Individual patient-centered target-driven intervention to improve clinical outcomes of diabetes, health literacy, and self-care practices in Nepal: A randomized controlled trial

Factors influencing health-seeking behaviours and self-care practices among black-African Caribbean people living with type 2 diabetes: a community-focused qualitative study from Southwestern England

BACKGROUND/OBJECTIVE

To examine factors influencing health-seeking behaviours and self-care practices of diabetes, including the uptake and use of diabetic services among community-dwelling black African-Caribbean people living in the UK.

DESIGN

Cross-sectional/qualitative.

SETTING

Community (Southwestern England).

PARTICIPANTS

Nineteen individuals of African-Caribbean heritage, over the age of 50 years, diagnosed with type 2 diabetes.

METHODS

Three focus group discussions (FGDs), each of which lasted for approximately 90 min, were held. These interviews were facilitated by a community-based health champion and a researcher of African-Caribbean heritage. Audio recordings were transcribed verbatim, coded in NVivo software, and analysed using an inductive thematic approach.

PRIMARY OUTCOME MEASURES

FGD data.

RESULTS

A total of nine culturally specific and non-specific (generic) themes were identified. Culturally specific themes included the normalisation of diabetes at the community level, which was more pronounced among men than women. Participants were found to be inclined to either substitute or complement diabetes medications with cultural herbal remedies. There was a lack of trust in medical centric advice received from healthcare practitioners. Participants also expressed that healthcare practitioners do not always listen to or understand their needs and reported that there was a lack of culturally appropriate diabetes education and training programmes for their community members. Generic themes included difficulties and frustrations in getting doctor's appointments, self-indiscipline and poor motivation for engaging in physical exercise and healthy eating.

CONCLUSION

Several cultural/community-related factors influence health-seeking behaviours and self-care practices of diabetes in African-Caribbean people living in the UK, often affecting men and women differently, alongside more general individual and healthcare system-related barriers. Addressing these factors is imperative in designing a culturally and demographically tailored diabetes education programme for these people.

Digital Health Literacy: A systematic review of interventions and their influence on healthcare access and sustainable development Goal-3 (SDG-3)

This study explores how interventions focused on digital health literacy (DHL) can improve access to healthcare and contribute to achieving Sustainable Development Goal-3 (SDG- 3). We scrutinized information from PubMed (MEDLINE), Scopus, and Web of Science released search articles from March 1, 2020 to January 31, 2024. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the review concentrated only on experimental studies that assessed how DHL initiatives have influenced enhancing patient health outcomes and access to healthcare. Research that did not cover DHL or the availability of healthcare, was not included. The analysis was primarily qualitative, focusing on thematic patterns and insights rather than statistical outcomes. Our results showed that DHL interventions typically result in enhanced health literacy, improved medication adherence, and higher self-confidence, particularly benefiting marginalized communities. Limitations to safe & accessible healthcare underscore the need for more focused and culturally appropriate strategies. This review shows that interventions by DHL can greatly enhance healthcare results, highlighting the need to tackle inequalities to ensure marginalized communities also benefit.

Knowledge, attitude, and diabetes self-care among individuals at high-risk of diabetes-related blindness in Bangladesh: a cross-sectional study

BACKGROUND/AIM

Adequate knowledge, attitude, and self-care practice (KAP) are paramount in reducing diabetes complications. This study examined diabetes-related KAP in individuals who have been previously reported to be at a higher risk of blindness such as those on insulin treatment or with a longer (>6 years) duration of diabetes in Bangladesh.

METHODS

Six hundred community-dwelling individuals (mean age = 52.7±11.6 years) who had been diagnosed with diabetes by their doctor were interviewed. A semi-structured questionnaire obtained self-reported information about diabetes-related KAP, duration, treatment of diabetes, and sociodemographic parameters including age, gender, and education level. Data were collected using a purposive sample technique and analyzed using Fischer's exact test or independent samples t-tests.

RESULTS

There were 271 males (45.2%) and 329 (54.8%) females. Of the total participants (mean diabetes duration = 6.6±6.2 years), 36.5% had diabetes for more than the median duration of 6 years, 80.7% were receiving insulin or insulin combined with tablets (insulin group) and the remaining 19.3% were on tablet only and/or diet control (non-insulin group). One-fifth (19.8%) of all the participants did not consider diabetes a serious disease, 31.3% were unaware that uncontrolled diabetes can cause blindness, 40.5% had never had their eyes tested for diabetic retinopathy and 41.5% stated that they would not attend diabetic retinopathy screening until their eyesight became worse. Among those in the insulin group, 42.1% reported being unaware that smoking may be harmful to diabetes compared to 30.2% of those in the non-insulin group (p= 0.02). Additionally, 64.7% of those in the insulin group were unaware that a diabetic retinal screening is different from a routine eye test for spectacles, compared to 44.8% in the non-insulin group (p< 0.001). Sixty-two percent of participants with diabetes duration of more than 6 years reported that diabetes management was a shared responsibility between the doctor and the patient compared to 48.3% with a shorter duration (p< 0.001). Those with a longer duration of diabetes (>6 years) also reported forgetting to take their medication more often than those with a shorter duration (p = 0.02). Twenty-one percent of participants with a duration of diabetes longer than six years had checked their eyes within the previous year compared to 63.5% of those with a shorter duration of diabetes (p< 0.001).

