Empowerment and Social Support as Predictors of Self-Care Behaviors and Glycemic Control in Individuals With Type 2 Diabetes

Determinants of Physical Activity 10 Months Following a Supervised Exercise Program in People With Type 2 Diabetes

AIMS

Supervised exercise provides numerous health benefits for people with type 2 diabetes mellitus (T2D); however, long-term adherence is poor. We aimed to identify (1) factors associated with total physical activity (PA) participation 10 months following supervised exercise and (2) barriers to and enablers of self-directed exercise.

METHODS

Fifty-seven adults with type 2 diabetes mellitus (age: 60.4 [8.6] y, 23% women, glycated hemoglobin [HbA1c]: 8.7% [1.9%], PA: 68.1 [142.3] min·wk-1) were allocated to low-volume combined aerobic and resistance high-intensity interval training (78 min·wk-1) or combined moderate intensity continuous training (210 min·wk-1). Participants completed 8 weeks of supervised training, then 10 months of self-directed exercise (12 mo total). Sociodemographic, medical, psychological, and health determinants of total PA at 12 months were identified using correlation and multiple regression analyses. Barriers and enablers were derived from individual participant interviews.

RESULTS

At 12 months, average weighted total PA was 209.4 (174.3) minutes per week. Only allocation to combined aerobic and resistance high-intensity interval training was an independent predictor of total PA at 12 months (β = 0.477, P = .027). Enablers of self-directed exercise included flexible exercise schedule and social support. Barriers were limited access to specialized equipment and competing time demands.

CONCLUSIONS

This study highlights factors to consider when designing long-term exercise support for people with type 2 diabetes mellitus.

Improving nursing care protocols for diabetic patients through a systematic review and meta-analysis of recent years

BACKGROUND

Diabetes mellitus has become one of the major pandemics of the 21st century. In this scenario, nursing interventions are essential for improving self-care and quality of life in patients with type 2 diabetes mellitus. Nursing interventions are crucial for managing the disease and preventing complications.

AIM

To analyse nursing interventions in recent years through a systematic review and meta-analysis and to propose improvements in care plans.

METHODS

This study conducted a systematic review and meta-analysis of the impact of nursing interventions on quantitative glycaemic variables, such as glycated haemoglobin and fasting plasma glucose.

RESULTS

After confirming that the combined effect of all studies from the past 5 years positively impacts quantitative variables, a descriptive analysis of the studies with the most significant changes was conducted. Based on this, an improvement in diabetic patient care protocols has been proposed through follow-up plans tailored to the patient's technological skills.

CONCLUSION

The combined results obtained and the proposal for improvement developed in this manuscript could help to improve the quality of life of many people around the world.

Socio-demographic and clinical determinants of self-care in adults with type 2 diabetes: a multicenter cross-sectional study in Zhejiang province, China

BACKGROUND

Self-care, a process of maintaining health through health-promoting practices and managing illness, is pivotal for the management of type 2 diabetes. This study aimed to explore the self-care level and investigate its socio-demographic and clinical determinants among Chinese adults with type 2 diabetes.

METHODS

In this multicenter cross-sectional study, we enrolled 495 Chinese adults with type 2 diabetes from the outpatient departments of three tertiary hospitals in Zhejiang province, China. The Self-Care of Diabetes Inventory (SCODI) was used to measure self-care maintenance, self-care monitoring, and self-care management as three critical components of the dynamic self-care process. Self-care self-efficacy is a critical factor affecting the self-care process, which was measured by the SCODI. Multiple quantile regression models were employed to identify the determinants of each self-care component and self-care self-efficacy.

RESULTS

Participants had a median age of 62 years, of whom 55.4% were male. The median scores for self-care maintenance, self-care monitoring, and self-care management were 66.67 (50.00-85.42), 47.06 (32.35-58.82), and 53.13 (34.38-68.75), respectively, whereas the median score for self-care self-efficacy was 70.45 (52.27-84.09). Living in the southwest of Zhejiang province and having lower self-care self-efficacy were associated with lower self-care maintenance. Female gender, belonging to minorities, having complications, not attending diabetes self-management education in the last year, living in the southwest of Zhejiang province, and having lower self-care self-efficacy were associated with lower self-care monitoring. Having complications, using insulin, living in the southwest of Zhejiang province, and having lower self-care self-efficacy were associated with a lower level of self-care management. Living in the southwest of Zhejiang province was associated with lower self-care self-efficacy.

CONCLUSIONS/INTERPRETATION

The findings of this study provide invaluable insights into the factors affecting self-care among Chinese adults with type 2 diabetes. By enhancing self-care self-efficacy and participating in diabetes self-management education, healthcare providers can develop tailored self-care interventions to improve diabetes care, particularly for adults with type 2 diabetes who are female, belong to minority groups, have complications, use insulin, or reside in the southwest of Zhejiang province.

