addressed with education or reminders. Founded in the study of internal motivation and health psychology, integrative health coaching (IHC) helps patients gain insight into their behaviors and make long-term, sustainable lifestyle changes. The purpose of the study is to determine whether IHC improves oral medication adherence, glycated hemoglobin (HbA1c), and psychosocial measures, and to assess whether adherence changes are sustained after the intervention. METHODS Using a prospective observational design, participants (n=56) received 14 coaching calls by telephone over 6 months. Medication possession ratio (MPR) was calculated for time intervals before, during, and after the intervention. HbA1c and patient-reported psychosocial outcomes were obtained to test interactions with MPR. RESULTS Medication adherence (MPR) increased from 0.74±0.197 to 0.85±0.155 during coaching, and was sustained at 0.82±0.175 during a 6-month period after the study. Better adherence correlated with a greater decrease in HbA1c. HbA1c decreased from 8.0±1.92% to 7.7±1.70% over the 6-month intervention. All psychosocial measures showed significant improvement. In addition to discussing medication adherence strategies with their coach, patients discussed nutrition and exercise (86.9% of calls), stress management (39.8%), and social support and relationships (15.4%). CONCLUSIONS IHC targets internal motivation and supports behavior change by facilitating patients' insight into their own behaviors, and it uses this insight to foster self-efficacy. This approach may yield sustainable results for medication adherence and warrants further exploration for health-related behavior change.
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Affiliation(s)
- Ruth Q Wolever
- Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Medicine, Vanderbilt Schools of Medicine & Nursing, Nashville, Tennessee, USA
- Duke Integrative Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mark H Dreusicke
- Duke Integrative Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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Costa LMFCD, Vieira SE. Quality of life of adolescents with type 1 diabetes. Clinics (Sao Paulo) 2015; 70:173-9. [PMID: 26017647 PMCID: PMC4449466 DOI: 10.6061/clinics/2015(03)04] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Revised: 11/19/2014] [Accepted: 01/05/2015] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Diabetes mellitus is a highly prevalent chronic disease. Type 1 diabetes mellitus usually develops during infancy and adolescence and may affect the quality of life of adolescents. OBJECTIVE To evaluate the quality of life of adolescents with type 1 diabetes mellitus in a metropolitan region of western central Brazil. METHODS Adolescents aged 10-19 years who had been diagnosed with type 1 diabetes mellitus at least 1 year previously were included. Patients with verbal communication difficulties, severe disease, and symptomatic hypo- or hyperglycemic crisis as well as those without an adult companion and who were <18 years of age were excluded. The self-administered Diabetes Quality of Life for Youths instrument was applied. RESULTS Among 96 adolescents (57% females; 47% white, and 53% nonwhite), 81% had an HbA1c level of >7%. In general, the adolescents consistently reported having a good quality of life. The median scores for the domains of the instrument were as follows: "satisfaction": 35; "impact": 51; and "worries": 26. The total score for all domains was 112. Bivariate analysis showed significant associations among a lower family income, public health assistance, and insulin type in the "satisfaction" domain; and a lower family income, public health assistance, public school attendance, and a low parental education level in the "worries" domain and for the total score. A longer time since diagnosis was associated with a worse total score. Multivariable analysis confirmed the association of a worse quality of life with public health assistance, time since diagnosis, and sedentary lifestyle in the "satisfaction" domain; female gender in the "worries" domain; and public health assistance for the total score. CONCLUSIONS Overall, the adolescents evaluated in this study viewed their quality of life as good. Specific factors that led to the deterioration of quality of life, including public assistance, time since diagnosis, sedentary lifestyle, and female gender, were identified. No potential conflict of interest was reported.
