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Tolentino DA, Boy P, Long SN, Roca RPE, Peña M, Palao GMG, Palao GJG, Luzuriaga MRUDO, Choi SE. Navigating Type 2 Diabetes Care: Asian American Perspectives on Self-Management Education and Support. Sci Diabetes Self Manag Care 2025:26350106251337487. [PMID: 40370043 DOI: 10.1177/26350106251337487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2025]
Abstract
PurposeThe purpose of this study was to explore the determinants of diabetes self-management education and support (DSMES) program engagement among Asian Americans with type 2 diabetes living in California.MethodsA qualitative descriptive study was conducted to explore DSMES experiences. Semistructured interviews with Filipino, Korean South Asian, Cambodian, Taiwanese, and Vietnamese Americans were conducted. Participants were recruited through outreach, referrals, and social media. All 12 interviews were audio-recorded and transcribed verbatim. The data analysis used a rigorous, iterative approach, beginning with open coding to generate initial codes, developing a codebook, and proceeding to a second coding level and thematic analysis to interpret key patterns.ResultsAnalysis revealed 4 major themes and 10 subthemes organized using the ecological model. The major themes are (1) individual-level barriers and facilitators (microsystem), (2) cultural and social influences (mesosystem), (3) structural barriers (exosystem), and (4) optimizing DSMES for inclusive diabetes care (macrosystem).ConclusionStudy findings highlight the need for culturally responsive DSMES programs, emphasizing family-centered approaches and prioritization of cultural beliefs. Improving DSMES engagement among Asian Americans requires multilevel interventions addressing systemic and individual barriers, highlighting the complex interplay of cultural, social, and structural factors in diabetes management.
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Affiliation(s)
| | - Paul Boy
- School of Nursing, University of California, Los Angeles, California
| | - Sorina Neang Long
- School of Nursing, University of California, Los Angeles, California
| | | | - Matthew Peña
- School of Nursing, University of California, Los Angeles, California
| | | | | | | | - Sarah E Choi
- School of Nursing, University of California, Los Angeles, California
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Deverts DJ, Zupa MF, Kieffer EC, Gonzalez S, Guajardo C, Valbuena F, Piatt GA, Yabes JG, Lalama C, Heisler M, Rosland AM. Patient and family engagement in culturally-tailored diabetes self-management education in a Hispanic community. PATIENT EDUCATION AND COUNSELING 2025; 134:108669. [PMID: 39854891 PMCID: PMC11913575 DOI: 10.1016/j.pec.2025.108669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Revised: 12/13/2024] [Accepted: 01/16/2025] [Indexed: 01/27/2025]
Abstract
OBJECTIVES Diabetes self-management education (DSME) is effective in improving outcomes among adults with diabetes (AWD); but engagement in DSME has been lower among Hispanic AWD. We examined factors predicting engagement of Hispanic AWD in culturally tailored DSME that included a family/friend 'support person'. METHODS 222 predominantly Hispanic AWD enrolled in DSME with a support person (SP), half of the AWD-SP pairs participated in pair-focused ('FAM-ACT') DSME and the others in patient-focused DSME. Enrollment survey and health record-based participant characteristics were compared to program attendance data. RESULTS On average, AWD completed 3.8 of 6 and SPs 2.6 of 6 sessions. Engaged AWD (attended ≥4/6 DSME sessions) were more likely to live apart from their SP, have HbA1c ≥ 9 % (11.8 mmol/L), and currently prioritize diabetes among other competing demands. Engaged AWD in FAM-ACT were more likely to have SPs who also met engagement criteria (attended ≥3 DSME sessions), and SPs with pre-diabetes and high 'patient activation'. CONCLUSIONS Hispanic AWD who co-attended with family supporters, had higher glycemic levels, and ability to prioritize diabetes management were more engaged in culturally-tailored DSME. PRACTICE IMPLICATIONS Engaging family supporters and focusing on those with current health and personal motivation may increase Hispanic adult engagement in DSME.
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Affiliation(s)
- Denise J Deverts
- Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Caring for Complex Chronic Conditions Research Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Margaret F Zupa
- Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Caring for Complex Chronic Conditions Research Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Stephanie Gonzalez
- Community Health and Social Services (CHASS) Center, Inc., Detroit, MI, USA
| | - Claudia Guajardo
- Community Health and Social Services (CHASS) Center, Inc., Detroit, MI, USA
| | - Felix Valbuena
- Community Health and Social Services (CHASS) Center, Inc., Detroit, MI, USA
| | | | - Jonathan G Yabes
- Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Christina Lalama
- Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Ann-Marie Rosland
- Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Caring for Complex Chronic Conditions Research Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; VA Center for Health Equity Research and Promotion, VA Pittsburgh Health Care System, Pittsburgh, PA, USA.
