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Zhu W, Liang D, Petersen JD, Zhang W, Huang J, Dong Y. Relationship between diabetic knowledge, attitudes and practices among patients with diabetes in China: a structural equation model. BMJ Open 2023; 13:e076464. [PMID: 37973542 PMCID: PMC10660206 DOI: 10.1136/bmjopen-2023-076464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES Whether the routine delivery of diabetes-related knowledge can change patients' attitudes and hence influence their self-management activities remains unknown in primary healthcare settings in China. Thus, this study aims to explore the complex transformation process between knowledge, attitude and practice (KAP) among patients with diabetes in a city in China. DESIGN A cross-sectional study. SETTING Yuhuan City, Zhejiang Province, China. PARTICIPANTS A total of 803 patients with diabetes were invited to attend a questionnaire survey and 782 patients with type 2 diabetes completed the survey. The average age of participants was 58.47 years old, 48.21% of whom only attended primary school or below. PRIMARY AND SECONDARY OUTCOME MEASURES A questionnaire based on existing scales and expert consultation was applied to assess patients' socio-demographic information (SI), disease progression risk and diabetes-related KAP. A structural equation model was built to analyse the relationships between patients' characteristics and KAP. RESULTS No significant association was found between patients' knowledge and attitude (β=0.01, p=0.43). Better knowledge and attitude were both found to be associated with better diet and physical activities (β=0.58, p<0.001; β=0.46, p=0.01). However, patients with a more positive attitude toward diabetic care showed worse foot care practice (β=-0.13, p=0.02), while better knowledge was associated with better foot care practice (β=0.29, p<0.001). In addition, patients with higher SI (β=0.88, p<0.001) and/or disease progression risk (β=0.42, p<0.001) tended to present higher levels of disease knowledge. CONCLUSIONS While successful KAP transformation has been achieved in practice for diet and physical activities, there is a need to improve foot care practice. Health education should also prioritise the prevention, detection and care of diabetic foot. Also, appropriate methods should be adopted to deliver health education to vulnerable patients, such as the elderly, those living in rural areas, those with minimal education, the unemployed and low-income patients.
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Affiliation(s)
- Wenjun Zhu
- School of Public Health, National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, People's Republic of China
| | - Di Liang
- School of Public Health, National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, People's Republic of China
| | - Jindong Ding Petersen
- Research Unit for General Practice, Department of Public Health, University of Copenhagen, Kobenhavn, Denmark
- International School of Public Health and One Health, Hainan Medical University, Haikou, China
| | - Weijun Zhang
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Jiayan Huang
- School of Public Health, National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, People's Republic of China
| | - Yin Dong
- People's Hospital of Yuhuan, Taizhou, China
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Pogrebnoy D, Dennett AM, Simpson DB, MacDonald-Wicks L, Patterson AJ, English C. Effects of Using Websites on Physical Activity and Diet Quality for Adults Living With Chronic Health Conditions: Systematic Review and Meta-Analysis. J Med Internet Res 2023; 25:e49357. [PMID: 37856187 PMCID: PMC10623240 DOI: 10.2196/49357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/20/2023] [Accepted: 08/09/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Adults with chronic health conditions need support to manage modifiable risk factors such as physical inactivity and poor diet. Disease-specific websites with health information on physical activity and diet quality may be effective in supporting adults in managing their chronic illnesses. OBJECTIVE The primary aim of this review was to determine whether using websites with health information can lead to improvements in physical activity levels or diet quality in adults with chronic health conditions. METHODS Randomized controlled trials evaluating the effectiveness of website use on levels of physical activity or diet quality in adults with chronic health conditions were included. MEDLINE, Embase, CINAHL, and the Physiotherapy Evidence Database were searched from the earliest available record until February 2023. Data for outcomes measuring physical activity levels; diet quality; and, where reported, self-efficacy and quality of life were independently extracted by 2 reviewers. The risk of bias was assessed using the Physiotherapy Evidence Database scale, and