scholarly journals A socioecological perspective : the "ups and downs" of living with type 2 diabetes among working adults in the rural south

2019 ◽  
Author(s):  
◽  
Lynn E. Glenn
Keyword(s):  
Type 2 Diabetes ◽  
Health Services ◽  
Health Care Providers ◽  
Preventive Health Services ◽  
Patient Activation ◽  
Preventive Health ◽  
Self Management ◽  
Care Providers ◽  
Working Adults

Persons with higher patient activation levels are more likely to engage in preventive health behaviors. This qualitative study addressed a population that may be particularly vulnerable to poor diabetes outcomes: rural, working adults with type 2 diabetes (T2 DM) with low levels of patient activation. This study sought to gain a better understanding of the individual, interpersonal, health system, and community spheres of influence on engagement in diabetes self-management and recommended preventive health services among rural, working adults. A socioecological approach, based on Fisher's (2005) Resources and Supports for Self-Management Model, guided the study. The Patient Activation Measure (PAM-10) was used to identify individuals with low patient activation. Participants (N = 20) had PAM-10 scores less than 75 (M = 59.4) and were predominately African American (n = 12) and female (n = 14), earning incomes less than $50,000 (n = 13). The overarching theme, "ups and downs" of living with diabetes, emerged from the data. Four other major themes emerged: "the struggle", "you don't talk about it", "diabetes is not the priority", and "we're lucky to have what we have". Most participants had social support, employer health benefits, and a trusting, satisfactory relationship with health care providers. However, a lack of equitable workplace and community resources may have contributed to lack of engagement in diabetes self-management and preventive health services.

A qualitative thematic analysis of online UK diabetes health forums to assess experiences and perspectives of insulin therapy in Type 2 Diabetes (Preprint)

2021 ◽  
Author(s):  
Maya Allen-Taylor ◽  
Laura Ryan ◽  
Rebecca Upsher ◽  
Kirsty Winkley-Bryant
Keyword(s):  
Type 2 Diabetes ◽  
Health Care ◽  
Insulin Therapy ◽  
Health Care Providers ◽  
Thematic Analysis ◽  
Self Management ◽  
Search Term ◽  
Care Providers ◽  
Study Results

BACKGROUND Despite the advent of newer therapeutic agents, many individuals with T2D will require insulin treatment. Insulin refusal and cessation of treatment in this group is common and their needs under explored. OBJECTIVE To understand the experiences and perspectives of individuals with type 2 diabetes who have been recommended or prescribed insulin therapy, expressed on online health forums. METHODS Setting: Retrospective archived forum threads from the two largest, freely and publicly accessible diabetes health forums in the UK were screened over a 12-month period (August 2019-20). Design: Within the Diabetes UK forum, the search term ‘insulin (title only)’ was employed to identify relevant threads. Within Diabetes.co.uk, threads were screened within an existing ‘Type 2 with insulin’ message board. Three independent researchers coded the forum threads and posts. Pertinent themes and subthemes were identified and have been illustrated by paraphrasing of members quotes, to ensure anonymity. Participants: n=299 posts from 29 threads from Diabetes UK and n=295 posts from 28 threads from Diabetes.co.uk, were analysed over the study period. Fifty-seven threads in total met the inclusion criteria and were included in the thematic analysis. RESULTS Four overarching themes with subthemes were generated to illustrate the unmet needs that had prompted members to seek information, advice and support outside of their usual care provision, via the forums: (1) unmet practical needs and self-management support; including insulin injection technique, titration, travel, driving with insulin and utilising new technology, (2) psychological and peer support; advice, encouragement and empathy, which was readily offered and well received, (3) seeking and providing extended lifestyle advice; discussions around alternative diet strategies, types of activity and their effects on glycaemia and body weight, and (4) relationships with health care professionals (HCPs); including recounting of problematic experiences such as paternalism, lack of HCP knowledge and inadequate provision of effective insulin focused diabetes self-management education. CONCLUSIONS This is the first study to utilise data from online health forums, to characterise the experiences and perspectives of people with T2D who are recommended or prescribed insulin therapy. The observed naturalistic conversations have generated useful insights. Our findings suggest there are additional needs that are not being currently met by health care providers. They also suggest that problematic relationships with HCPs remain a barrier to effective insulin therapy. The study results will help to directly inform insulin focused diabetes self-management and support strategies, in order to enable individuals to achieve their best outcomes.