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Abu S, Llahana S. Factors influencing the uptake of culturally tailored diabetes self-management education and support programmes among ethnic minority patients with type 2 diabetes: A systematic review. Prim Care Diabetes 2025; 19:103-110. [PMID: 39894748 DOI: 10.1016/j.pcd.2025.01.010] [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: 10/25/2024] [Revised: 01/26/2025] [Accepted: 01/28/2025] [Indexed: 02/04/2025]
Abstract
PURPOSE This systematic review aimed to evaluate the factors influencing the uptake of culturally-tailored Diabetes Self-Management Education and Support (DSMES) programmes among ethnic minority patients diagnosed with type 2 diabetes mellitus (T2DM). METHODS A systematic review, following PRISMA guidelines, was conducted, including quantitative research studies published in peer-reviewed journals from January 2013 to January 2023. Studies were extracted via the following databases, AMED, MEDLINE, CINAHL, EMBASE, EMCARE, PSYCHINFO, Ovid Nursing, and grey literature. Studies were selected based on eligibility criteria including the evaluation of DSMES programmes tailored for ethnic minorities and involving adult participants with T2DM. The factors affecting the uptake of these programs were mapped against the three categories of the Andersen's Behavioural Model of Health Services Use: predisposing, enabling, and need factors. The quality of the included studies was assessed using the Critical Appraisal Skills Program (CASP) checklist, and a narrative synthesis was conducted to analyse the findings. RESULTS Nine studies met the inclusion criteria, demonstrating that culturally-tailored DSMES programmes significantly improve uptake among ethnic minorities. Key factors influencing participation included demographic characteristics, diabetes knowledge, emotional support, and cultural beliefs. Barriers such as language proficiency, cost, and diabetes fatalism were identified, while enablers included the use of local champions and culturally specific strategies. CONCLUSIONS This systematic review highlights the effectiveness of culturally-tailored DSMES programmes in improving health outcomes among ethnic minority groups. It suggests that more research is needed to explore these barriers and develop strategies to enhance the uptake of DSMES programmes among underserved populations.
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Affiliation(s)
- Sariata Abu
- Tulasi Medical Centre, 10 Bennett's Castle Ln, Dagenham RM8 3XU, United Kingdom.
| | - Sofia Llahana
- School of Health & Medical Sciences, City St George's, University of London, London, United Kingdom.
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Zupa M, Hamm M, Alexander L, Rosland AM. Patient and Clinician Perspectives on the Effectiveness of Current Telemedicine Approaches in Endocrinology Care for Type 2 Diabetes: Qualitative Study. JMIR Diabetes 2025; 10:e60765. [PMID: 40068145 PMCID: PMC11937712 DOI: 10.2196/60765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 11/15/2024] [Accepted: 01/22/2025] [Indexed: 03/29/2025] Open
Abstract
BACKGROUND Since the rapid widespread uptake in 2020, the use of telemedicine to deliver diabetes specialty care has persisted. However, evidence evaluating patient and clinician perspectives on benefits, shortcomings, and approaches to improve telemedicine care for type 2 diabetes is limited. OBJECTIVE This study aims to assess clinician and patient perspectives on specific benefits and limitations of current telemedicine care delivery for type 2 diabetes and views on approaches to enhance telemedicine effectiveness for patients who rely on it. METHODS We conducted semistructured qualitative interviews with diabetes specialty clinicians and adults with type 2 diabetes. We used a qualitative description approach to characterize participant perspectives on care delivery for type 2 diabetes via telemedicine. RESULTS Both clinicians (n=15) and patients (n=13) identify significant benefits of telemedicine in overcoming both physical (geographic and transportation) and scheduling (work commitments and wait times) barriers to specialty care for type 2 diabetes. In addition, telemedicine may enhance communication around diabetes care by improving information sharing between patients and clinicians. However, clinicians identify limited availability of home blood glucose data and vital signs as factors, which impair the optimal management of type 2 diabetes and related comorbid conditions via telemedicine. Previsit preparation, involvement of multidisciplinary providers, and frequent brief check-ins were identified by patients and clinicians as potential strategies to improve the quality of telemedicine care for adults with type 2 diabetes. CONCLUSIONS Patients and clinicians identify key strengths of telemedicine in enhancing access to diabetes specialty care for adults with type 2 diabetes and describe approaches to ensure that telemedicine delivers high-quality diabetes care to patients who rely on it.
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Affiliation(s)
- Margaret Zupa
- Division of Endocrinology and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
- Caring for Complex Chronic Conditions Research Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Megan Hamm
- Qualitative, Evaluation and Stakeholder Engagement Services, Center for Research on Health Care Data Center, University of Pittsburgh, Pittsburgh, PA, United States
| | - Lane Alexander
- Qualitative, Evaluation and Stakeholder Engagement Services, Center for Research on Health Care Data Center, University of Pittsburgh, Pittsburgh, PA, United States
| | - Ann-Marie Rosland
- Caring for Complex Chronic Conditions Research Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Health System, Pittsburgh, PA, United States
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Ramey O, Gildea C. Factors associated with attendance at a pharmacist-led group diabetes self-management education class and impact on health outcomes. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2024; 16:100526. [PMID: 39498229 PMCID: PMC11532769 DOI: 10.1016/j.rcsop.2024.100526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Revised: 10/08/2024] [Accepted: 10/10/2024] [Indexed: 11/07/2024] Open
Abstract
Background Group education has demonstrated benefits among people with diabetes, including reduced A1C and improved self-monitoring practices. Despite this, attendance rates are low for a variety of reasons, including lack of understanding of potential benefits among patients. Objectives The pharmacist-led diabetes self-management education program at a community hospital has low attendance. This project assesses characteristics associated with attendance and compares outcomes among attendees and non-attendees. Methods Retrospective data was collected between July 2022 and December 2023. Variables included: age, sex, class attendance, pre- and ≥ 90-day post-class A1C, pre- and post-class BMI, attending pharmacist-led clinic prior to scheduled class, social determinants of health screening survey responses, and diagnosis of depression or anxiety. Results 103 patients were identified. 53 % attended at least one class out of a series of four. Attendance at the pharmacist-led diabetes clinic (70 % among attendees versus 30 % among non-attendees, p < 0.001) was associated with attendance. Age, gender, concurrent mental health diagnoses (depression and anxiety), and SDOH related needs were not associated with attendance. Baseline A1C was similar for attendees and non-attendees (9.6 vs. 9.7 %, respectively). Post-class A1C was 7.4 % for attendees of at least one class and 8 % for non-attendees. Patients who attended all four classes achieved a mean A1C <7 %. Discussion There are many factors that lead to lack of engagement with group education for diabetes. Referral to group education by a pharmacist who has established rapport with the patient and can speak to specific details about benefits of the classes may improve attendance at diabetes group education.