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Affiliation(s)
| | - Sandra E Vieira
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Currie CJ, Peyrot M, Morgan CL, Poole CD, Jenkins-Jones S, Rubin RR, Burton CM, Evans M. The impact of treatment non-compliance on mortality in people with type 1 diabetes. J Diabetes Complications 2013; 27:219-23. [PMID: 23157988 DOI: 10.1016/j.jdiacomp.2012.10.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 10/05/2012] [Accepted: 10/06/2012] [Indexed: 12/31/2022]
Abstract
AIMS To determine if a diagnostic record of poor treatment compliance (medication non-compliance and/or non-attendance at medical appointments) was associated with all-cause mortality in people with type 1 diabetes. METHODS This is an observational cohort study of data extracted from The Health Improvement Network (THIN) database, comprising data on patients served by over 350 primary care practices in the U.K. Participants were included in the study if they had diagnostic codes indicative of type 1 diabetes. Treatment non-compliance was defined as missing one or more scheduled appointment, or one or more codes indicating medication non-compliance. RESULTS Of 2946 patients with type 1 diabetes, 867 (29.4%) had a record of either appointment non-attendance or medication non-compliance in the 30 month compliance assessment period. The crude, unadjusted mortality rate for those patients who were treatment non-compliant was 1.462 (95% CI 0.954-2.205). Following adjustment for confounding factors, treatment non-compliance was associated with increased all-cause mortality (HR=1.642; 95% CI 1.055-2.554). CONCLUSIONS Treatment non-compliance was associated with increased all-cause mortality in patients with type 1 diabetes. Understanding and addressing factors that contribute to patient treatment non-compliance will be important in improving the life expectancy of patients with type 1 diabetes.
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Affiliation(s)
- Craig J Currie
- Department of Medicine, School of Medicine, Cardiff University, Cardiff, UK.
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Ahola AJ, Groop PH. Barriers to self-management of diabetes. Diabet Med 2013; 30:413-20. [PMID: 23278342 DOI: 10.1111/dme.12105] [Citation(s) in RCA: 166] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 10/31/2012] [Accepted: 12/18/2012] [Indexed: 12/27/2022]
Abstract
People with diabetes hold major responsibility for the day-to-day management of their chronic condition. The management that, amongst others, includes blood glucose monitoring, medication taking, diet and physical activity, aims at normalizing blood glucose levels. In many individuals, the level of glycaemia, however, frequently exceeds the recommendations. This observation, together with patients' and practitioners' reports, suggests that active self-management is suboptimal. Various reasons, both individual and environment related, contribute to the suboptimal concordance with treatment regimen. The aim of this review is to discuss some of the barriers to optimal diabetes self-management.
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Affiliation(s)
- A J Ahola
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Finland
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Schoenthaler AM, Schwartz BS, Wood C, Stewart WF. Patient and Physician Factors Associated With Adherence to Diabetes Medications. DIABETES EDUCATOR 2012; 38:397-408. [DOI: 10.1177/0145721712440333] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this study was to examine the influence of patient and physician psychosocial, sociodemographic, and disease-related factors on diabetes medication adherence. These factors were also examined as effect modifiers of the association between quality of the patient-physician relationship and medication adherence. Methods Data were collected from 41 Geisinger Clinic primary care physicians and 608 of their patients with type 2 diabetes. Adherence to oral hypoglycemic medications was calculated using a medication possession ratio based on physician orders in electronic health records (MPREHR). MPREHR was defined as the proportion of total time in the 2 years prior to study enrollment that the patient was in possession of oral hypoglycemic medications. Linear regression was used to examine the influence of patient- and physician-level factors on adherence. Effect modification of the patient-physician relationship-adherence association was evaluated by adding the main effects of the individual-level factors and their cross-products to the models. Results In adjusted analyses, satisfaction with the physician’s patient education skills, patient beliefs about the need for their medications, and lower diabetes-related knowledge were associated with better adherence to oral hypoglycemic medications. Shorter duration of time with diabetes and taking only oral hypoglycemic medications were also associated with better adherence. Finally, the association between shared decision making and medication adherence was significantly modified by patients’ level of social support. Conclusions This study identified several patient-, physician-, and disease-related factors that should be targeted to maximize the potential for developing tailored adherence-enhancing interventions within the context of a collaborative patient-physician relationship.