Diabetes Self-Management Education and Self-Efficacy Among African American Women Living With Type 2 Diabetes in Rural Primary Care

2017 ◽  
Vol 10 (1) ◽  
pp. 11-16
Author(s):  
Cynthia Harrington ◽  
Heather D. Carter-Templeton ◽  
Susan J. Appel
Keyword(s):  
Type 2 Diabetes ◽  
African American ◽  
African American Women ◽  
Health Care Providers ◽  
Self Efficacy ◽  
Self Management ◽  
Health Clinic ◽  
Care Providers ◽  
American Women

African American women suffer the highest prevalence of type 2 diabetes (T2D). Self-efficacy is important for optimal diabetes self-management (DSM). Purpose: To evaluate DSM by comparing pre- and postintervention responses to a diabetes self-efficacy scale. Design: Descriptive pilot study. Sample: Participants for this study were N = 15 African American women aged 25–65 years (M = 47.4 years) and recruited from a rural health clinic in the Southeastern United States, who received a 4-hr DSM class. Method: Data were collected using the Stanford Self-Efficacy for Diabetes (SED). Results: The increase in the pre- and posttest SED scores were statistically significant, (p < .001). Implications for Nursing: Health care providers should tailor a diabetes education program for these individuals living with T2D. Through a collaborative patient–provider relationship to care, individuals may ultimately experience increased self-efficacy leading to improved DSM.

scholarly journals Barriers to and facilitators of diabetes self-management practices in Rupandehi, Nepal- multiple stakeholders’ perspective

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mandira Adhikari ◽  
Hridaya Raj Devkota ◽  
Tomris Cesuroglu
Keyword(s):  
Type 2 Diabetes ◽  
Health Care Providers ◽  
Low Income ◽  
Management Practices ◽  
Self Management ◽  
Care Providers ◽  
Structured Interviews ◽  
Multiple Stakeholders ◽  
Adherence To Medication

Abstract Background Self-management of diabetes is associated with glycaemic control and adherence to medication and healthy lifestyle practices. There is lack of information on the barriers to and facilitators of diabetes self-management practices in low income country, Nepal. This study aimed to explore the barriers to and facilitators of Type 2 diabetes self-management practices taking multiple stakeholders’ perspectives in Nepal. Methods Four focus group discussions and 16 semi-structured interviews with people with Type 2 diabetes, caregivers, health care providers and health managers were conducted from April to May 2018 in Rupandehi district of Western Nepal. They were audio-recorded, transcribed, and analysed using a thematic approach. Results Five main themes emerged that influenced diabetes self-management practices: individual factors, socio-cultural and economic factors, health system and policy factors, availability and accessibility of resources, and environmental factors. The important barriers were: lack of knowledge about diabetes self-management practices, cultural practices, insufficient counselling, lack of guidelines and protocols for counselling, and financial problems. The major facilitators were: motivation; support from family, peers, and doctors; and availability of resources in the community. Conclusion Based on our findings, a multilevel approach is needed to address these barriers and facilitators. These findings will help guide strategies to develop programs that impart knowledge and skills to improve the diabetes self-management practices of people with Type 2 diabetes.

scholarly journals Healthcare Professionals’ Perspectives of Patients’ Experiences of the Self-Management of Type 2 Diabetes in the Rural Areas of Pakistan: A Qualitative Analysis

2021 ◽  
Vol 18 (18) ◽  
pp. 9869
Author(s):  
Rashid M. Ansari ◽  
Mark Harris ◽  
Hassan Hosseinzadeh ◽  
Nicholas Zwar
Keyword(s):  
Type 2 Diabetes ◽  
General Practitioners ◽  
Health Care Providers ◽  
Healthcare Professionals ◽  
Self Management ◽  
Methodological Framework ◽  
Care Providers ◽  
Interview Guide ◽  
Diabetes Patients