Artificial intelligence for diabetes care: current and future prospects

Artificial intelligence (AI) use in diabetes care is increasingly being explored to personalise care for people with diabetes and adapt treatments for complex presentations. However, the rapid advancement of AI also introduces challenges such as potential biases, ethical considerations, and implementation challenges in ensuring that its deployment is equitable. Ensuring inclusive and ethical developments of AI technology can empower both health-care providers and people with diabetes in managing the condition. In this Review, we explore and summarise the current and future prospects of AI across the diabetes care continuum, from enhancing screening and diagnosis to optimising treatment and predicting and managing complications.

Assessment of hepatitis-related knowledge, attitudes, and practices on quality of life with the moderating role of internalized stigma among hepatitis B-positive patients in Pakistan

Aim

This study aimed to assess the Pakistani hepatitis B patients' knowledge, attitudes, and practices towards hepatitis management and the impact of self-management on the quality of life of hepatitis B patients as well as the moderating role of stigmatization.

Methods

A cross-sectional study design was used, and the data was collected from a total of 432 hepatitis B positive patients through a self-designed questionnaire. The studied subjects consisted of men (n = 205, 47%), women (n = 165, 38%), and transgender (n = 62, 14%). The obtained data were statistically analyzed using SPSS software version 26.0 for Windows.

Results

The mean age of the study participants was 48. Knowledge has a significant positive relationship with hepatitis self-management and quality of life, whereas knowledge has a negative relationship with stigmatization. Furthermore, multivariate analysis revealed that men were more knowledgeable about the disease than women and transgender people (6.14 ± 2.08 vs. 3.23 ± 1.61 vs. 1.03 ± 0.73, F = 8.2**, p = .000). On the scale of attitude and practice, significant gender differences were found. Women had more experience with hepatitis self-management than men or transgender (4.21 ± 13.0 vs. 2.17 ± 6.02 vs. 0.37 ± 0.31, F = 6.21**, p = .000). The regression analysis showed that self-management has a positive association with quality of life (B = 0.36, p = .001). The moderation analysis revealed that stigmatization negatively moderates the relationship between self-management and quality of life (B = -0.53, p = .001).

Conclusion

Generally, patients had good knowledge about the disease and its self-management. However, a societal and community-level awareness campaign should be organized on the quality of life and stigmatization of people with chronic illness regarding their human rights, dignity, and physical, mental, and social well-being.

Promoting foot self-care in type 2 diabetes mellitus patients receiving hemodialysis based on the information-motivation-behavioral skills model

This study develops and verifies the use of the foot self-care behavioral model in patients with type 2 diabetes mellitus (T2DM) receiving hemodialysis (HD) based on the information-motivation-behavioral skills model. Data were collected between June and August 2021 from 156 outpatients with type 2 diabetes who were receiving regular HD. A structured questionnaire and electronic medical records were used to collect demographic and disease-related data along with Foot Care Knowledge Questionnaires, third version of Diabetes Attitude Scale, Multidimensional Scale of Perceived Social Support, Foot Care Confidence Scale, and Foot Self-care Behavior Scale. Age, diabetic foot care knowledge, social support, and foot care self-efficacy had a direct effect on foot self-care behavior. Foot care self-efficacy had a mediating effect on foot care knowledge, diabetes-related attitudes, social support, and foot self-care behavior. The information-motivation-behavioral skills model was suitable as a foot self-care behavioral model for patients with T2DM receiving HD. Additionally, these findings suggest that it is crucial to improve foot self-care behavior through increased foot care knowledge, diabetes-related attitudes, and social support, which could contribute to enhancing foot care self-efficacy.

Factors associated with Diabetes Empowerment among patients with type 2 diabetes, at OPD setting, Karachi, Pakistan

Diabetes Empowerment is important for diabetic control as it postpones the onset of complications. This study aimed to investigate the association of medication adherence, self-care behaviors, and diabetes knowledge with Diabetes Empowerment among patients with type II diabetes. A cross-sectional study was conducted on 451 type II diabetes patients attending Endocrinology clinics at OPD setting in Karachi. Data was collected electronically using a structured questionnaire comprising of tools to measure Diabetes Empowerment, medication adherence, self-care behaviors, diabetes knowledge, and socioeconomic scale. It also included health-related information from patients' medical record. As outcome variable was continuous, so multiple linear regression analysis was used to assess the independent effect of Diabetes Empowerment on medication adherence, self-care behaviors and diabetes knowledge with other co-variates. The mean Diabetes Empowerment score was 3.62 (SD = 0.31). The mean age of the participants was 56.68 (SD = 11.76). 53.88% were females, 80.71% were married, 77.56% were obese, and 66.30% were upper-middle class with average diabetes duration of 11.7 years (SD = 7.89). HbA1c values were ≥ 7 in 63.41% of study participants. Diabetes Empowerment was significantly associated with medication adherence (P = 0.001), general diet (P < 0.001), special diet (P = 0.011), smoking status (P = 0.001), and socioeconomic status (upper lower, P = 0.085). A comprehensive strategy for the treatment of type II diabetes is essential to enhance clinical results, improve patient quality of life, and prevent diabetes-related comorbidities. People with type II diabetes should be encouraged to embrace an empowerment-based approach by healthcare providers. It is critical to do research that promotes empowerment.