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Affiliation(s)
- Antoinette M. Schoenthaler
- Department of Medicine, New York University School of Medicine, New York, New York (Dr Schoenthaler)
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland (Dr Schwartz)
- Geisinger Center for Health Research, Danville, Pennsylvania (Mr Wood, Dr Stewart)
| | - Brian S. Schwartz
- Department of Medicine, New York University School of Medicine, New York, New York (Dr Schoenthaler)
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland (Dr Schwartz)
- Geisinger Center for Health Research, Danville, Pennsylvania (Mr Wood, Dr Stewart)
| | - Craig Wood
- Department of Medicine, New York University School of Medicine, New York, New York (Dr Schoenthaler)
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland (Dr Schwartz)
- Geisinger Center for Health Research, Danville, Pennsylvania (Mr Wood, Dr Stewart)
| | - Walter F. Stewart
- Department of Medicine, New York University School of Medicine, New York, New York (Dr Schoenthaler)
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland (Dr Schwartz)
- Geisinger Center for Health Research, Danville, Pennsylvania (Mr Wood, Dr Stewart)
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Gillibrand R, Stevenson J. The extended health belief model applied to the experience of diabetes in young people. Br J Health Psychol 2006; 11:155-69. [PMID: 16480561 DOI: 10.1348/135910705x39485] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The experience of diabetes in young people was investigated within the theoretical framework of the extended health belief model (EHBM). It was anticipated that participant reports of high internal locus of control, high diabetes related empowerment, coping with hypoglycaemia, and diabetes related social support would be associated with good patient adherence to the self-care regime. METHOD 118 participants aged 16-25 years with Type 1 diabetes mellitus were sent a set of questionnaires incorporating previously published scales measuring all variables of the EHBM. RESULTS High levels of family support and low locus of control beliefs in powerful others to control their diabetes reduce the young person's perception of severity and vulnerability to diabetes related complications. High internal locus of control beliefs and high levels of self-efficacy predicted the benefits of adhering to the self-care regime as outweighing the costs of doing so. Adherence to self-care regime was predicted by high levels of family support. CONCLUSION The final model explained 12% of the variance in the young person's adherence to diabetes self-care regime. It is proposed that the EHBM is an adequate model for understanding the socio-psychological factors present in the young person's appraisal of their diabetes, which, in turn, influences adherence to the diabetes self-care regime.
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Affiliation(s)
- Rachel Gillibrand
- Faculty of Applied Sciences, University of the West of England, Bristol, UK.
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Hearnshaw H, Lindenmeyer A. What do we mean by adherence to treatment and advice for living with diabetes? A review of the literature on definitions and measurements. Diabet Med 2006; 23:720-8. [PMID: 16842475 DOI: 10.1111/j.1464-5491.2005.01783.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS In order to measure the effectiveness of interventions claiming to improve adherence in diabetes, valid measurement of adherence is necessary. Any measurement must first be based on a definition. This study aimed to identify and categorize definitions and measurements of adherence in living with diabetes, from a review of the literature. METHODS Publications were identified from the medline database. Adherence, compliance and concordance were used as terms in the search algorithm, along with diabetes, diabetes mellitus and treatment. Two hundred and ninety-three papers were identified. Abstracts of these papers were read by two researchers independently. Two hundred and thirty-nine papers did not contain definitions or measures of adherence and were discarded. Of the remaining 54 papers, 26 included definitions and 46 described measurements of adherence. RESULTS Definitions and measurements fell into five categories: coincidence of behaviour with professional advice, relationship as part of the process of care, outcome and process targets, taking the medication as prescribed and others. No single definition of adherence emerged. Many authors did not provide definitions of adherence. Glycated haemoglobin was the most common measurement of adherence, although this can raise problems. CONCLUSIONS Research which claims to show an intervention has, or has not, improved adherence must be interpreted cautiously. Interventions which appear to fail may actually succeed in aspects of adherence which were not defined or measured in the study. Clinicians and researchers could use clear definitions and measurements, such as the ones presented in this review.