the overall certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. Where values were presented as the same unit of measure, postintervention scores were pooled for meta-analysis to yield an overall mean difference (MD). A standardized MD (SMD) was calculated for the pooled data in which different units for the same outcome were used. Individual trial data were described in cases where the data of trials could not be pooled. RESULTS A total of 29 trials (N=6418 participants) across 8 different disease groups with intervention periods ranging from 4 weeks to 12 months were included in the analysis. There was moderate-certainty evidence that using websites with health information increased levels of moderate to vigorous physical activity (MD=39 min/wk, 95% CI 18.60-58.47), quality of life (SMD=0.36, 95% CI 0.12-0.59), and self-efficacy (SMD=0.26, 95% CI 0.05-0.48) and high-certainty evidence for reduction in processed meat consumption (MD=1.1 portions/wk, 95% CI 0.70-1.58) when compared with usual care. No differences were detected in other measures of diet quality. There was no increased benefit for website users who were offered additional support. CONCLUSIONS The use of websites for risk factor management has the potential to improve physical activity levels, quality of life, and self-efficacy as well as reduce processed meat consumption for adults living with chronic health conditions when compared with usual care. However, it remains unclear whether using websites leads to meaningful and long-lasting behavior change. TRIAL REGISTRATION PROSPERO CRD42021283168; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=283168.
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Affiliation(s)
- Dina Pogrebnoy
- School of Health Sciences, University of Newcastle, Newcastle, Australia
- Department of Physiotherapy, Western Health, St Albans, Australia
| | - Amy M Dennett
- Allied Health Clinical Research Office, Eastern Health, Melbourne, Australia
- School of Allied Health, Human Services and Sport, Latrobe University, Melbourne, Australia
| | - Dawn B Simpson
- School of Health Sciences, University of Newcastle, Newcastle, Australia
- Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, Australia
| | - Lesley MacDonald-Wicks
- School of Health Sciences, University of Newcastle, Newcastle, Australia
- Food and Nutrition Program, Hunter Medical Institute, Newcastle, Australia
| | - Amanda J Patterson
- School of Health Sciences, University of Newcastle, Newcastle, Australia
- Food and Nutrition Program, Hunter Medical Institute, Newcastle, Australia
| | - Coralie English
- School of Health Sciences, University of Newcastle, Newcastle, Australia
- Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, Australia
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Exploring the Feasibility of an Online Diabetes Wellness Programme among Periodontitis Patients with Type II Diabetes Mellitus during the COVID-19 Pandemic. Healthcare (Basel) 2022; 10:healthcare10112129. [DOI: 10.3390/healthcare10112129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 01/09/2023] Open
Abstract
There were massive interruptions, including patient visits for dietary advice and dental services, during the COVID-19 outbreak. This study assessed the feasibility of an online diabetes wellness programme among periodontitis patients with type II diabetes mellitus. Patients were grouped into the intervention group (IG) and control group (CG). At baseline and week 12, all patients answered online questionnaires on diabetes-related knowledge, physical activity, and oral impacts on daily performances (OIDP). Body weight and waist circumference were self-measured with guided instructions. Diet recalls were used to estimate dietary and added sugar intake. All patients received a weekly educational video, but the IG attended three e-consultation sessions with a dietitian (weeks 1, 3, and 8) and a dentist (week 8) via video call. A semi-structured interview was conducted to collate qualitative feedback among the IG participants at the end of the programme. A total of 24 periodontitis patients (14 IG and 10 CG) participated in this study. Among the IG patients, significant improvements in diabetes knowledge, body weight, BMI, calories, carbohydrates, fat, and added sugar intakes were observed at week 12. The CG patients only had a significant reduction in carbohydrate intake post intervention. No changes were reported in physical activity level and OIDP for both groups. Feedback received from the IG participants included convenience, practical, preferred approach during the pandemic, increased awareness and knowledge, and favourable lifestyle changes. This study demonstrates that an online diabetes wellness programme with healthcare professionals is feasible and can facilitate knowledge and lifestyle improvements that can be adapted during the crisis situation.
