Adolescents\u2019 Experiences of Being a Sibling of a Child With Type 1 Diabetes: A Qualitative Study

BackgroundVarious guidelines recommend that all adults diagnosed with type 1 diabetes (T1D) should be offered an evidence based, structured education programme (SEP) to optimize self-management care. China has a 13,000 annual increase in newly diagnosed T1D cases, of which 65% are adults. However, there is yet no validated SEP targeted to T1D patients in China. The purpose of this study is to establish a structured T1D self-management education programme—‘Type 1 Diabetes Education in Lifestyle and Self Adjustment’ (TELSA) that is adapted to medical and cultural practices in China.MethodsTELSA programme was developed based on the ADDIE model, following three steps: i) Semi-structured interviews were administered to 10 healthcare professionals (HCPs) and 13 T1D patients. Different topic guides, focusing on 4 dimensions including goals, contents, format of delivery, and quality assurance, were designed for either HCPs or patients. The interviews were recorded and analysed with thematic analysis. ii) Extracted themes were modified according to Delphi consultation. iii) Preliminary courses were conducted as pilot study to evaluate the effects of TELSA and optimization of the curriculum was finalized accordingly.ResultsA total of 18 themes in 4 dimensions of the programme design were identified in the final version: i) goals: ‘behaviour modification’ and ‘outcome improvement’; ii) contents: ‘living with T1D’, ‘self-monitoring of blood glucose’, ‘knowing insulin’, ‘insulin dose adjustment’, ‘carbohydrates and carbohydrate counting’, ‘hypoglycaemia’, ‘complications of diabetes’, ‘managing psychological issues’, ‘physical activity’, and ‘question-and-answer’; iii) format: ‘multidisciplinary team combined with peer support’, ‘face-to-face education followed by remote learning’, and ‘2-day programme held on weekends’; and iv) quality assurance: ‘after-class quiz’, ‘patients’ feedback’, and ‘long-term evaluation on effectiveness’.ConclusionsA type 1 diabetes structured education programme in China was set up and shown to be applicable under local medical, social, and cultural environment.Trial registrationNCT03610984. Date of registration: August 2, 2018.

Health literacy plays an important role in self-management of non-communicable diseases. To lay the groundwork for development of a patient education intervention for people with chronic obstructive pulmonary disease (COPD) or type 2 diabetes (T2D), this study investigates health literacy and self-management of people with COPD or T2D in Greenland. Individual, semi-structured interviews about the experiences of living with COPD or T2D in Greenland were conducted at the National Hospital in Nuuk and at the four regional hospitals. Informants (n = 24) were selected by purposeful sampling. Interviews were audio-recorded. During the analyses, we applied the results using the qualitative methodology Interpretive Description, alongside Osborne's Health Literacy Questionnaire (HLQ) and the Precaution Adoption Process Model (PAPM) as theoretical frameworks. Three themes emerged: Gaining knowledge of one's disease; Understanding how to apply knowledge in everyday life, and Integrating knowledge to perform self-management. We created a model to illustrate how the three themes could be related to the seven stages in PAPM and with the nine health literacy domains in the HLQ. We found varying levels of knowledge about disease and health literacy among the informants. Furthermore, the informants' experiences were situated at different places in our model. Depending on their position in the model, they needed certain kinds of knowledge related to their disease, such as bio-medical knowledge or experience-based knowledge. Social support from society, peers, and health care professionals was essential at all places in the model. The ability to perform self-management required several skills and competences, which had to be supported to some extent to be able to change lifestyle behaviours and perform self-management. There was a great desire for more knowledge about COPD and T2D and for information in Greenlandic. The study showed considerable individual variation in knowledge about disease and health literacy, and involving the informants' network in management of the disease was found essential. The study's results can support the development of a culturally adapted patient education intervention. The intervention must be multifaceted, accessible to all citizens in Greenland, targeted to the individuals' situations, prioritised, and quality assured as an integrated part of overall care.

Most adults with type 2 diabetes mellitus (T2DM) do not meet their physical activity (PA) goals despite its importance in improving their health outcomes. Our study aim was to explore the opinions of healthcare professionals regarding barriers and facilitators to PA participation in Ghanaian adults with T2DM. Using qualitative descriptive design, data were collected through semi-structured interviews with 13 healthcare professionals experienced in diabetes management in Ghana. Three main themes relating to PA barriers and facilitators were identified in a thematic analysis: health system-related factors, healthcare practitioner factors, and patient factors. Inadequate accessibility to physical therapists and therapy centres hindered the provision of PA programs. Nurses and doctors lacked sufficient knowledge and training on effective PA interventions for individuals with T2DM. Time constraints during patient consultations limited discussions on PA, while the cost associated with accessing physical therapy posed a significant challenge. Patients often disregarded PA advice from physical therapists due to their reliance on doctors, and some perceived PA as irrelevant for diabetes treatment. Despite these barriers, healthcare professionals expressed belief in PA facilitators, including integrating physical therapists and diabetes educators into diabetes care, providing structured exercise resources, improving curriculum planning to emphasise PA in health science education, and addressing knowledge gaps and misconceptions. Overall, this study highlights patient-related and healthcare system-related factors that influence PA behaviour in Ghanaian adults with T2DM. Findings from this study should inform the development of tailored PA programs for this population.