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Affiliation(s)
- H Hearnshaw
- Warwick Diabetes Care, Warwick Medical School, University of Warwick, Warwick, UK.
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Hagedoorn M, Keers JC, Links TP, Bouma J, Ter Maaten JC, Sanderman R. Improving self-management in insulin-treated adults participating in diabetes education. The role of overprotection by the partner. Diabet Med 2006; 23:271-7. [PMID: 16492210 DOI: 10.1111/j.1464-5491.2006.01794.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS To examine the role of overprotection by the partner--i.e. excessive protection, unnecessary help, excessive praise for accomplishments, or attempts to restrict activities as a consequence of underestimating the patient's capabilities--in changes in patient self-management in the context of diabetes education. METHODS Sixty-seven insulin-treated patients with a partner completed questionnaires on admission to a Multidisciplinary Intensive Education Programme (MIEP) and 3 months after completing the core module of MIEP. Factors assessed were overprotection by their partner and three aspects of diabetes self-management, namely internal locus of control, diabetes-related distress and HbA1c. Regression analyses were used to test the independent associations of patient sex, baseline overprotection and the interaction between sex and overprotection with diabetes self-management at the follow-up stage, controlling for the baseline value of the dependent variable. RESULTS The increase in internal locus of control and decrease in HbA1c were both significantly less for female patients who perceived their partner to be rather overprotective than for female patients who did not perceive their partner to be overprotective. The more patients, both male and female, perceived their partner to be overprotective, the less their diabetes-related distress decreased. CONCLUSIONS Overprotection by the partner showed a negative association with improvement in diabetes self-management, especially for female patients. Thus, an intervention programme with the aim of reducing overprotection by the partner, or the perception of this, may enhance self-management in patients participating in diabetes education.
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Affiliation(s)
- M Hagedoorn
- Northern Centre for Health Care Research, Department of Public Health and Health Psychology, University of Groningen, Groningen, the Netherlands.
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Lawson VL, Lyne PA, Harvey JN, Bundy CE. Understanding why people with type 1 diabetes do not attend for specialist advice: a qualitative analysis of the views of people with insulin-dependent diabetes who do not attend diabetes clinic. J Health Psychol 2005; 10:409-23. [PMID: 15857871 DOI: 10.1177/1359105305051426] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Attendance at diabetes clinic is associated with improved medical outcome, however, significant numbers of people with type 1 diabetes choose not to attend. In order to understand the reasons underlying this decision, qualitative interviews were carried out with 12 long-term non-attenders. Three distinct groups emerged differing in terms of their cognitive and emotional responses to diabetes and their coping strategies: (1) the 'High fear' group; (2) the 'Patient as expert' group; and (3) the 'Low motivation' group. These differences should be recognized and suitable approaches developed to ensure that all people with diabetes are able to accept appropriate specialist support.
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Affiliation(s)
- Valerie L Lawson
- Wrexham Academic Unit, Wales College of Medicine, Cardiff University, Wrexham, UK.
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12
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Abstract
AIMS AND OBJECTIVES The aim of this paper is to explore self-care in diabetes and to present a model of factors that affect self-care according to reviewed literature. BACKGROUND Self-care in diabetes is crucial to keep the disease under control. Self-care consists at least four aspects: (i) self-monitoring of blood glucose, (ii) variation of nutrition to daily needs, (iii) insulin dose adjustments to actual needs and (iv) taking exercise regularly. It is known that diverse factors influence self-care such as knowledge, physical skills and emotional aspects and self-efficacy which have been listed as being of high importance. METHODS The searched databases were ProQuest, PsycINFO and Medline from 1995 to 2002. The search terms were "self-care" or "self-management" coexisting with diabetes and "self-efficacy". The search was limited to English and adults with type 1 diabetes. RESULTS The main components of the model clarify how knowledge, physical skills and emotional factors as well as self-efficacy influence self-care which again affects metabolic control. Flexible self-care indicates high level of self-care when patients are able to care for and manage the disease in a responsible and flexible way that does not affect their life extensively, resulting in adequate glycosylated haemoglobin value. Self-efficacy is a strong predictor of flexible self-care and affects metabolic control through increased perceived ability to conduct self-care. CONCLUSIONS The review illuminated that benefits of self-care should be emphasized and knowledge of the Diabetes Complication and Control Trial results can contribute to better self-care. However, factors affecting flexible self-care still require better identification. RELEVANCE TO CLINICAL PRACTICE The review emphasizes and adds to the topic, that in daily practice health care practitioners must assess diabetes-related knowledge, physical skills and emotional factors in combination with self-efficacy and the four self-care areas. The effects of self-monitoring of blood glucose needs better clarifications as it is now regarded the cornerstone of flexible self-care.