Factors associated with poor glycemic control among adult patients with type 2 diabetes mellitus in Gamo and Gofa zone public hospitals, Southern Ethiopia: A case-control study

BACKGROUND

Diabetes mellitus is a serious global public health problem that affects the whole life of people in terms of their biological, psychological, and social effects. Complications and death from diabetes occur from poorly controlled blood glucose levels. Thus, dealing with glycemic control is essential for controlling the development of devastating acute and chronic complications related to diabetes. Therefore, this study aims to assess factors associated with poor glycemic control among type2 diabetes patients in public hospitals of Gamo and Gofa zone southern, Ethiopia, 2021.

METHODS

An institution-based unmatched case-control study was employed among 312 randomly selected participants using a pre-tested, interviewer-administered, and structured questionnaire. Bivariate and multivariable logistic regression analysis was conducted to identify factors associated with poor glycemic control using IBM SPSS version 25. The strength of association was assessed by using an Adjusted odds ratio (AOR) with a 95% confidence interval (CI).

RESULT

Factors associated with poor glycemic control based on multivariable analysis were, having comorbidity (AOR = 2.35, 95% CI (1.39-3.95)), adhering to dietary recommendations (AOR = 0.31, 95% CI (089-0.51)), poor social support (AOR = 3.31, 95% CI (1.59-6.85)), physical exercise (AOR = 1.86 95% CI (1.11-3.12)), and having poly-pharmacy (AOR = 2.83, 95% CI (1.39-5.74)).

CONCLUSION AND RECOMMENDATION

This study indicated a significant association of comorbidity, physical exercise, poly-pharmacy, low social support, and adherence to dietary recommendations with poor glycemic control. We suggest that the health care providers and concerned bodies encourage patients to have regular check-ups and work on providing necessary social support.

Reducing health inequalities among most disadvantaged type 2 diabetes patients: A cross-sectional exploratory pilot study

BACKGROUND

Demographic changes and the increased chronical diseases burden are global challenges that cannot go unnoticed by healthcare systems, which must be organized without losing sight of the increasing influence of social determinants.

AIM

To evaluate the results of a primary care program implemented to reduce health inequalities associated with social determinants in patients with type 2 diabetes.

METHOD

An exploratory pilot retrospective cross-sectional study that includes secondary data of 404 nonrandomized patients belonging to socially depressed areas and conventional areas. Descriptive, bivariate, and multivariate analyses were performed.

RESULTS

The age of the subjects included in the study was 66.80 ± 9.7 years with a proportion of 56.7% men. Proportions of patients from socially depressed areas and adherence to the Nursing Follow-up Program were around 33% and 60%, respectively. The obesity rate was 51%, percentage of patients with HbA1c<7% was 59%. No significant differences were found between patients belonging to socially depressed areas and those who do not, except for greater adherence to nursing follow-up programs. Multivariate models assessed chronical complications as health outcomes (cardiovascular diseases, retinopathy, and nephropathy) as health outcomes showing the influence of previously described risk factors. However, in none of the models did belonging to a socially depressed area or adherence to the Nursing Follow-up Program were predictors.

CONCLUSIONS

The program has proven to be efficient in equating the health outcomes related with cardiovascular risk of patients from both types of areas. Well-directed health policies could bring primary care systems closer to sustainable development goals through the reduction of health disparities that affect socially vulnerable groups.

CLINICAL RELEVANCE

To introduce a risk strategy and to adopt a family approach, contemplating the sociocultural and educational differences that diversely affect men and women in their health status has proven to be useful in reducing health disparities due to social determinants in patients with type 2 diabetes.

Glycaemic control and its associated factors in patients with type 2 diabetes in the Middle East and North Africa: An updated systematic review and meta-analysis

Aims

To examine the patient‐related factors that have been linked to glycaemic control in people living with type 2 diabetes mellitus in Middle Eastern countries.

Design

A systematic review and meta‐analysis.

Data Sources

A computerized search was conducted using the databases MEDLINE (via PubMed and Ovid), EMBASE, Scopus and CINAHL to identify peer‐reviewed articles published in English between 1 January 2010 and 21 May 2020. On 28 June 2021, the search was updated with the same keywords and databases; however, no further relevant studies were identified.

Review Methods

Extracted data were analysed using Review Manager 5.4.