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Lee CS, Westland H, Faulkner KM, Iovino P, Thompson JH, Sexton J, Farry E, Jaarsma T, Riegel B. The effectiveness of self-care interventions in chronic illness: a meta-analysis of randomized controlled trials. Int J Nurs Stud 2022; 134:104322. [DOI: 10.1016/j.ijnurstu.2022.104322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 06/21/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022]
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Pilv L, Vermeire EIJJ, Rätsep A, Moreau A, Petek D, Yaman H, Oona M, Kalda R. Diabetes-related quality of life in six European countries measured with the DOQ-30. Eur J Gen Pract 2021; 27:191-197. [PMID: 34338125 PMCID: PMC8330755 DOI: 10.1080/13814788.2021.1954615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background The quantification of diabetes-related quality of life (DR-QoL) is an essential step in making Type 2 Diabetes (T2DM) self-management arrangements. The European General Practitioners Research Network (EGPRN) initiated the EUROBSTACLE study to develop a broadly conceptualised DR-QoL instrument for diverse cultural and ethnic groups; high and low-income countries. In 2016 the Diabetes Obstacles Questionnaire-30 (DOQ-30) was introduced. Objectives The research aimed to study obstacles a patient with diabetes (PWD) may face in everyday life. First, we assessed how descriptive and clinical characteristics and the residential country were associated with the obstacles. Secondly, we calculated the proportion of respondents who expressed obstacles. Methods Data were collected in 2009 in a cross-sectional survey in Belgium, France, Estonia, Serbia, Slovenia, and Turkey. Multiple linear regressions were computed to detect associations between descriptive and clinical characteristics, residential country, and obstacles. Percentages of respondents who perceived obstacles were calculated. Results We found that although descriptive and clinical characteristics varied to quite a great extent, they were weakly associated with the perception of obstacles. The residential country was most often associated with the existence of some obstacle. The highest percent (48%) of all respondents perceived ‘Uncertainty about Insulin Use’ as an obstacle. Conclusion Descriptive and clinical characteristics were weakly associated with perceived obstacles. However, the residential country plays an essential role in the decline of the QoL of PWDs. Education of both PWDs and healthcare professionals (HCPs) plays an essential role in countering the fear of insulin.
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Affiliation(s)
- Liina Pilv
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | | | - Anneli Rätsep
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Alain Moreau
- Department of Family Medicine, University Claude Bernard Lyon, Lyon, France
| | - Davorina Petek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Marje Oona
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Ruth Kalda
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
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The development of My Care Hub Mobile-Phone App to Support Self-Management in Australians with Type 1 or Type 2 Diabetes. Sci Rep 2020; 10:7. [PMID: 31913296 PMCID: PMC6949290 DOI: 10.1038/s41598-019-56411-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 12/11/2019] [Indexed: 11/12/2022] Open
Abstract
Non-adherence to self-management poses a serious risk to diabetes complications. Digital behavioural change interventions have the potential to provide education and motivate users to regularly engage with self-management of diabetes. This paper describes the development of My Care Hub mobile phone application (app) aimed at supporting self-management in people with type 1 or type 2 diabetes. The development of My Care Hub involved a comprehensive process of healthy behavioural change identification, end users’ needs, expert consensus, data security and privacy considerations. The app translation was a highly iterative process accompanied by usability testing and design modification. The app development process included: (1) behaviour change strategy selection; (2) users’ involvement; (3) expert advisory involvement; (4) data security and privacy considerations; (5) design creation and output translation into a smartphone app and (6) two usability testings of the app prototype version. The app features include self-management activities documentation, analytics, personalized and generalized messages for diabetes self-management as well as carbohydrate components of common foods in Australia. Twelve respondents provided feedback on the usability of the app. Initially, a simplification of the documentation features of the app was identified as a need to improve usability. Overall, results indicated good user satisfaction rate.