CONCLUSION

Individuals on insulin treatment demonstrated poorer knowledge and awareness of diabetes and diabetes eye screening. Those with a longer diabetes duration exhibited poorer self-care practices, particularly not taking the medication regularly, and neglecting diabetic retinal checkups. These issues need to be addressed in designing targeted educational interventions to prevent blindness from uncontrolled diabetes in the high-risk groups in Bangladesh.

Diabetic health literacy and associated factors among patients with diabetes attending follow-up in public hospitals of Northeastern Ethiopia: a multicentre cross-sectional study

OBJECTIVE

To assess the magnitude of diabetic health literacy (DHL) and associated factors among diabetes patients attending follow-up at public hospitals in Northeastern Ethiopia.

DESIGN

An institution-based cross-sectional study was conducted from 24 May to 24 June 2022.

SETTING

Diabetic clinics of four public hospitals in Northeastern Ethiopia.

PARTICIPANTS

611 adult diabetes patients who have been undergoing follow-up care for at least 6 months were systematically selected. Patients who were unable to communicate, were critically ill and with gestational diabetes mellitus were excluded from the study.

OUTCOMES

DHL was assessed using a 15-item tool developed from existing literature.

RESULTS

Of all the participants, 300 (49.1%) had low, 174 (28.5%) moderate and 137 (22.4%) had high DHL levels. The significant factors impacting DHL included age (<40 years old: AOR=3.48, 95% CI=2.11-5.77; 40-60 years: AOR=2.79, 95% CI=1.75-4.46), low education (AOR=0.29, 95% CI=0.16-0.56 for those who can't read and write; AOR=0.41, 95% CI=0.23-0.74 for those who can read and write; AOR=0.45, 95% CI=0.27-0.76 for primary education), exposure to diabetic education (AOR=1.84, 95% CI=1.31-2.58), having ≥2 information sources (AOR=2.28, 95% CI=1.57-3.32), moderate social support (AOR=1.94, 95% CI=1.32-2.87), strong social support (AOR=2.73, 95% CI=1.75-4.26) and urban residence (AOR=1.65, 95% CI=1.14-2.39).

CONCLUSION

The study showed that less than a quarter of the patients have high DHL, with almost half having low levels of DHL. Tailoring health education programmes to diverse educational levels, incorporating multiple information sources and fostering social support networks could enhance DHL.

Risk factors for cardiometabolic health in Ghana: Cardiometabolic Risks Study Protocol-APTI Project

Introduction

Cardiometabolic diseases are rapidly becoming primary causes of death in developing countries, including Ghana. However, risk factors for these diseases, including obesity phenotype, and availability of cost-effective diagnostic criteria are poorly documented in an African-ancestry populations in their native locations. The extent to which the environment, occupation, geography, stress, and sleep habits contribute to the development of Cardiometabolic disorders should be examined.

Purpose

The overall goal of this study is to determine the prevalence of undiagnosed diabetes, prediabetes, and associated cardiovascular risks using a multi-sampled oral glucose tolerance test. The study will also investigate the phenotype and ocular characteristics of diabetes and prediabetes subgroups, as well as determine if lifestyle changes over a one-year period will impact the progression of diabetes and prediabetes.

Methods and analysis

The study employs a community-based quasi-experimental design, making use of pre- and post-intervention data, as well as a questionnaire survey of 1200 individuals residing in the Cape Coast metropolis to ascertain the prevalence and risk factors for undiagnosed diabetes and prediabetes. Physical activity, dietary habits, stress levels, sleep patterns, body image perception, and demographic characteristics will be assessed. Glucose dysregulation will be detected using oral glucose tolerance test, fasting plasma glucose, and glycated hemoglobin. Liver and kidney function will also be assessed. Diabetes and prediabetes will be classified using the American Diabetes Association criteria. Descriptive statistics, including percentages, will be used to determine the prevalence of undiagnosed diabetes and cardiovascular risks. Inferential statistics, including ANOVA, t-tests, chi-square tests, ROC curves, logistic regression, and linear mixed model regression will be used to analyze the phenotypic variations in the population, ocular characteristics, glycemic levels, sensitivity levels of diagnostic tests, etiological cause of diabetes in the population, and effects of lifestyle modifications, respectively. Additionally, t-tests will be used to assess changes in glucose regulation biomarkers after lifestyle modifications.

Ethics and dissemination

Ethics approval was granted by the Institutional Review Board of the University of Cape Coast, Ghana (UCCIRB/EXT/2022/27). The findings will be disseminated in community workshops, online learning platforms, academic conferences and submitted to peer-reviewed journals for publication.