Results

The final sample consisted of 54 articles with a total of 41,079 participants. Pooled data showed an increased risk of inadequate glycaemic control in smokers [OR = 1.26, 95% confidence interval (CI): 1.05, 1.52; p = .010], obese patients (OR = 1.30, 95% CI: 1.10, 1.54; p = .002), patients with elevated waist to hip ratio (OR = 1.62, 95% CI: 1.16, 2.26; p = .004) and longer disease duration (OR = 2.01, 95% CI: 1.64, 2.48; p < .001). A lower risk of inadequate control was associated with physical activity (OR = 0.40, 95% CI: 0.24, 0.67; p < .001) and self‐management (OR = 0.49, 95% CI: 0.29, 0.82; p = .006).

Conclusion

These findings highlight the opportunity to address factors to improve glycaemic control. Further longitudinal studies are required to better understand these variations, to assess all predictors of glycaemic control in participants with type 2 diabetes, and to provide a strong basis for future measures to optimize glycaemic control.

Online social support and collective empowerment: Serial mediation effect on self-efficacy among mothers of children with type 1 diabetes

AIM

To identify a serial multiple mediation effect of social support in online health communities and collective empowerment on the relationship between diabetes-related burden (DRB) and self-efficacy, among mothers using a continuous glucose monitoring device for children with type 1 diabetes (T1D).

DESIGN

A secondary analysis, cross-sectional, descriptive study.

METHODS

Data were obtained from 198 mothers of children with T1D via a web survey, from August to September 2020. Measures used were the Collective Empowerment in the Online Health Community Scale, a modified version of the Multidimensional Scale of Perceived Social Support, Problem Areas in Diabetes Survey-Parent Revised version and a modified version of the Maternal Self-efficacy for Diabetes Management Scale. Data were analysed using SPSS 25.0, and PROCESS MACRO for SPSS v3.5.

RESULTS

A serial multiple mediation model was used. The indirect effects of both social support in online health communities and collective empowerment were identified in the relationship between DRB and diabetes self-efficacy (DSE). However, there was no indirect effect of social support in online health communities on these relationships.

CONCLUSION

These findings suggest that online social support alone has a limited role in chronic disease management self-efficacy. Collective empowerment should be a strategic component in intervention development using online health communities to strengthen DSE in mothers of children with T1D.

IMPACT

This study provides novel insights into the functional mechanism of online health communities for T1D. Peer mentor coaching by parents of children with T1D effectively helps other children's parents with its recent diagnosis. The findings recognize a need for strategies enhancing collective empowerment among parents of children with T1D. Along with peer coaching, these strategies should strengthen knowledge of resources and methods to impact social change as well as resource mobilization for collective actions.

Determining the Predictors of Self-Management Behaviors in Patients With Type 2 Diabetes: An Application of Socio-Ecological Approach

Background

Type 2 diabetes complications are responsible for 2% of hospital emergency visits. Self-management practices are one of the most essential approaches to control type 2 diabetes. The goal of this study was to use an ecological approach to investigate the predictors of self-management behaviors in diabetes patients referred to the emergency department in Ardabil in 2020.

Methods

In this cross-sectional study, 273 individuals with type 2 diabetes who were sent to the emergency department of Imam Khomeini Educational and Medical Center in Ardabil were included using the available sample method. Demographic information questionnaires, including the Diabetes Distress Screening Tool (DDS2), General Diabetes Knowledge (DKT2), Diabetes Empowerment Questionnaire (DES-SF), Patient Health Questionnaire 9 (PHQ 9), Beliefs to Treatment Effectiveness Scale (BTES), Diabetes Self-Efficacy Scale (DSES), Chronic Illness Resources Survey (CIRS), Situational Effects Questionnaire, and Diabetes self-management support (DSMS), were all used to collect data. The independent t-test, one-way ANOVA, Pearson correlation coefficient, and multiple regression were used to analyze the data.

Results

The results of the study showed that in the framework of ecological approach, predictors of self-management behaviors at the four levels are as follows: at the individual level—gender (p = 0.025), education (p = 0.002), duration of diabetes (p = 0.38), having a glucometer at home (p &lt; 0.001), diabetes empowerment (p &lt; 0.001), personal support (p = 0.002), and self-efficacy (p = 0.047); at the interpersonal level—the main health support (p &lt; 0.001), membership in social networks (p &lt; 0.005), family/friends support (p &lt; 0.001), and neighborhoods support (p &lt; 0.001); at the group and organizational level—organizational support (p = 0.013); at the community and policy level—the impact of mass media in health (p &lt; 0.001) and situational influence (p &lt; 0.001).

Conclusion

The impact of non-individual levels, such as the environment, on a person's decision to manage diabetes is crucial. Diabetes management necessitates a significant amount of effort, which involves maintaining the health of diabetes patients and the community while also minimizing emergency department workload.