The main objective of this research work was to explore the healthcare professionals’ perspectives of type 2 diabetes patients’ experiences of self-management of diabetes in the rural area of Pakistan. In this study, we have carried out a methodological approach to use a self-management framework to direct the interview guide for healthcare professionals to examine their perceptions and expectations of their diabetes patients’ adherence to the medications prescribed. Twenty healthcare professionals were recruited in this study consisting of ten general practitioners and ten nurses from various clinics (medical centres) of Al-Rehman Hospital at Abbottabad, Pakistan. This qualitative study explored the feelings and opinions of general practitioners on patients’ compliance and adherence by using the semi-structured interview guide using a methodological framework. All interviews of participants were audiotaped and transcribed for content analysis. Six major themes were identified: patient–doctor relationship; patient’s non-adherence to diet and exercise; conflicts with the patients; low self-efficacy and feeling of “resignation with poor care”; the influence of culture on patients’ self-management activities and lack of support for patients by health care providers, patients, and their families. We have derived relevant solutions from qualitative studies and considered that communication, tailored, and shared care is the best approach for patient adherence to treatment. GPs felt that a structured consultation and follow-up in a multidisciplinary team might help to increase adherence. The results of this qualitative health research highlighted the challenges healthcare professionals are facing in rural Pakistan in managing patients with type 2 diabetes and supporting their management activities. Healthcare professionals and patients may benefit by adopting a methodological framework approach to ensure meaningful participation and adjusting the patient–doctor relationship, and setting up achievable management and self-management goals.

scholarly journals An integrated model to evaluate the impact of social support on improving self-management of type 2 diabetes mellitus

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Xiaojia Wang ◽  
Linglan He ◽  
Keyu Zhu ◽  
Shanshan Zhang ◽  
Ling Xin ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Social Support ◽  
Type 2 Diabetes ◽  
Health Care ◽  
Health Care Providers ◽  
Integrated Model ◽  
Self Management ◽  
Care Providers ◽  
The Impact

Abstract Background Type 2 Diabetes Mellitus (T2DM) is a chronic disease closely related to personal life style. Therefore, achieving effective self-management is one of the most important ways to control it. There is evidence that social support can help to improve the self-management ability of patients with T2DM, but which social support is more effective has been rarely explored. The purpose of this study is to construct an integrated model to analyze which social support has more significant impact on self-management of T2DM, and provide reasonable suggestions to health care providers on how to effectively play the role of social support. Methods We established a social support indicator evaluation system and proposed an integrated model that combines ANP (Analytical Network Process) and CRITIC (CRiteria Importance through Intercriteria Correlation) methods to evaluate the impact of social support on T2DM self-management from both subjective and objective perspectives. The weights calculated by the model will serve as the basis for us to judge the importance of different social support indicators. Results Informational support (weighting 49.26%) is the most important criteria, followed by tangible support (weighting 39.24%) and emotional support (weighting 11.51%). Among 11 sub-criteria, guidance (weighting 23.05%) and feedback (weighting 14.68%) are two most relevant with T2DM self-management. This result provides ideas and evidence for health care providers on how to offer more effective social support. Conclusion To our knowledge, this is the first study in which Multi-Criteria Decision Making (MCDM) tools, specifically ANP and CRITIC, are used to evaluate the impact of social support on improving self-management of type 2 diabetes. The study suggests that incorporating two sub-indicators of guidance and feedback into the diabetes care programs may have great potential to improve T2DM self-management and further control patient blood glucose and reduce complications.