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Kusnanto, Widyanata KAJ, Suprajitno, Arifin H. DM-calendar app as a diabetes self-management education on adult type 2 diabetes mellitus: a randomized controlled trial. J Diabetes Metab Disord 2019; 18:557-563. [PMID: 31890682 DOI: 10.1007/s40200-019-00468-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 11/05/2019] [Indexed: 01/11/2023]
Abstract
Purpose Era Disruption 4.0 demands development in the management of Diabetes Mellitus (DM) by using application-based intervention that can facilitate nursing intervention. The aim was to evaluate the effect of diabetes mellitus calendar app as a Diabetes Self-Management Education (DSME) program on self-efficacy, HbA1c levels, lipid profile, and insulin in adult type 2 diabetes mellitus (T2DM). Methods It was randomized experimental design - simple random sampling used with a total sample of 30 respondents. The instruments used diabetes management self-efficacy scales and standard of operational procedure blood sampling. The statistical tests used were a Paired t-test, Wilcoxon, and an Independent t-test. Results DSME with an Android-based DM calendar affected self-efficacy (p < 0.001), HbA1c levels (p = 0.005), cholesterol (p = 0.009), triglyceride (p = 0.000), HDL-c (p = 0.048), LDL-c (p = 0.010), and insulin (p = 0.000) compared with the control group. Education with these electronic media has increased the perception of self-efficacy and improved the behavior of good self-management that can be seen from changes in controlled HbA1c level, lipid profile and insulin. Conclusion The results of this study can be used as a reference for providing educational experimental in patients with Type 2 Diabetes Mellitus (T2DM).
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Affiliation(s)
- Kusnanto
- 1Department of Fundamental, Critical, and Medical-Surgical Nursing, Faculty of Nursing, Universitas Airlangga, Kampus C Mulyorejo, Surabaya, East Java 60115 Indonesia
| | - Komang Agus Jerry Widyanata
- 1Department of Fundamental, Critical, and Medical-Surgical Nursing, Faculty of Nursing, Universitas Airlangga, Kampus C Mulyorejo, Surabaya, East Java 60115 Indonesia
| | - Suprajitno
- School of Nursing, Patria Husada Blitar, East Java, Indonesia
| | - Hidayat Arifin
- 1Department of Fundamental, Critical, and Medical-Surgical Nursing, Faculty of Nursing, Universitas Airlangga, Kampus C Mulyorejo, Surabaya, East Java 60115 Indonesia
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Tang TS, Yusuf FLA, Polonsky WH, Fisher L. Assessing quality of life in diabetes: II - Deconstructing measures into a simple framework. Diabetes Res Clin Pract 2017; 126:286-302. [PMID: 28190527 DOI: 10.1016/j.diabres.2016.10.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 10/13/2016] [Indexed: 12/19/2022]
Abstract
A growing number of instruments measuring diabetes-specific health-related quality of life (HRQOL) have been identified in previous systematic reviews, the most recent being published in 2008. The purpose of this paper is report on an updated systematic review of diabetes-specific HRQOL measures highlighting the time period 2006-2016; to deconstruct existing diabetes-specific HRQOL measures into a simple framework for evaluating the goodness-of-fit between specific research needs and instrument characteristics; and to present core characteristics of measures not yet reported in other reviews to further facilitate scale selection. Using the databases Medline, Pubmed, CINAHL, OVID Embase, and PsycINFO, we identified 20 diabetes-specific HRQOL measures that met our inclusion criteria. For each measure, we extracted eight core characteristics for our measurement selection framework. These characteristics include target population (type 1 vs. type 2), number and type of HRQOL dimensions measured and scored, type of score and calculation algorithm, sensitivity to change data reported in subsequent studies, number of survey items, approximate time length to complete, number of studies using the instrument in the past 10years, and specific languages instruments is translated. This report provides a way to compare and contrast existing diabetes-specific HRQOL measures to aid in appropriate scale selection and utilization.
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Affiliation(s)
| | | | - William H Polonsky
- Behavioral Diabetes Institute, San Diego, CA, USA; University of California, San Diego, CA, USA
| | - Lawrence Fisher
- University of California, San Francisco, San Francisco, CA, USA
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