Relationships between social capital, patient empowerment, and self-management of patients undergoing hemodialysis: a cross-sectional study

Background

Hemodialysis is the most common treatment of end-stage renal disease. However, it is associated with a range of symptoms affecting patients’ daily activities and quality of life. Effective self-management has proven crucial for the alleviation of symptoms. According to Social Cognitive Theory, social capital and patient empowerment may be important variables for predicting self-management. To date, few studies have explored the mechanisms underlying these results. The study aimed to verify whether patient empowerment mediated the effect of social capital on the self-management of hemodialysis patients.

Methods

The study was performed with 245 hemodialysis patients from January 2021 to April 2021 in Taiyuan, China. Demographic and clinical characteristics, social capital, patient empowerment, and self-management of patients undergoing hemodialysis were measured with a self-reported questionnaire. Descriptive statistics were used to summarize the participants’ demographic and clinical characteristics, and bootstrapping tests were used to verify whether patient empowerment mediated the association of social capital with self-management in patients undergoing hemodialysis.

Results

Mediation analysis indicated that social capital and patient empowerment significantly predicted self-management. Patient empowerment partially mediated the relationship between social capital and self-management in hemodialysis patients.

Conclusions

The results suggest that hemodialysis patients show relatively poor self-management and that patient empowerment mediates both social capital and self-management. Strategies to mobilize patients’ social networks and help them identify and utilize effective social resources may provide useful information regarding the implementation of optimal health management for their disease.

The Impact of the Otago Exercise Program on Frailty and Empowerment in Older Nursing Home Residents: A Randomized Controlled Trial

Background

This study assessed the impact of Otago exercises on frailty and empowerment in older nursing home residents.

Methods

This randomized controlled trial included 72 individuals aged over 65 years residing in a single nursing home in Izmir, Turkey. The participants were randomly assigned to the Otago exercise group (OEG) or control group (CG). The OEG performed Otago exercises for 45 minutes, 3 days per week for 12 weeks plus a walking program the 3 other days of the week. In addition to Otago exercise training, the OEG received training based on empowerment consisting of 10 sessions lasting 30 minutes each. The CG received no intervention except routine care in the nursing home. The data collected were sociodemographic characteristics, Edmonton Frail Scale (EFS) scores, and Elderly Empowerment Scale (EES) scores before and 3 months after the intervention.

Results

We observed significant differences between the mean EFS (p=0.0001) and mean EES (p=0.0001) before and 3 months after the intervention in the OEG compared to the CG. We also observed a significant difference between the OEG and CG in mean EFS (p=0.018) and EES (p=0.0001) 3 months after the intervention.

Conclusion

The results of the present study demonstrated the positive impact of the Otago exercise program on preventing/delaying frailty and enhancing empowerment in older people.

Defining an enabling environment for those with chronic disease: an integrative review

BACKGROUND

Health policies are currently being implemented to cope with the 37% of those affected by chronic disease and 63% of deaths worldwide. Among the proposals, there is accelerating support for greater autonomy for patients, which incorporates several concepts, including empowerment. To achieve this, develop an environment to increase an individual's capacity for action seems to be a fundamental step. The aim of this study is to characterize an enabling environment for patients in the context of chronic disease management.

METHODS

An integrative review design was applied. Medline, CINAHL, and Web of Science databases were searched to identify relevant literature published between 2009 and 2019. Overall, the review process was guided by the PRISMA 2020 checklist. The Mixed Methods Appraisal Tool for quality evaluation was used.

RESULTS

A total of 40 articles were analyzed, divided into 18 quantitative studies, 11 qualitative studies, two mixed studies, seven expert opinions, one theory and one conference report. The following characteristics defining an enabling environment were taken from the literature relating to those with a chronic condition: Needs assessment-adaptation of responses, supporting "take care", involvement in support, knowledge improvement, engagement with professionals, use of information and communication technologies, and organization of care. Beyond that, the interactions highlighted between these seven categories characterize an enabling environment.

CONCLUSION

This review specifies the essential elements of an enabling environment for patients with chronic conditions. It encompasses the partnership between the healthcare professional, such as the advanced practice nurse, and the individual for whom interventions and care strategies must be devised.

Here for You: A Review of Social Support Research in Young Adults With Diabetes

Living with and managing diabetes is challenging during young adulthood, and social support may help relieve or minimize the burdens young adults with diabetes experience. This article reviews the types and sources of support young adults with diabetes receive and their associations with behavioral, psychosocial, and glycemic outcomes. Intervention research integrating social support and future directions for care are discussed.