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Affiliation(s)
- Arún K Sigurdardóttir
- Faculty of Health Sciences, University of Akureyri, PO Box 224, IS-602 Akureyri, Iceland.
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Westaway MS, Seager JR, Rheeder P, Van Zyl DG. The effects of social support on health, well-being and management of diabetes mellitus: a black South African perspective. ETHNICITY & HEALTH 2005; 10:73-89. [PMID: 15841588 DOI: 10.1080/1355785052000323047] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVES To determine the underlying dimensions of a social support measure and investigate the effects of social support on health, well-being and management of diabetes mellitus (metabolic control and blood pressure (BP) control). DESIGN A cross-sectional, analytical design was used with a structured questionnaire, comprising demographic characteristics, the MOS Social Support Survey scale and the health perceptions and mental health sub-scales from the SF-20. SETTING Two outpatient diabetes mellitus clinics in Pretoria, South Africa. PARTICIPANTS Over a three-month period, the questionnaire was administered to 263 black diabetes mellitus outpatients (174 women and 89 men), aged between 16 and 89 years. The majority of patients (91%) were diagnosed as type 2 diabetes mellitus. Only 22% of the patients had acceptable metabolic control (HbA1c < 8.0%), in comparison with 46% who had good BP control (130/85 mmHg). There were significant differences between the clinics on BP control: participants from clinic 1 had better BP control than participants from clinic 2. RESULTS Principal components analysis, followed by an orthogonal (VARIMAX) rotational solution, resulted in two social support factors accounting for 78.9% of the variance. The first factor was labelled socio-emotional support, due to the emphasis on close caring relationships. The second factor was concerned with the more tangible aspects of social support, such as the provision of assistance. Coefficient alpha was 0.97 (socio-emotional support), 0.95 (tangible support) and 0.97 (overall social support). Patients with lower levels of social support had poorer general health and well-being than patients with higher levels of social support. Controlling for clinic, patients with controlled BP had significantly more socio-emotional and tangible support than patients with poor BP control. CONCLUSIONS The study demonstrated that: (1) socio-emotional and tangible support were the underlying dimensions of social support; (2) socio-emotional support is an important determinant of health and well-being; and (3) social support is beneficial for one aspect of diabetes mellitus management, namely, BP control.
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Abstract
In this study, the authors examined the relation between glycemic control and sense of coherence (SOC) and the mediating role of psychological distress and of adherence to self-care behaviors in 67 people with type 1 and type 2 diabetes. In addition, 29 individuals without any chronic disease composed a control group. The authors determined glycemic control by glycosylated hemoglobin (HbA1c) measures. The participants answered a questionnaire that included questions about medical data, an adherence to self-care behaviors inventory, Derogatis' Brief Symptoms Inventory, and Antonovsky's SOC scale. People with diabetes showed higher levels of psychological distress than matched controls, but similar SOC scores. A path analysis revealed that SOC was indirectly related to glycemic control, through adherence to self-care behaviors and psychological distress. Adherence did not mediate the effect of psychological distress on glycemic control In addition, the type of diabetes of the subject was directly related to glycemic control. The model explained 38% of the variance of glycemic control. The results suggest a possible role of SOC in the psychological and physical wellbeing of people with diabetes. SOC should constitute a focus of further research, particularly studies of possible psychological intervention to enhance SOC in people with diabetes.