Promoting Cultural Capital in a Medical Camp for American Indian Youth with Diabetes

2014 ◽  
Vol 38 (1) ◽  
pp. 123-144 ◽  
Author(s):  
Jennie Joe
Keyword(s):  
Type 2 Diabetes ◽  
Cultural Capital ◽  
American Indian ◽  
American Indians ◽  
Health Care Providers ◽  
Lifestyle Changes ◽  
Self Management ◽  
Care Providers ◽  
American Indian Youth

Type 2 diabetes mellitus, a disease that previously was characterized with an onset in the fourth decade of life or later, is now being diagnosed in children, particularly children from minority groups, including American Indians. Because children with the disease are frequently asymptomatic, they tend to ignore recommendations from their health care providers about appropriate self-management behaviors, thus increasing their risk for early onset of secondary complications, including retinopathy and end-stage renal disease. This problem with self-management can in part be attributed to a lack of knowledge as well as to denial about their disease. This article describes an intervention that encourages and motivates American Indian youth with type 2 diabetes to improve their diabetes self-management. The Medical Wellness Camp is a partnership program hosted by several Arizona tribes and the University of Arizona. The camp provided these youth with the education and the skills needed to prevent or delay diabetes-related complications that will negatively impact their quality of life. This camp is unique because it builds on and integrates an intertribal "cultural capital" model to help them learn how to adopt the lifestyle changes necessary to live with this chronic disease. The program emphasis is on education, not research. This position honors the wishes of tribal partners whose communities have been reluctant to involve their children in research, a reluctance fueled by reports about unethical research practices that have harmed other tribal communities.

scholarly journals Understanding Gestational Diabetes, Future Diabetes Risk, and Diabetes Prevention: A Qualitative Study of Patient, Provider and Staff Perspectives

2021 ◽  
Author(s):  
Hannah R. Lucas ◽  
Roxann C. Williams ◽  
Laura N. Hollar ◽  
Bethany Johnson-Javois ◽  
Heidi B. Miller ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Gestational Diabetes ◽  
Health Care Providers ◽  
Diabetes Prevention ◽  
Diabetes Risk ◽  
Care Providers ◽  
Diabetes Screening ◽  
Structured Interviews ◽  
Future Diabetes

Gestational diabetes mellitus (GDM) increases type 2 diabetes risk; however, postpartum diabetes screening rates are low. Using semi-structured interviews and focus groups, this study investigates the understanding of GDM and its relationship to future diabetes risk and diabetes prevention among patients with public or no insurance (<i>n </i>= 36), health care providers (<i>n </i>= 21), and clinic staff (<i>n </i>= 9) from Federally Qualified Health Centers. Five main themes emerged: <i>1</i>) general understanding of GDM diagnosis with focus on neonatal complications; <i>2</i>) variable recall of diet, exercise, and weight recommendations; <i>3</i>) overwhelming medication and self-monitoring routines; <i>4</i>) short-term focus of type 2 diabetes risk and screening; and <i>5</i>) limited understanding of all options for diabetes prevention. The results may inform diabetes screening and prevention interventions in primary care settings.

scholarly journals Preferences for mHealth Technology and Text Messaging Communication in Patients With Type 2 Diabetes: Qualitative Interview Study (Preprint)

2020 ◽  
Author(s):  
Julie C Lauffenburger ◽  
Renee A Barlev ◽  
Ellen S Sears ◽  
Punam A Keller ◽  
Marie E McDonnell ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Health Care ◽  
Mobile Technology ◽  
Diabetes Care ◽  
Technology Use ◽  
Text Messages ◽  
Self Management ◽  
Care Providers ◽  
Mhealth Technology