Effect of Family Empowerment on Self Care of Patients with Type-2 Diabetes Mellitus: A Systematic Review

Introduction: Diabetes Mellitus Type 2 (T2DM) is a chronic disease that will be suffered for life, so it is necessary to provide education to patients and families so that it is easy to understand the course of the disease, prevention and obstacles in the management of T2DM. Family empowerment can be started by optimizing family functions to help patients with T2DM to adapt and comply with self-care actions through four dimensions, empathic (emotional), encouragement (reward), facilitative (instrumental), and participatory (participation). This systematic review aims to identify and evaluate the effect of family empowerment interventions on self-care for T2DM patients. Methods: The database used for article searches consisted of EBSCO, PubMed and ProQuest using relevant keywords based on the topic and title of the study. The selection of articles used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) diagram method, the overall results were 2,635 articles and 8 articles that fit the inclusion criteria and were analyzed descriptively narrative and had met the methodological quality study according to JBI guidelines (Joanna Briggs Critical Appraising Methodology). Results: 8 articles with the Family Empowerment Process Model intervention program and the Diabetes Mellitus Education Program which is a family-oriented program that includes education classes, group discussions, home visits, and telephone follow-up. Education is provided to families through direct discussion and through telephone calls with a duration of each call of approximately 15 to 20 minutes scheduled for 9 am to 12 noon. Follow-up was done by telephone in the intervention group for approximately 3 months to 12 months. Conclusion: The findings of this systematic review indicate that family empowerment interventions based on health education can have a good effect on improving self-care for patients with type 2 diabetes mellitus

Health literacy and diabetes self-care in individuals with type 2 diabetes in Turkey

AIM

The aim of this study was to examine the relationship between health literacy and diabetes self-care in individuals with type 2 diabetes.

METHODS

This cross-sectional study was conducted with 207 individuals with Type 2 diabetes at a diabetes outpatient clinic of a foundation university hospital in Istanbul, Turkey. The data were collected using a sociodemographic and illness characteristics questionnaire, the Turkish version of the European Health Literacy Survey Questionnaire (HLS-EU-Q-TR), and the Diabetes Self-Care Scale (DSCS). Data were analyzed using descriptive statistics, one-way ANOVA, Student's t-test, Pearson correlation test, and multiple regression analysis.

RESULTS

It was found that 81.5% of individuals with type 2 diabetes were at an inadequate or limited and problematic level of health literacy. The DSCS mean scores of patients with an inadequate health literacy level were significantly lower than that of patients at other levels of health literacy. It was determined that education level, exercise status, and HLS-EU-Q-TR scores were significantly related to diabetes self-care (R² = 0.245, p < 0.001).

CONCLUSION

The study found that individuals with type 2 diabetes had higher diabetes self-care if they had a high education level, regularly exercised, or had high HLS-EU-Q-TR mean scores.

Coconstruction d’une intervention infirmière centrée sur la personne pour soutenir l’autogestion des individus vivant avec le diabète de type 2

Introduction&#160;: People living with type 2 diabetes are brought to make demanding behavioral changes that can lead to self-management difficulties.Background&#160;: The guidelines recommend that healthcare professionals follow a person-centered approach (PCA) when caring. However, this approach seems difficult to adopt in practice.Objective&#160;: Coconstruct an intervention inspired by the concept map (CM) to promote the adoption of PCA by nurses during self-management support encounters.Method&#160;: This study is based on a model for developing evidence-based nursing interventions. Five experts (2 patients, 2 nurses, 1 educational specialist) collaborated in the coconstruction of the intervention.Results&#160;: The Person-Centered Approach Diabetes Self-Management Support (PCA-DSMS) intervention has been developed in accordance with the foundations of a PCA and the CM. It includes four steps&#160;: 1) Introduce the intervention&#160;; 2) Develop the Needs Map&#160;; 3) Intervene according to priority needs&#160;; 4) Conclude and plan a follow-up.Discussion&#160;: More studies are needed to explore whether the intervention is acceptable and feasible as well as its ability to lead nurses to adopt PCA.Conclusion&#160;: The PCA-DSMS could bring nurses to adopt a PCA.

Identifying the Predictors of Self-Management Behaviors in Patients with Diabetes Based on Ecological Approach: A Systematic Review

BACKGROUND

Recognizing and promoting the factors that affect the self-management behaviors of diabetes lead to a reduction in the number of patients and an improvement in the quality of care. The ecological approach focuses on the nature of people's interactions with their physical and socio-cultural environments.

OBJECTIVE

The purpose of this study was to identify the predictors of self-management behaviors with a comprehensive approach in these patients.

METHODS

The keywords were investigated in the relevant national and international databases, including PubMed, Google Scholar, Science Direct, Scopus, and Scientific Information Database, Magiran, and Iran Medex, to obtain the articles published from 2009 to 2019. The search and article selection strategy was developed based on the Prisma checklist and was carried out in three steps.

RESULTS

Most studies have shown that personal factors had the highest prediction power for the self-management of diabetes. The interpersonal factors, society and policy-making factors, and group and organization factors were then the most frequently reported predictors of self-management behaviors in diabetic patients.

CONCLUSION

Self-management of diabetes is necessary for controlling it because 95% of care is done by the patient. When designing self-management interventions, factors are based on the individual level that is to increase self-management behaviors.