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Affiliation(s)
- Olivia Ramey
- Saint Joseph Health System – Family Medicine Center, 611 E. Douglas Rd Ste. 407, Mishawaka, IN 46545, United States of America
| | - Christopher Gildea
- Saint Joseph Health System – Family Medicine Center, 611 E. Douglas Rd Ste. 407, Mishawaka, IN 46545, United States of America
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Yaagoob E, Lee R, Stubbs M, Hakami M, Chan S. People with type 2 diabetes experiences of using WhatsApp-based diabetes self-management education and support: The process evaluation. J Eval Clin Pract 2024; 30:1571-1584. [PMID: 38963909 DOI: 10.1111/jep.14083] [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: 03/14/2024] [Revised: 06/19/2024] [Accepted: 06/22/2024] [Indexed: 07/06/2024]
Abstract
RATIONAL Online Diabetes Self-Management Education and Support (DSMES) offers people with type 2 diabetes mellitus (T2DM) accessible and tailored education, utilising innovative and interactive tools such as social media to enhance engagement and outcomes. Despite the demonstrated effectiveness of social media-based DSMES in improving health outcomes, there remains a significant gap in qualitative insights regarding participants' experiences. AIM This study aims to explore the experiences of people with T2DM who are using a newly developed WhatsApp-based DSMES. METHODS A qualitative descriptive approach was adopted. Data consisted of 23 semi-structured phone interviews with people with T2DM who had received the WhatsApp-based DSMES. Interviews were analysed using qualitative content analysis. The present study adheres to the COREQ guidelines. RESULTS Four themes emerged from the data: (1) acceptability of the programme, (2) flexible accessibility of the programme, (3) promoting healthy lifestyle and (4) future preferences for the programme use. CONCLUSION This study explored the experiences of people with T2DM participating in a 6-week WhatsApp-based DSMES. The findings indicated that the programme was acceptable, accessible, effectively revealing necessary self-management knowledge and skills, and provided essential support from professional and peer. The study also indicated that WhatsApp-based programmes could be feasibly implemented in various populations, healthcare settings and communities to support people with T2DM globally.
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Affiliation(s)
- Esmaeel Yaagoob
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Regina Lee
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Michelle Stubbs
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
| | | | - Sally Chan
- Tung Wah College, Homantin, Hong Kong, China
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Amante DJ, Shenette L, Wainaina S, Balakrishnan K, Bhatia S, Lee JA, Lemon SC, McManus D, Harlan DM, Malkani S, Gerber BS. Digital Health Tools and Behavioral Strategies to Increase Engagement With Diabetes Self-Management Education and Support: Design and Feasibility of DM-BOOST. Sci Diabetes Self Manag Care 2024; 50:497-509. [PMID: 39399983 DOI: 10.1177/26350106241285829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2024]
Abstract
PURPOSE The purpose of the study was to describe the development and feasibility of implementing the DM-BOOST program in support of an established diabetes self-management education and support (DSMES) program. METHODS A patient panel of 4 adults with type 2 diabetes (T2DM) codesigned DM-BOOST. DM-BOOST is a patient-focused program that includes peer-written text messages about diabetes self-management behaviors and digital health training to improve patient portal use and initiate goal setting prior to a scheduled DSMES appointment. Adults with T2DM and A1C ≥8.0% participated in a 6-month feasibility pilot. Participants were randomly assigned (1:1) to receive either DM-BOOST or usual care. Outcomes included DSMES engagement (scheduled and attended DSMES appointments) and changes in diabetes self-efficacy and treatment satisfaction. RESULTS Pilot participants (n = 60) were 60.0% female with mean age 45.5 years (SD 8.3) and A1C 10.1% (SD 1.8%). All DM-BOOST participants (30/30, 100%) had DSMES appointments scheduled compared to 86.7% of usual care (26/30). DM-BOOST participants had fewer DSMES appointment no-shows/cancellations (3/30, 10%) compared to usual care (10/26, 35%). There was greater improvement in diabetes self-efficacy in the DM-BOOST group compared to usual care and no difference in treatment satisfaction. CONCLUSIONS DM-BOOST, leveraging peer-written text messaging and digital health training, increased DSMES engagement. Implementation of DM-BOOST was determined to be feasible, with several system-level barriers identified, including obtaining provider referrals and scheduling appointments. An effectiveness trial of DM-BOOST is needed to evaluate the impact on clinical outcomes.