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Affiliation(s)
- Miri Cohen
- Faculty of social welfare and health studies at Haifa University, Israel.
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Creencias, actitudes y conocimientos de las personas con diabetes tipo 2 respecto a su enfermedad. ENFERMERIA CLINICA 2004. [DOI: 10.1016/s1130-8621(04)73908-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Auerbach SM, Clore JN, Kiesler DJ, Orr T, Pegg PO, Quick BG, Wagner C. Relation of diabetic patients' health-related control appraisals and physician-patient interpersonal impacts to patients' metabolic control and satisfaction with treatment. J Behav Med 2002; 25:17-31. [PMID: 11845556 DOI: 10.1023/a:1013585617303] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Desire for healthcare control, health locus of control, perceived control over diabetes, satisfaction with diabetes treatment, and general personality traits were assessed in 54 Type 1 and Type 2 diabetic patients of the same male endocrinologist during a regularly scheduled office visit. At the end of the consultation, both patients and the physician completed a measure describing the interpersonal impacts produced in each by the other's control and affiliation behaviors. Patient success at diabetes control was assessed via glycosylated hemoglobin A1C (HA1C) level on the day of the visit and variability in HA1C levels across several visits. Patients' satisfaction with treatment was unrelated to diabetes control measures. Patients' desire for behavioral involvement in their own healthcare and NEO Agreeableness scores were positively associated with diabetes control. Better diabetes control also resulted when the physician perceived patients to be more controlling and less submissive, and when there was more reciprocity in patient and physician's perceptions of the other's controlling interpersonal behavior. Findings support the conclusion that both a patient's self-reported desire for involvement in his or her healthcare and the transactional fit of patient-physician interpersonal behaviors are potentially important contributors to better diabetes outcomes.
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Affiliation(s)
- Stephen M Auerbach
- Department of Psychology, Virginia Commonwealth University, Box 842018, Richmond, Virginia 23284, USA
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Schilling LS, Grey M, Knafl KA. The concept of self-management of type 1 diabetes in children and adolescents: an evolutionary concept analysis. J Adv Nurs 2002; 37:87-99. [PMID: 11784402 DOI: 10.1046/j.1365-2648.2002.02061.x] [Citation(s) in RCA: 135] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AIM An evolutionary concept analysis was undertaken to clarify the concept of self-management of type 1 diabetes in children and adolescents. BACKGROUND Several problems exist in the literature on self-management of type 1 diabetes in children and adolescents. There is no uniform terminology and there is no uniform definition of the concept. Also, there is no differentiation in the literature between self-management of diabetes in children and adults. METHODS Ninety-nine references were reviewed and analysed in the disciplines of nursing, medicine, and psychology. After separate analyses revealed no significant differences across disciplines, the analyses were combined to describe the attributes, antecedents, consequences, and surrogate and related concepts. RESULTS The three essential attributes of the concept were identified as process, activities, and goals. Self-management of type 1 diabetes in children and adolescents is an active and proactive process; it is daily, lifelong, and flexible, and it involves shifting and shared responsibility for diabetes care tasks and decision-making between child and parent. It is a process that involves collaboration with health care providers. Self-management of type 1 diabetes in children and adolescents also consists of varied and many activities related to giving insulin, monitoring metabolic control, regulating diet and exercise, to name just a few. The concept also involves goals, which may differ from one parent/child dyad to another. A working definition of the concept is suggested. CONCLUSIONS It is hoped that a more uniform definition of the concept will enable researchers to continue investigating antecedents and consequences of the concept in a way that allows for aggregating results.
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Affiliation(s)
- Lynne S Schilling
- Yale University, School of Nursing, New Haven, Connecticut 06536-0740, USA.