From the crisis in acute care to postdischarge resilience - The communication experience of Geriatric patients: A qualitative study

BACKGROUND

Hospital readmissions due to illness among geriatric patients result in human suffering and psychological trauma. Resilience in chronic illness protects geriatric patients from outcomes of trauma leads to psychological and physical well-being and enables bouncing back to life. While communication has been linked to improved health outcomes, little is known about communication pathways in the context of postdischarge resilience.

AIM AND OBJECTIVE

To explore the role of communication pathways that acute-care clinicians used with geriatric patients in postdischarge resilience.

METHODOLOGICAL DESIGN AND JUSTIFICATION

Participants were ten geriatric patients who were readmitted several times in the past year. Twenty narrative interviews were conducted, one upon discharge and the other a month thereafter. Data for each phase of interviews were analysed using methods of selection mechanisms and Bricolage.

ETHICAL ISSUES

The ethics committee approved the study. Participants signed an informed-consent form for participation and publication.

FINDINGS

Communication in acute care that enhanced health literacy, perceived control and reflection, contributed to higher comprehensibility and manageability during the hospitalisation and postdischarge meaningfulness postdischarge, contributing resilience. Participants who experienced other forms of communication demonstrated anxiety and helplessness with lingering psychological trauma postdischarge.

CONCLUSIONS

Acute care may provide clinicians with opportunities to alleviate the suffering of geriatric patients and contribute to their postdischarge resilience. The suggested T.E.R model delineates communication pathways to fuel the trajectory from psychological trauma to postdischarge resilience in practice.

Factors associated with subsequent diabetes-related self-care activities: The role of social support and optimism

Aim

This study aimed to explore how social support (external factor), optimism (internal factor) and their interaction associated with diabetes-related self-care activities (DRSCA) over 3 months among people with type 2 diabetes mellitus (T2DM).

Design

Both questionnaire-based and telephone-based survey were used. The data were collected face to face, the first time by questionnaire and the second time by telephone.

Methods

One hundred and fifty-five patients completed valid survey questionnaires (response rate was about 70% in the first and 62% in the second round). The association of social support and optimism with subsequent DRSCA was examined after adjusting for demographics and disease information.

Results

Based on results, optimism was significantly associated with subsequent DRSCA. In the dimensions of social support, objective social support and support use were significantly associated with subsequent DRSCA. The results showed that the mediation of optimism between the dimensions of social support and DRSCA was not significant after controlling for covariates. The results also indicated that social support and optimism played directly an important role in improving diabetes-related self-care activities.

Exploring patient empowerment

Purpose

The purpose of this paper is to develop a research framework for exploring and improving patient empowerment through the analysis of the effects produced by a satisfying physician relationship on patient involvement in the healthcare process.

Design/methodology/approach

The authors begin with a literature review of patient empowerment in healthcare, useful to highlight the importance of relational aspects. Then, the authors tested the hypotheses of the research through the analysis of 450 questionnaires. The results are analyzed through covariance-based structural equation modeling.

Findings

This paper highlights how empowerment is a more complex phenomenon, needing many dimensions to be investigated. The hypotheses were tested, and correlations computed, highlighting a medium-strong positive correlation between physician relationship and patient involvement determining satisfying patient empowerment.

Research limitations/implications

The considerations conducted in the paper are restricted to physician relationship and needs further research aimed to analyze and evaluate the changes in the patient behaviors influenced by empowerment.

Practical implications

The research points offer new insight into patient empowerment and allow the healthcare provider to create new opportunities for promoting patient empowerment through the development of quality relationship for effective patient involvement.

Originality/value

The study developed contributes new insight about patient empowerment in the healthcare management literature, proving the key role of satisfying physician relationship useful for future researches.

Factors for self-management activities among rural patients with chronic hepatitis B: A cross-sectional study

AIMS AND OBJECTIVES

To assess the self-management activities among rural patients with chronic hepatitis B (CHB), and the influence of psychosocial and demographic factors on their self-management activities.

BACKGROUND

Chronic hepatitis B is a serious public health concern. Rural patients may have limited access to healthcare services. Although self-management is important for controlling chronic hepatitis B, few studies focus on the self-management activities among rural patients with chronic hepatitis B. Understanding self-management activities and related factors in this population are important to design and implement appropriate intervention strategies.

DESIGN

A cross-sectional study.

METHODS

From June-December 2017, totally 236 rural patients with chronic hepatitis B were recruited from hepatology department in two hospitals in Chongqing, China. The questionnaire included demographic characteristics, Chronic Hepatitis B Self-Management Scale, Self-Efficacy for Managing Chronic Disease, and Social Support Rating Scale. The study followed the STROBE checklist.

RESULTS

Rural patients with chronic hepatitis B reported poor self-management activities for the score indexes of symptom management (57.36%), lifestyle management (54.89%), psychosocial coping (54.84%) and disease information management (53.11%) were all below 60%. Self-efficacy, objective support, subjective support, gender, education level and marital status showed significant effect on self-management activities.