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Affiliation(s)
- Daniel J Amante
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts
| | - Lisa Shenette
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts
| | - Stacey Wainaina
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts
| | - Kavitha Balakrishnan
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts
| | - Shina Bhatia
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts
| | - Jung Ae Lee
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts
| | - Stephenie C Lemon
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts
| | - David McManus
- Department of Medicine, UMass Chan Medical School, Worcester, Massachusetts
| | - David M Harlan
- Department of Medicine, UMass Chan Medical School, Worcester, Massachusetts
- Diabetes Center of Excellence, UMass Chan Medical School, Worcester, Massachusetts
| | - Samir Malkani
- Department of Medicine, UMass Chan Medical School, Worcester, Massachusetts
- Diabetes Center of Excellence, UMass Chan Medical School, Worcester, Massachusetts
| | - Ben S Gerber
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts
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Gaid D, Giasson G, Gaboury I, Houle L, Layani G, Menear M, de Tilly VN, Pomey MP, Vachon B. Quality priorities related to the management of type 2 diabetes in primary care: results from the COMPAS + quality improvement collaborative. BMC PRIMARY CARE 2024; 25:397. [PMID: 39550565 PMCID: PMC11568624 DOI: 10.1186/s12875-024-02641-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Accepted: 10/25/2024] [Indexed: 11/18/2024]
Abstract
BACKGROUND This study aims to describe the main type 2 diabetes mellitus (T2DM) quality improvement (QI) challenges identified by primary care teams in the province of Quebec who participated in the COMPAS + QI collaborative. METHODS A qualitative descriptive design was used to analyse the results of 8 COMPAS + workshops conducted in 4 regions of the province between 2016 and 2020. Deductive content analysis was performed to classify the reported QI priorities under the Consolidated Framework for Implementation Research domains; and proposed change strategies under the Behavior Change Wheel (BCW) intervention functions. RESULTS A total of 177 participants attended the T2DM COMPAS + workshops. Three QI priorities were identified: (1) lack of coordination and integration of T2DM care and services; (2) lack of preventive services for pre-diabetes and T2DM; and (3) lack of integration of the patients-as-partners approach to support T2DM self-management. The proposed QI strategies to address those priorities were classified under the education, training, persuasion, habilitation and restructuring BCW intervention functions. CONCLUSION This study provides insights on how QI collaboratives can support the identification of QI priorities and strategies to improve T2DM management in primary care.
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Affiliation(s)
- Dina Gaid
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, CP 6128 Succursale Centre-Ville, Montreal, QC, H3C 3J7, Canada
| | - Guylaine Giasson
- Department of Family Emergency Medicine, Faculty of Medicine and Health Sciences, Centre de recherche Charles-LeMoyne (CR-CRCLM), Université de Sherbrooke - Campus de Longueuil, Longueuil, QC, Canada
| | - Isabelle Gaboury
- Department of Family and Emergency Medicine, Faculty of Medicine and Health Sciences, Centre de recherche Charles-LeMoyne (CR-CRCLM), Université de Sherbrooke Campus de Longueuil, Longueuil, QC, Canada
| | - Lise Houle
- Institut national d'excellence en santé et en services sociaux (INESSS), Montreal, QC, Canada
| | - Géraldine Layani
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Montreal, QC, Canada
- Centre de recherche du Centre hospitalier universitaire de l'Université de Montréal, Montreal, QC, Canada
| | - Matthew Menear
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada
- VITAM - Centre de recherche en santé durable, Quebec, QC, Canada
| | | | - Marie-Pascale Pomey
- Centre de recherche du Centre hospitalier universitaire de l'Université de Montréal, Montreal, QC, Canada
- Public Health School, Department of Management, evaluation and health policy, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Brigitte Vachon
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, CP 6128 Succursale Centre-Ville, Montreal, QC, H3C 3J7, Canada.
- Centre de recherche du CIUSSS de l'Est de l'Île de Montréal, Montreal, QC, Canada.
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Burton W, Padgett L, Nixon N, Ells L, Drew KJ, Brown T, Bakhai C, Radley D, Homer C, Marwood J, Dhir P, Bryant M. Transferability of the NHS low-calorie diet programme: A qualitative exploration of factors influencing the programme's transfer ahead of wide-scale adoption. Diabet Med 2024; 41:e15354. [PMID: 38822506 DOI: 10.1111/dme.15354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 06/03/2024]
Abstract
INTRODUCTION Although behavioural interventions have been found to help control type 2 diabetes (T2D), it is important to understand how the delivery context can influence implementation and outcomes. The NHS committed to testing a low-calorie diet (LCD) programme designed to support people living with excess weight and T2D to lose weight and improve diabetes outcomes. Understanding what influenced implementation during the programme pilot is important in optimising rollout. This study explored the transferability of the NHS LCD Programme prior to wider adoption. METHODS Twenty-five interviews were undertaken with stakeholders involved in implementing the LCD programme in pilot sites (health service leads, referring health professionals and programme deliverers). Interviews with programme participants (people living with T2D) were undertaken within a larger programme of work, exploring what worked, for whom and why, which is reported separately. The conceptual Population-Intervention-Environment-Transfer Model of Transferability (PIET-T) guided study design and data collection. Constructs of the model were also used as a deductive coding frame during data analysis. Key themes were identified which informed recommendations to optimise programme transfer. RESULTS Population: Referral strategies in some areas lacked consideration of population characteristics. Many believed that offering a choice of delivery model would promote acceptability and accessibility of the eligible population. INTERVENTION Overall, stakeholders had confidence in the LCD programme due to the robust evidence base along with anecdotal evidence, but some felt the complex referral process hindered engagement from GP practices. ENVIRONMENT Stakeholders described barriers to accessing the programme, including language and learning difficulties. Transferability: Multidisciplinary working and effective communication supported successful implementation. CONCLUSION Referral strategies to reach underrepresented groups should be considered during programme transfer, along with timely data from service providers on access and programme benefits. A choice of delivery models may optimise uptake. Knowledge sharing between sites on good working practices is encouraged, including increasing engagement with key stakeholders.
