Barriers to Self-Management in Depressed Women With Type 2 Diabetes

Barriers and facilitators to self-management of chronic conditions reported by women: a systematic review of qualitative studies

OBJECTIVES

This systematic review aims to identify, appraise and synthesise the findings of published qualitative research exploring the barriers and facilitators to self-management of chronic conditions reported by women.

DESIGN

A systematic literature review and thematic synthesis of qualitative studies.

DATA SOURCES

A search of MEDLINE, CINAHL, Embase and PsycInfo was undertaken using the search terms 'Women', 'Woman' 'Female,' 'Chronic', 'Long-term', 'Disease', 'Illness', 'Condition' 'Health,' 'Self-management,' 'Qualitative,' 'Barrier' and 'Facilitator'. A hand search for literature was also performed.

ELIGIBILITY CRITERIA

Studies published before 2005 and those not in English were excluded.

DATA EXTRACTION AND SYNTHESIS

Extracted data were analysed thematically and emerging and recurring themes identified. Themes were mapped to the six components of the COM-B model. Critical appraisal of included publications was undertaken using the CASP (Critical Appraisal Skills Programme) qualitative checklist and finding weighted on quality.

RESULTS

Eighty-four publications were identified and eligible for inclusion within the review. Studies were conducted in five continents, with a focus on 20 different chronic conditions and included a total of 1788 women. Barriers and facilitators to physical capability, psychological capability, physical opportunity, social opportunity, autonomic motivation and reflective motivation were identified with a number of recurring themes found. Self-prioritisation, support and culture all had a significant impact on whether women followed self-management recommendations. Certain groups of women such as those living remotely, those with financial difficulties, migrants and those who do not speak the predominant language appear to face additional barriers to self-management.

CONCLUSIONS

This review highlights that to self-manage chronic conditions women have to overcome various cultural, financial and social barriers. Self-management programmes should be designed taking into account these factors in order to ensure women are better supported and enabled to improve their health outcomes.

The effects of education on foot care behaviors and self-efficacy in type 2 diabetes patients

Background

Diabetic foot significantly affects the quality of life of patients with diabetes. It leads to loss of labor force, psychosocial trauma, and high treatment costs due to serious morbidity and mortality. Nurses have an important responsibility to improve the metabolic status of individuals with diabetes, to protect them from foot complications, and to teach patients foot care skills.

Aim

This study investigated the effects of education on type 2 diabetes patients regarding diabetic foot care and self-efficacy.

Materials and Methods

This quasi-experimental study was conducted from February to July 2016 in hospitals located in the city of Balıkesir in Turkey with type 2 diabetes patients who were admitted to the internal medicine clinic and monitored by the endocrinology and internal medicine outpatient clinics. G*power 3.1.9.2 software was used to calculate the sample size of 94 people with a 5% type 1 error, and 90% power. The study was carried out with stratified randomization, and a questionnaire was administered to the experimental and control groups. The experimental group received training, and both groups' scores on the Diabetic Foot Behavior Questionnaire [Appendix 1] and the Diabetic Foot Care Self-Efficacy Scale [Appendix 2] were compared after three months. The t-test, the paired t-test, and the Chi-square test were used.

Results

While the self-efficacy and the foot care behavior scores of the control group did not show any differences (P > 0.05), the experimental group's scores were significantly higher (P < 0.05). The control group's self-efficacy and foot care behavior scores on the pre-test and final test were similar, while the experimental group's scores increased (P < 0.05).

Conclusions

Starting from the diagnosis of diabetes, it is advisable to carry out foot assessments and to follow up with diabetics who received foot care education to increase their self-efficacy, to make foot care a habit, and to re-evaluate missing or incorrect practices during check-ups.

THE EFFECT OF DIABETES SYMPTOMS ON QUALITY OF LIFE IN INDIVIDUALS WITH TYPE 2 DIABETES

OBJECTIVE

This study aimed to investigate the effect of symptoms of diabetes on the quality of life of individuals with Type 2 diabetes.

METHOD

The study used a cross-sectional design. No sampling procedure was employed in the study; instead, 410 individuals presenting to the Balikesir Atatürk City Hospital Endocrinology and Internal Medicine Polyclinics between December 2016 and July 2017, diagnosed with Type 2 diabetes, and meeting the inclusion criteria were enrolled in the study sample. The study data were collected with a "Socio-demographic Characteristics Questionnaire", the "Diabetes Symptom Checklist", and the "SF-36 Quality of Life Questionnaire".

RESULTS

The participants obtained the highest mean scores from the hyperglycemia subscale of the Diabetes Symptoms Checklist (3.35±0.60) and the mental health subscale of the SF-36 Quality of Life Questionnaire (50.65±8.10). The hypoglycemia, cardiology, psychology, and neurology variables included in the model were statistically significant and predicted 35% of the mental subscale score of the SF 36 questionnaire. SF 36 physical subscale score increased as the hypoglycemia, cardiology, psychology, and neurology scores decreased (p<0.05).

CONCLUSION

The participants obtained high scores from the hyperglycemia subscale of the diabetes symptom checklist and mental health subscale of the quality of life questionnaire. Diabetes symptoms were found to affect the quality of life of individuals with diabetes.