CONCLUSION

Rural patients with chronic hepatitis B were found to perform insufficient self-management activities. Self-efficacy, social support, gender, education level and marital status were identified to influence their self-management activities.

RELEVANCE TO CLINICAL PRACTICE

Self-management activities should be promoted among rural patients with chronic hepatitis B. The factors that were identified in this study should be addressed when developing interventions to promote the performance of self-management activities for rural patients with chronic hepatitis B.

Self-management behaviors in adults with chronic hepatitis B: A structural equation model

BACKGROUND

Chronic hepatitis B is a serious and chronic health problem, requiring self-management to control the disease and related complications.

OBJECTIVES

To develop a structural model to identify how social support, self-efficacy and disease knowledge contribute to their self-management behaviors in adults with chronic hepatitis B.

DESIGN

A cross-sectional study.

SETTINGS

Hepatology units in two hospitals in Chongqing, China.

PARTICIPANTS

A total of 306 patients with chronic hepatitis B were recruited.

METHODS

Data were collected using Social Support Rating Scale, Self-Efficacy for Managing Chronic Disease, Hepatitis B Knowledge Questionnaire and Chronic Hepatitis B Self-Management Scale. Structural equation model was applied to analyze the data.

RESULTS

The final model showed good model fit. Social support directly influenced self-management behaviors (β = 0.19, p < 0.01), and indirectly influenced self-management behaviors (β = 0.20, p < 0.01) through self-efficacy. Self-efficacy directly influenced self-management behaviors (β = 0.37, p < 0.05). Disease knowledge indirectly influenced self-management behaviors (β = 0.12, p < 0.05) through self-efficacy.

CONCLUSIONS

Our findings indicated that social support, self-efficacy and disease knowledge directly or indirectly affected self-management behaviors in adults with chronic hepatitis B. This provides a theoretical basis for developing self-management interventions for patients with chronic hepatitis B, which may lead to health improvements in this population.

Modeling patient empowerment and health literacy to glycemic control in insulin-treated patients: A prospective study

OBJECTIVE

To model the pathways of patient empowerment (PE) and health literacy (HL) to glycemic control specific to insulin-treated patients by prospective design.

METHODS

Insulin-treated patients with type 2 diabetes (T2DM) (N = 185) were recruited by convenience sampling. Data of personal characteristics, PE, and HL were collected by questionnaires at baseline and 9 months later. The 9-month glycosylated hemoglobin (HbA1c) levels of each participant were collected from medical records. Structural equation modeling was used to test a hypothesized model.

RESULTS

Baseline and 9-month communicative HL and critical HL significantly and negatively correlated with 9-month HbA1c levels. Structural equation modeling supported that baseline and 9-month PE significantly affected HL at corresponding time points. Baseline PE indirectly affected 9-month HL through 9-month PE. The 9-month HL directly affected 9-month HbA1c. Baseline HL indirectly affected 9-month HbA1c through 9-month HL.

CONCLUSION

Communicative HL and critical HL rather than functional HL were crucial in improving glycemic control. PE is essential to improve HL in insulin-treated patients.

PRACTICE IMPLICATIONS

Healthcare providers could apply the empowerment approach to educate insulin-treated patients. Through reciprocal dynamic process of PE, insulin-treated patients with T2DM might improve their communicative and critical HL; and finally, glycemic control could be improved.

Predictors of Empowerment in Individuals With Type 2 Diabetes Mellitus

Introduction: Type 2 diabetes is a chronic, progressive disease that has reached pandemic proportions. In Turkey, the frequency of diabetes in individuals aged 20 years or older has been reported to be 13.7% compared with the worldwide prevalence of 8.5%. Empowerment has been correlated with improvement in diabetic self-management capabilities and glycemic control. The purpose of this study was to examine predictors of “empowerment” in individuals with type 2 diabetes from Turkey. Method: This was a secondary analysis with a cross-sectional correlation design using stepwise linear regression to evaluate previously collected data from 220 type 2 diabetic individuals in Turkey from January through July 2014. Demographic and Disease-Related Information Form, Diabetes Empowerment Scale, and Multidimensional Scale of Perceived Social Support were used to collect the research data. Results: Being educated about diabetes (β = .22, p < .001), high school (β = .16, p = .007), university (β = .12, p = .046), age (β = −.18, p = .003), social support (β = .15, p = .027), employment status (β = .13, p = .045), and A1C (β = −.12, p = .046) were statistically significant predictors of empowerment of type 2 diabetic individuals, and these variables explained 30% of the common variance. Discussion: It is important for nurses to assess sources of social support and integrate the results of this assessment to ensure the empowerment of the patient during diabetes education. For the empowerment of diabetic individuals, attempts should be made to increase the diabetes literacy levels of diabetic individuals who have low level of education and who are in the older age group, and patients who can get employed could be directed to work life.