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Affiliation(s)
- Wendy Burton
- Department of Health Sciences, University of York, York, UK
| | - Louise Padgett
- Department of Health Sciences, University of York, York, UK
| | - Nicola Nixon
- Department of Health Sciences, University of York, York, UK
| | - Louisa Ells
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | - Kevin J Drew
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | - Tamara Brown
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | - Chirag Bakhai
- Larkside Practice, Churchfield Medical Centre, Bedfordshire, UK
| | - Duncan Radley
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | - Catherine Homer
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Jordan Marwood
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | - Pooja Dhir
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | - Maria Bryant
- Department of Health Sciences, University of York, York, UK
- Hull York Medical School, University of York, York, UK
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Weise S, Du Y, Heidemann C, Baumert J, Frese T, Heise M. Diabetes self-management education programs: Results from a nationwide population-based study on characteristics of participants, rating of programs and reasons for non-participation. PLoS One 2024; 19:e0310338. [PMID: 39264968 PMCID: PMC11392325 DOI: 10.1371/journal.pone.0310338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 08/28/2024] [Indexed: 09/14/2024] Open
Abstract
OBJECTIVE Population-based studies of reasons for not participating in diabetes self-management education (DSME) are scarce. Therefore, we investigated what sociodemographic and disease-related factors are associated with participation in DSME, the reasons for not participating in DSME and how participants evaluate DSME. RESEARCH DESIGN AND METHODS We used data from the nationwide survey "Disease knowledge and information needs-Diabetes mellitus 2017", which included a total of 1396 participants diagnosed with diabetes mellitus (diabetes; n = 394 DSME-participants, n = 1002 DSME-never-participants). Analyses used weighted logistic or multinominal regression analyses with bivariate and multivariable approaches. RESULTS Participants were more likely to attend DSME if they had a medium (OR 1.82 [95%CI 1.21-2.73]),or high (OR 2.04 [95%CI 1.30-3.21]) level of education, had type 1 diabetes (OR 2.46 [1.24-4.90]) and insulin treatment (OR 1.96 [95%CI 1.33-2.90]). Participants were less likely to attend DSME if they lived in East Germany (OR 0.57 [95%CI 0.39-0.83]), had diabetes for >2 to 5 years (OR 0.52 [95%CI 0.31-0.88] compared to >5 years), did not agree that diabetes is a lifelong disease (OR 0.30 [95%CI 0.15-0.62], had never been encouraged by their physician to attend DSME (OR 0.19 [95%CI 0.13-0.27]) and were not familiar with disease management programs (OR 0.67 [95%CI 0.47-0.96]). The main reasons for non-participation were participant's personal perception that DSME was not necessary (26.6%), followed by lack of recommendation from treating physician (25.7%) and lack of information on DSME (20.7%). DSME-participants found DSME more helpful if they had a medium educational level (OR 2.06 [95%CI 1.10-3.89] ref: low level of education) and less helpful if they were never encouraged by their treatment team (OR 0.46 [95%CI 0.26-0.82]). DISCUSSION Professionals treating persons with diabetes should encourage their patients to attend DSME and underline that diabetes is a lifelong disease. Overall, the majority of DSME participants rated DSME as helpful.
