Content analysis of group work sessions in the context of an educational program for inpatient diabetes patients

Positive experiences of type 2 diabetes in Japanese patients: An exploratory qualitative study

BACKGROUND

Previous research on self-management in people with diabetes mellitus mostly focused on the negative aspects of the disease, such as depression, lack of support, and psychological stress.

OBJECTIVES

The purpose of this study was to explore the existence of positive experiences in people with type 2 diabetes. 'Positive experience' is operationally defined as positive thoughts or good feelings in coping with diabetes expressed by the participants.

DESIGN

An exploratory qualitative design using constant comparative method.

METHOD

Convenience sampling was used to recruit participants receiving care in two hospitals in Kansai area, Japan. The following eligibility criteria were used: (1) individuals diagnosed with type 2 diabetes; (2) individuals capable of conversing in Japanese; and (3) individuals receiving care at either setting. Data collection and data analysis were conducted concurrently. Each verbatim transcript was read several times, and the data were coded line by line. Codes were constantly compared with each other for similarity and dissimilarity and were grouped to form categories.

RESULTS

Ten patients from the outpatient department and seven patients from the inpatient education program were interviewed between June and December in 2002. All the participants expressed positive experience in coping with diabetes. Three categories emerged from repeated coding: (1) positive appraisal; (2) diversion; and (3) bonding.

CONCLUSION

A tentative model of coping from the patient's perspective was proposed for a future research. Asking the patient about positive experience with their illness is important to elicit positive thoughts and experience.

Evaluation of the locus of control in patients with type 2 diabetes after long-term management by group care

AIM

To investigate the locus of control in patients with type 2 diabetes followed by systemic group education (Group Care) and traditional one-to-one care.

METHODS

In a post-hoc analysis, two questionnaires were administered to 56 patients who had been followed for 5-7 years by Group Care and 51 controls followed by individual care, similar by age, sex, diabetes duration, glycaemia, insulinaemia, weight and other clinical variables. Patients on Group Care had lower HbA1c (7.40 +/- 1.21%) than controls (7.99 +/- 1.48%), P = 0.027. The Peyrot and Rubin questionnaire, specific for diabetes, and the Wallston and Wallston questionnaire, more generic for chronic diseases, were administered. Both questionnaires explore 3 areas: internal control of disease, and the role of chance or powerful other people, including health operators, in changing the disease.

RESULTS

Both questionnaires showed lower scores for chance in patients followed by Group Care (P < 0.001), while scores for powerful others did not differ from those of patients followed by traditional care. The Peyrot and Rubin tool showed increased Internal Control (P < 0.001) in the patients followed by Group Care. Multivariate analysis showed that the HOMA index of insulin resistance was inversely related to Internal Control (B = -0.144, P = 0.005) independently of BMI and HbA1c.

CONCLUSION

Fatalistic attitudes were lower and internal control higher in patients with type 2 diabetes followed by Group Care. These changes may be related to insulin resistance, above and beyond the effects of body weight and metabolic control.