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Abstract
The purpose of the study reported in this paper was to describe adherence to self-care, perceived difficulties and social support in a group of adult patients (n = 213) with insulin-treated diabetes from two outpatient clinics in Northern Finland. Data were collected by questionnaire. The instruments were developed to measure adherence to self-care, difficulties in self-care and social support. The response rate was 76%. One-way ANOVA, logistic regression analysis, contingency and Pearson's correlation coefficients were used in the statistical analysis. A fifth of the respondents were neglecting their self-care. The others undertook flexible, regimen-adherent or self-planned self-care. The subjects had no difficulties with insulin treatment, but had more problems with other aspects of self-care. Poor metabolic control, smoking and living alone predicted neglect of self-care, but if patients had support from family and friends, living alone was not a predictor of neglect of self-care. Those with poor metabolic control perceived themselves as getting peer support from other persons with diabetes.
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Affiliation(s)
- M Toljamo
- Department of Nursing and Health Administration, Oulu University Hospital, University of Oulu, Finland.
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Toljamo M, Hentinen M. Adherence to self-care and glycaemic control among people with insulin-dependent diabetes mellitus. J Adv Nurs 2001; 34:780-6. [PMID: 11422548 DOI: 10.1046/j.1365-2648.2001.01808.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
AIM OF THE STUDY Factors associated with adherence to self-care and glycaemic control were studied in 213 people with insulin-dependent diabetes mellitus using a self-report questionnaire and a biochemical indicator (glycosylated haemoglobin). METHODS The data were collected in the Oulu Health Center and the Central Hospital of Lapland in Northern Finland. The response rate was 76%. In order to verify the reliability and validity of the instruments, we used correlation coefficients, factor analysis and item-total analysis. Internal consistency was checked by Cronbach's alpha. The connections between self-care and the background variables were examined by cross-tabulation. FINDINGS The majority of subjects accomplished their insulin treatment as scheduled, but had more difficulties with the other aspects of self-care. According to the findings, a fifth (19%) of the respondents were neglecting their self-care. The others undertook flexible (46%), regimen-adherent (16%) or self-planned self-care (19%). The subjects who were adherent to self-care had better metabolic control than those who neglected self-care. According to logistic regression analysis, poor metabolic control (P=0.003), smoking (P=0.009) and living alone (P=0.014) were associated with neglect of self-care. Gender, concurrent diseases and complications as a result of diabetes increased the risk, but had no significant association with adherence to or neglect of self-care. CONCLUSION The findings demonstrated that adherence to self-care does not always lead to good metabolic control, but neglect of self-care is likely to lead to poor metabolic control.
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Affiliation(s)
- M Toljamo
- Department of Nursing and Health Administration, Oulu University Hospital, Box 5000 University of Oulu, FIN-90 014, Finland.
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Gillibrand W, Flynn M. Forced externalization of control in people with diabetes: a qualitative exploratory study. J Adv Nurs 2001; 34:501-10. [PMID: 11380717 DOI: 10.1046/j.1365-2648.2001.01779.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIM The purpose of this study was to explore and describe the patients' perceptions of the Diabetic Disease State and its complications using an ethnographic method. BACKGROUND Diabetes mellitus is an extensively researched and studied disease, however, relatively little attention has been given to the lived experience of chronic illness. METHODS A purposive sample of 18 people with diabetes was derived from a diabetes register database. Data were collected by semistructured interviews, which were tape-recorded and transcribed. The transcripts were analysed together with the researchers' observational notes, using open coding procedures to identify main categories. Discussion of the results is made in the theoretical context of the locus of control (LOC) framework. FINDINGS Three main categories emerged from the data: information-knowledge of illness; the psychological burden of diabetes; rationalizing. A further subcategory, reality avoidance, was identified. The findings showed that these people with diabetes experience and describe complex psychological effects and coping mechanisms in having a chronic illness. CONCLUSIONS The findings also suggested that participants in this study might have felt that the control of their chronic condition had been externalized to the health care professionals responsible for their care.
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Affiliation(s)
- W Gillibrand
- Faculty of Health, Department of Primary and Community Nursing, Greenbank Building, University of Central Lancashire, Preston PR1 2HE, UK.
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