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Affiliation(s)
- Solveig Weise
- Institute of General Practice and Family Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Saxony-Anhalt, Germany
| | - Yong Du
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Unit Physical Health, Berlin, Berlin, Germany
| | - Christin Heidemann
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Unit Physical Health, Berlin, Berlin, Germany
| | - Jens Baumert
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Unit Physical Health, Berlin, Berlin, Germany
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Saxony-Anhalt, Germany
| | - Marcus Heise
- Institute of General Practice and Family Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Saxony-Anhalt, Germany
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Boswell E, Probst J, Hung P, Herbert L, Crouch E. Rural-Urban Differences in Self-Reported Participation in Diabetes Self-Management Education. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024:00124784-990000000-00239. [PMID: 39248720 DOI: 10.1097/phh.0000000000001928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2024]
Abstract
CONTEXT Rural America faces a dual challenge with a higher prevalence of diabetes mellitus (hereafter, diabetes) and diabetes-related mortality. Diabetes self-management education (DSME) can improve glucose control and reduce adverse effects of diabetes, but certified DSME programs remain disproportionately limited in rural counties than in urban counties. OBJECTIVE The goal of this study is to examine the proportion of urban and rural adults who report having received DSME using a nationwide, 29-state survey while considering the potential consequences of lower service availability. DESIGN This cross-sectional study used data from the 2019 Behavioral Risk Factor Surveillance System (BRFSS). Residence was defined as urban (metropolitan county) vs rural (non-metropolitan county). Logistic regression, incorporated survey weights, was used to determine the odds of having received DSME by residence. SETTING BRFSS is a nationally representative survey, and this study included participants from 29 states that were distributed throughout all regions of the United States. PARTICIPANTS The study sample consisted of 28,179 adults who reported having diabetes, lived in one of the states that administered the diabetes module in 2019, and answered all relevant questions. MAIN OUTCOME MEASURES The main outcome measure was whether a participant had ever received DSME. Participants were considered to have received DSME if they self-reported having ever taken a class on how to manage diabetes themselves. RESULTS Overall, 54.5% of participants reported having received DSME; proportionately fewer rural residents (50.4%, ±1.1%) than urban residents (55.5%, ±1.0%) reported DSME. Rural disparities persisted after adjusting for demographic, enabling, and need factors (Adjusted Odds Ratio = 0.79; CI, 0.71-0.89). By sociodemographic factors, Hispanic persons vs non-Hispanic White persons and single vs married/coupled individuals were less likely to report DSME receipt (both 0.76 [0.62-0.94]). CONCLUSIONS Ongoing national efforts addressing rural disparities in diabetes-related complications should target individuals most at risk for missing current diabetes educational programming and design appropriate interventions.
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Affiliation(s)
- Emma Boswell
- Author Affiliations: Rural and Minority Health Research Center, (Ms Boswell and Drs Probst and Crouch); Department of Health Services Policy and Management, Arnold School of Public Health, (Drs Hung and Crouch); and College of Nursing, University of South Carolina, Columbia, South Carolina (Dr Herbert)
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12
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Tharakan A, McPeek Hinz E, Zhu E, Denmeade B, German J, Huang WA, Brucker A, Rinker J, Memering C, Spratt S. Accessibility of diabetes education in the United States: barriers, policy implications, and the road ahead. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae097. [PMID: 39206435 PMCID: PMC11350287 DOI: 10.1093/haschl/qxae097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 05/24/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024]
Abstract
Diabetes Self-Management Education and Support (DSMES) programs are an effective, yet underutilized, resource to improve health outcomes and behaviors for people with diabetes. We examined the attendance and referral rates for people with diabetes to DSMES classes at an academic medical center, noting a 10% referral rate and 37% completion rate for those referred. We identified barriers to DSMES care at patient, provider, and health system levels. Current technology platforms and training fail to prioritize referrals to diabetes education; providers and people with diabetes are often unfamiliar with program content and benefits. Scheduling mechanisms often delay or lose interested patients in receiving vital education. Existing Medicare reimbursement strategies limit expansion of DSMES programs, generating significant wait times and limit capabilities for Diabetes Care and Education Specialists. We identify potential policy solutions and recommend alterations to existing referral and scheduling systems to expand existing technology platforms for DSMES programs and shift reimbursement policies to individualize and better support care for persons with diabetes.
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Affiliation(s)
- Anna Tharakan
- Department of Undergraduate Studies, Duke University, Durham, NC 27710, United States
- Margolis Center for Health Policy, Duke University, Durham, NC 27710, United States
| | - Eugenia McPeek Hinz
- Division of General Internal Medicine, Department of Medicine, Duke School of Medicine, Durham, NC 27710, United States
| | - Emelia Zhu
- Duke Primary Care, Duke University Hospital, Durham, NC 27710, United States
| | - Brad Denmeade
- Division of Endocrinology, Metabolism and Nutrition, Department of Medicine, Duke School of Medicine, Durham, NC 27710, United States
| | - Jashalynn German
- Division of Endocrinology, Metabolism and Nutrition, Department of Medicine, Duke School of Medicine, Durham, NC 27710, United States
| | - Wei Angel Huang
- Duke Department of Biostatistics and Bioinformatics, Duke University, Durham, NC 27710, United States
| | - Amanda Brucker
- Duke Department of Biostatistics and Bioinformatics, Duke University, Durham, NC 27710, United States
| | - Joanne Rinker
- Association of Diabetes Care & Education Specialists, Asheville, NC 28175, United States
- North Carolina Diabetes Advisory Council, New Bern, NC 28560, United States
| | - Chris Memering
- North Carolina Diabetes Advisory Council, New Bern, NC 28560, United States
- Carolina East Medical Center, Carolina East Health System, New Bern, NC 28560, United States