Effectiveness of shared decision-making for glycaemic control among type 2 diabetes mellitus adult patients: A systematic review and meta-analysis

BACKGROUND

In diabetes care and management guidelines, shared decision-making (SDM) implementation is explicitly recommended to help patients and health care providers to make informed shared decisions that enable informed choices and the selection of treatments. Despite widespread calls for SDM to be embedded in health care, there is little evidence to support SDM in the management and care of diabetes. It is still not commonly utilized in routine care settings because its effects remain poorly understood. Hence, the current systematic review and meta-analysis aimed to evaluate the effectiveness of SDM for glycaemic control among type 2 diabetes adult patients.

METHODS

Literature sources were searched in MEDLINE, PubMed, Cochrane library and HINARI bibliographic databases and Google Scholar. When these records were searched and reviewed, the PICO criteria (P: population, I: intervention, C: comparator, and O: outcome) were applied. The extracted data was exported to RevMan software version 5.4 and STATA 17 for further analysis. The mean differences (MD) of glycated hemoglobin (HbA1c) were pooled using a random effect model (REM), and sub-group analysis were performed to evaluate the effect size differences across the duration of the follow-up period, modes of intervention, and baseline glycated hemoglobin level of patient groups. The sensitivity analysis was performed using a leave-one-out meta-analysis to quantify the impact of each study on the overall effect size in mean difference HbA1c%. Finally, the statistically significant MD of HbA1c% between the intervention groups engaged in SDM and control groups received usual care was declared at P ˂0.05, using a 95% confidence interval (CI).

RESULTS

In the database search, 425 records were retrieved, with only 17 RCT studies fulfilling the inclusion criteria and were included in the meta-analysis. A total of 5416 subjects were included, out of which 2782(51.4%) were included in trial arms receiving SDM and 2634(48.6%) were included in usual diabetes care. The Higgins (I2) test statistics were calculated to be 59.1%, P = 0.002, indicating statistically significant heterogeneity was observed among the included studies, and REM was used as a remedial to estimate the pooled MD of HbA1c% level between patients who participated in SDM and received usual care. As a result, the pooled MD showed that the SDM significantly lowered HbA1c by 0.14% compared to the usual care (95% CI = [-0.26, -0.02], P = 0.02). SDM significantly decreased the level of HbA1c by 0.14% (95% CI = -0.28, -0.01, P = 0.00) when shared decisions were made in person or face-to-face at the point of care, but there was no statistically significant reduction in HbA1c levels when patients were engaged in online SDM. In patients with poorly controlled glycaemic level (≥ 8%), SDM significantly reduced level of HbA1c by 0.13%, 95% CI = [-0.29, -0.03], P = 0.00. However, significant reduction in HbA1c was not observed in patients with ˂ 8%, HbA1c baseline level.

CONCLUSIONS

Overall, statistically significant reduction of glycated hemoglobin level was observed among T2DM adult patients who participated in shared decision-making compared to those patients who received diabetes usual care that could lead to improved long-term health outcomes, reducing the risk of diabetes-related complications. Therefore, we strongly suggest that health care providers and policy-makers should integrate SDM into diabetes health care and management, and further study should focus on the level of patients' empowerment, health literacy, and standardization of decision supporting tools to evaluate the effectiveness of SDM in diabetes patients.

Barriers to Medication Adherence Among Patients with Non-Communicable Disease in North Wollo Zone Public Hospitals: Socio-Ecologic Perspective, 2023

Background

The practice of taking medication as directed by a healthcare provider is known as medication adherence. Therefore, the application of a socio-ecological model to this study identifies multilevel factors on barriers of medication adherence on chronic non-communicable disease and provides information to develop scientific health communication interventional strategies to improve medication adherence.

Objective

This study aimed to explore barriers of medication adherence on non-communicable disease prevention and care among patients in North Wollo Zone public hospitals, northeast Ethiopia.

Methods

A phenomenological study design was carried out between February 5 and February 30, 2023. The study participants were chosen using a heterogeneous purposive sampling technique. In-depth interviews and targeted focus groups were used to gather data. The focus group discussions and in-depth interviews were captured on audio, accurately transcribed, and translated into English. Atlas TI-7 was utilized to do the thematic analysis.

Results

Four main themes, intrapersonal, interpersonal, community level, and health care related, as well as seven subthemes, financial problems, lack of family support, poor communication with healthcare providers, effects of social ceremonies, remote healthcare facility, and drug scarcity, were identified by this study. In this study participants reported that lack of knowledge about the disease and drugs were the main barrier for medication adherence. The study revealed that financial problems for medication and transportation cost were the main factor for medication adherence for non-communicable disease patients.

Conclusion

This study explored that lack of knowledge, financial problem, lack of family support, poor communication with healthcare providers, social ceremony effects, remote healthcare facility, and scarcity of drugs were barriers of medication adherence among non-communicable disease patients. In order to reduce morbidity and mortality from non-communicable diseases, it is advised that all relevant bodies look for ways to reduce medication adherence barriers for patients at every level of influence.