BACKGROUND Individuals with diabetes need regular support to help them manage their diabetes on their own, ideally delivered via mechanisms that they already use, such as their mobile phones. One reason for the modest effectiveness of prior technology-based interventions may be that the patient perspective has been insufficiently incorporated. OBJECTIVE This study aims to understand patients’ preferences for mobile health (mHealth) technology and how that technology can be integrated into patients’ routines, especially with regard to medication use. METHODS We conducted semistructured qualitative individual interviews with patients with type 2 diabetes from an urban health care system to elicit and explore their perspectives on diabetes medication–taking behaviors, daily patterns of using mobile technology, use of mHealth technology for diabetes care, acceptability of text messages to support medication adherence, and preferred framing of information within text messages to support diabetes care. The interviews were digitally recorded and transcribed. The data were analyzed using codes developed by the study team to generate themes, with representative quotations selected as illustrations. RESULTS We conducted interviews with 20 participants, of whom 12 (60%) were female and 9 (45%) were White; in addition, the participants’ mean glycated hemoglobin A<sub>1c</sub> control was 7.8 (SD 1.1). Overall, 5 key themes were identified: patients try to incorporate <i>cues</i> into their routines to help them with consistent medication taking; many patients leverage some form of technology as a cue to support adherence to medication taking and diabetes self-management behaviors; patients value simplicity and integration of technology solutions used for diabetes care, managing medications, and communicating with health care providers; some patients express reluctance to rely on mobile technology for these diabetes care behaviors; and patients believe they prefer positively framed communication, but communication preferences are highly individualized. CONCLUSIONS The participants expressed some hesitation about using mobile technology in supporting diabetes self-management but have largely incorporated it or are open to incorporating it as a cue to make medication taking more automatic and less burdensome. When using technology to support diabetes self-management, participants exhibited individualized preferences, but overall, they preferred simple and positively framed communication. mHealth interventions may be improved by focusing on integrating them easily into daily routines and increasing the customization of content.

scholarly journals Sociocultural Influences on African Americans’ Representations of Type 2 Diabetes: A Qualitative Study

2018 ◽  
Vol 28 (1) ◽  
pp. 25 ◽  
Author(s):  
Olayinka O. Shiyanbola ◽  
Earlise Ward ◽  
Carolyn Brown
Keyword(s):  
Type 2 Diabetes ◽  
African Americans ◽  
Racial Discrimination ◽  
Health Care Providers ◽  
Eating Habits ◽  
Cultural Beliefs ◽  
Sociocultural Factors ◽  
Diabetes Diagnosis ◽  
Care Providers

<p class="Pa7"><strong>Objective: </strong>Illness representations, known as patients’ beliefs and expectations about an illness, may be influenced by cultural beliefs and personal experiences. This study explored African Americans’ perceptions of the sociocultural factors that influence their representations of diabetes.</p><p class="Pa7"><strong>Design: </strong>Six semi-structured focus groups.</p><p class="Pa7"><strong>Setting: </strong>Private space at a convenient site.</p><p class="Pa7"><strong>Participants: </strong>Forty African Americans, aged 45-60 years with type 2 diabetes for at least one year prior.</p><p class="Pa7"><strong>Results: </strong>Participants perceived that there was a race-mediated effect of how they developed diabetes because of poverty due to past slavery, racial discrimination by health care providers, and the stigma associated with diabetes within the African American community. Participants perceived that pov­erty influenced African Americans’ unhealthy eating habits, which led to diabetes diagnosis among their ancestors and their develop­ment of the disease since it was hereditary. Participants also perceived that there was provider ill intention, ie, providers were pur­posefully making people sick, and their lack of education on diabetes from providers was done on purpose, as information on diabetes was withheld and not shared due to racial discrimination. Perceived stigma by the com­munity led to African Americans’ avoidance and denial of the disease, and subsequently the development of diabetes.</p><p class="Pa7"><strong>Conclusions: </strong>To enhance disease manage­ment for African Americans with diabetes, it is important to focus on the sociocultural context of how African Americans view their world that may be influenced by their knowl­edge of negative historical circumstances and their current provider relationship, which, in turn, may be reflected in their perceptions of diabetes.</p><p class="Pa7"><em>Ethn Dis. </em>2018;28(1):25-32; doi:10.18865/ed.28.1.25.</p>

scholarly journals Health Care Providers’ Perceptions of Responsibilities and Resources to Reduce Type 2 Diabetes Risk After Gestational Diabetes Mellitus

2018 ◽  
Vol 36 (2) ◽  
pp. 160-167
Author(s):  
Sumali S. Hewage ◽  
Shweta R. Singh ◽  
Claudia Chi ◽  
Jerry K.Y. Chan ◽  
Tong Wei Yew ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Health Care ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Health Care Providers ◽  
Diabetes Risk ◽  
Care Providers
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