| | - Susan Spratt
- Division of Endocrinology, Metabolism and Nutrition, Department of Medicine, Duke School of Medicine, Durham, NC 27710, United States
- Population Health Management Office, Duke University Hospital, Durham, NC 27710, United States
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13
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Jairoun AA, Al-Hemyari SS, Shahwan M, Al-Qirim T, Shahwan M. Author Response to Comment on: "Benefit-Risk Assessment of ChatGPT Applications in the Field of Diabetes and Metabolic Illnesses: A Qualitative Study". Clin Med Insights Endocrinol Diabetes 2024; 17:11795514241260240. [PMID: 38894857 PMCID: PMC11184991 DOI: 10.1177/11795514241260240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 05/21/2024] [Indexed: 06/21/2024] Open
Affiliation(s)
- Ammar Abdulrahman Jairoun
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor, Malaysia
- Health and Safety Department, Dubai Municipality, Dubai, UAE
| | - Sabaa Saleh Al-Hemyari
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor, Malaysia
- Pharmacy Department, Emirates Health Services, Dubai, UAE
| | - Moyad Shahwan
- College of Pharmacy and Health Sciences, Ajman University, Ajman, UAE
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, UAE
| | - Tariq Al-Qirim
- Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Monzer Shahwan
- Diabetes Clinic, AL-Swity Center for Dermatology and Chronic Diseases, Ramallah, Palestine
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14
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Yaagoob E, Lee R, Stubbs M, Shuaib F, Johar R, Chan S. WhatsApp-based intervention for people with type 2 diabetes: A randomized controlled trial. Nurs Health Sci 2024; 26:e13117. [PMID: 38566413 DOI: 10.1111/nhs.13117] [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: 06/26/2023] [Revised: 03/13/2024] [Accepted: 03/16/2024] [Indexed: 04/04/2024]
Abstract
Diabetes mellitus is a metabolic disease characterized by prolonged elevated blood glucose levels. Diabetes self-management education and support programs are widely used in western countries. The impact of social media education and support interventions such as a WhatsApp-based program and the nurses' role in supporting and implementing this self-management program unclear. Using a WhatsApp-based program, we evaluated the effects of a 6-week program in improving self-efficacy and education among people with type 2 diabetes mellitus in Saudi Arabia. Eligible participants (n = 80) were recruited with the support of nurses into a randomized controlled trial and randomly assigned into self-management intervention and control groups. The intervention group (n = 40) received the self-management program support and the usual care. The control group (n = 40) received only the usual care with nurses' support. Results from generalized estimating equation analysis showed a significant increase in self-efficacy, self-management, and education in the WhatsApp-based intervention support group compared with the control group at 6 and 12 weeks (follow-up). Implementing the program via social media improves self-efficacy. The use of social media platforms should be promoted for global diabetes management.
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Affiliation(s)
- Esmaeel Yaagoob
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, Australia
| | - Regina Lee
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, Australia
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Michelle Stubbs
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, Australia
| | - Fatimah Shuaib
- Diabetic Education Clinic, Jizan Diabetes Center, Jazan, Saudi Arabia
| | - Raja Johar
- Diabetic Education Clinic, Jizan Diabetes Center, Jazan, Saudi Arabia
| | - Sally Chan
- President's Office, Tung Wah College, Homantin, Hong Kong
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15
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Zhang J, Yang C, Liu Y, Wu D, Liu L, Zheng H, Xu DR, Liao J. Conditions for successful implementation of couple-based collaborative management model of diabetes among community-dwelling older Chinese: a qualitative comparative analysis. BMC Geriatr 2023; 23:832. [PMID: 38082267 PMCID: PMC10712117 DOI: 10.1186/s12877-023-04565-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 12/05/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Diabetes mellitus is a prevalent and potentially devastating chronic illness affecting many older adults. Given spousal involvement in many aspects of diabetes management, coping with their partners is increasingly seen as a potential solution to make up for limited resources. This study aimed to identify the key conditions for optimal implementation of couple-based collaborative management model (CCMM) among Chinese older couples with type 2 diabetes mellitus. METHODS Older couples and community healthcare practitioners were selected according to couples' joint intervention attendance rate and community's average attendance rate. This mixed methods research consisted of a qualitative phase and a quantitative phase. In the qualitative phase, in-depth interviews were conducted among 12 pairs of couples in the intervention group and 4 corresponding practitioners, in the follow-up period of the multicentered RCT from January to April 2022. Qualitative comparative analysis (QCA) in the quantitative phase to identify conditions influencing CCMM's implementation and to explore necessary and sufficient combinations of conditions (i.e., solutions) for improving patients' glycated hemoglobin (HbA1c) control (outcome). RESULTS Key conditions included implementation process, couple's role in diabetes management, their belief and perception of CCMM, as well as objective obstacles and subjective initiative for behavior change. Accordingly, major barriers in CCMM's implementation were patients' strong autonomy (particularly among husbands), misbelief and misperception about diabetes management as a result of low literacy, and mistrust of the practitioners. QCA further revealed that no single condition was necessary for effective HbA1c control, while three types of their combinations would be sufficient. Solution 1 and 2 both comprised the presence of spousal willingness to help, plus correct belief and perception of diabetes management, well embodying the utility of couple collaborative management in supporting patients' HbA1c control. On the other hand, solution 3 indicated that high-quality implementation even without spousal support, can promote the patient's subjective initiative to overcome objective obstacles, suggesting enhanced self-management for HbA1c control. CONCLUSIONS Tailored CCMM should be implemented in reference to older couple's preferences and literacy levels, to ensure intervention fidelity, and establish correct understanding of collaborative management among them.
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Affiliation(s)
- Jing Zhang
- Department of Medical Statistics & Epidemiology, Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, No.135 Xingang West Road, Guangzhou, 510275, P.R. China
| | - Conghui Yang
- Department of Medical Statistics & Epidemiology, Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, No.135 Xingang West Road, Guangzhou, 510275, P.R. China
- Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, Guangzhou, P.R. China
| | - Yixuan Liu
- Department of Medical Statistics & Epidemiology, Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, No.135 Xingang West Road, Guangzhou, 510275, P.R. China
- Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, Guangzhou, P.R. China
| | - Dadong Wu
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, P.R. China
| | - Lingrui Liu
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, United States
| | - Huiqiong Zheng
- Department of Medical Statistics & Epidemiology, Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, No.135 Xingang West Road, Guangzhou, 510275, P.R. China
- Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, Guangzhou, P.R. China
| | - Dong Roman Xu
- Center for World Health Organization Studies, Department of Health Management, School of Health Management, Southern Medical University, Shenzhen, P.R. China
- ACACIA Lab for Implementation Research, SMU Institute for Global Health (SIGHT), Dermatology Hospital of Southern Medical University (SMU), Guangzhou, P.R. China
| | - Jing Liao
- Department of Medical Statistics & Epidemiology, Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, No.135 Xingang West Road, Guangzhou, 510275, P.R. China.
- Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, Guangzhou, P.R. China.
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Rubner S, D'Annibale M, Oliver N, McGowan B, Guess N, Lorencatto F, Gibson R. Individual, social and environmental factors influencing dietary behaviour in shift workers with type 2 diabetes working in UK healthcare: A cross-sectional survey. J Hum Nutr Diet 2023; 36:1992-2009. [PMID: 37452756 DOI: 10.1111/jhn.13198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The present study aimed to understand the individual, social and environmental factors influencing dietary behaviour in shift workers with type 2 diabetes (T2D) working in UK healthcare settings. METHODS A cross-sectional study was conducted using data collected from an anonymous online survey. Participant agreement was measured using five-point Likert scale (strongly disagree to strongly agree) against 38 belief statements informed by the Theoretical Domains Framework (TDF) of behaviour change. RESULTS From the complete responses (n = 119), 65% worked shifts without nights, 27% worked mixed shift rota including nights and 8% worked only night shifts. The statements ranked with the highest agreements were in the TDF domains: Environment Context/Resources (ECR) - mainly identified as a barrier to healthy eating, Behaviour Regulation (BR) and intention (IN) - identified as enablers to healthy eating. For the belief statement 'the available options for purchasing food are too expensive' (ECR), 80% of night workers and 75% non-night workers agreed/strongly agreed. Taking their own food to work to prevent making unhealthy food choices (BR) had agreement/strong agreement in 73% of non-night and 70% night workers; 74% non-night workers and 80% of night workers agreed/strongly agreed with the statement 'I would like to eat healthily at work' (IN). Mixed shift workers agreed that following dietary advice was easier when working a non-night compared to a night shift (p = 0.002). CONCLUSIONS Access and affordability of food were identified as important determinants of dietary behaviour during shifts. The findings support interventions targeting the food environment for shift workers with T2D.
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Affiliation(s)
- Sophie Rubner
- Department of Nutritional Sciences, King's College London, London, UK
| | - Maria D'Annibale
- Department of Nutritional Sciences, King's College London, London, UK
| | - Nick Oliver
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Barbara McGowan
- Department of Diabetes and Endocrinology, Guy's and St Thomas' NHS Trust, London, UK
| | - Nicola Guess
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Rachel Gibson
- Department of Nutritional Sciences, King's College London, London, UK
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Shahabi N, Hosseini Z, Aghamolaei T, Ghanbarnejad A, Behzad A. Application of Pender's health promotion model for type 2 diabetes treatment adherence: protocol for a mixed methods study in southern Iran. Trials 2022; 23:1056. [PMID: 36578044 PMCID: PMC9795658 DOI: 10.1186/s13063-022-07027-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 12/15/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) mellitus treatment as a chronic disease requires adequate adherence to treatment including controlling blood glucose levels and lifestyle management. The aim of this study is to investigate the factors affecting of adherence to T2D treatment from the perspective of patients and design an intervention program based on Pender's health promotion model (HPM) to increase T2D treatment adherence in Bandar Abbas, a city located in the south of Iran. METHODS This mixed method study will consist of qualitative stage, questionnaire design and a randomized, open-label, parallel-group interventional study based on HPM in southern Iran. Sampling for qualitative stage will continue until reaching the saturation. In the intervention stage, participants will be 166 T2D patients referring to the Bandar Abbas Diabetes Clinic will be randomized into intervention and control groups (allocation 1:1). After identifying the factors affecting adherence to treatment in T2D patients by qualitative study and literature review, a questionnaire based on HPM will be designed. In the next stage, 10 sessions of intervention for the intervention group will be designed. To evaluate the effect of the intervention, intervention and control groups will be tested for hemoglobin A1c (HbA1c) before and 3 months after the intervention. DISCUSSION This designed study is a program for improving treatment adherence in T2D based on the HPM model and contributes to a better understanding of effective factors in adherence to treatment in T2D patients. The results of this project can be used for macro-diabetic planning. TRIAL REGISTRATION This study is registered on the Iranian Registry of Clinical Trials (IRCT20211228053558N1: https://www.irct.ir/trial/61741 ) and first release date of 17th March 2022.
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Affiliation(s)
- Nahid Shahabi
- Student Research Committee, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Zahra Hosseini
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
| | - Teamur Aghamolaei
- Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Amin Ghanbarnejad
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Ahmad Behzad
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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