Virtual Clinics for Diabetes Care.

ISPAD Clinical Practice Consensus Guidelines 2022: Ramadan and other religious fasting by young people with diabetes.

Objective: To explore what psychological factors might impact attendance of, and engagement with, structured education for Type-2 Diabetes (T2D). Design: A qualitative design using semi-structured interviews and thematic analysis. Participants: Twenty-one adults with T2D with varying exposure to structured education courses. Findings: Five themes with sub-themes were identified; ‘Stereotypes and stigma about T2D diagnosis’, ‘Self-management motivators and inhibitors’, ‘Facilitating engagement with structured education’, ‘Sharing experience’ and ‘The same ‘menu’ won’t work for everyone.’ ‘Stereotypes and stigma about T2D diagnosis’ included two sub-themes that reflect participants’ experience of T2D as stigmatising whether or not they identified as overweight or leading an unhealthy lifestyle. ‘Self-management motivators and inhibitors’ involved motivation to attend education courses being linked with a sense of personal responsibility, fear of negative consequences of poor self-management, and beliefs about ones’ ability to impact T2D progression. Despite high motivation, long term success at maintaining self-management practices was problematic. ‘Facilitating engagement with structured education’ discussed the language used and messages provided by group facilitators as important to aid engagement. A non-blaming, positive approach and non-authoritarian stance was important. ‘Sharing experiences’ covered the importance of being able to share the burden of T2D management and learn with others with the diagnosis. ‘The same ‘menu’ won’t work for everyone’ examined the differing needs of people with a T2D diagnosis and how education might be adapted and individualised. Implications: The themes are related to the Common Sense Model, self-efficacy, and the window of tolerance. Implications are discussed in terms of what different groups of health professionals might contribute to promoting attendance of courses. It is suggested that reducing stigma and improving self-efficacy may facilitate engagement. It is suggested that promotional messages might emphasise the emotional support and co-learning that occurs in courses as a way to facilitate uptake and engagement.

The purpose of the study was to understand diabetes self-management practices among African American individuals living with type 2 diabetes (T2D) in rural communities. This qualitative descriptive study, undergirded by the theory of integration, purposively sampled African Americans (N = 34) diagnosed with T2D living in rural communities. Thematic analysis employed both a priori and inductive coding to identify salient themes. Participants' mean age was 65.9 (SD 12.3) years, with an average T2D diagnosis duration of 14 (SE 11.2) years. Two major themes emerged: deciphering the cues and body sensing, which the participants used to monitor their glucose level using a personalized feedback loop. Those with longer diabetes duration demonstrated an ability to recognize hypoglycemic or hyperglycemic symptoms (deciphering the cues), informing their decision-making and self-management strategies (body sensing). The decision-making involved in glycemic level management emerges as a complex developmental process influenced by disease trajectory and cultural and environmental factors. These findings may inform a conceptual framework to guide future inquiries and provide insights for primary care clinicians and diabetes care and education specialists to better understand the complexities of T2D management among African American individuals in rural settings.

BackgroundThe prevalence of type 2 diabetes (T2D) in Mexico is one of the highest in the world, with high morbidity and mortality, and difficulty meeting glycemic targets. The purpose of this study was to identify the challenges for T2D self-management as perceived by both adults with T2D and health care providers in primary health clinics from Seguro Popular in Mexico City.MethodsThis was a qualitative descriptive study conducted in three Seguro Popular primary care clinics in Mexico City using convenience sampling. Semi-structured interviews were conducted with participants and data were analyzed using a content analysis approach.ResultsThe sample included 20 adults with T2D [52.5 years old (SD = 9.9), diagnosed with T2D for 12.3 years (SD = 6.3), mean A1C of 9.8% (SD = 2.4), 80% female, 90% with financial insecurity] and 19 providers [primarily female (78.9%), mean age of 41.6 years old (SD = 11.4), 12.3 mean years in practice (SD = 8.50)]. Personal challenges included cultural beliefs, lack of resources, challenges to lifestyle modification, lack of family support/competing demands, and mental health issues. System level challenges included lack of resources, perceived quality of care, and patient engagement barriers.ConclusionsEvidence-based diabetes self-management programs need to become more accessible, taking into consideration the social determinants of health and building upon current initiatives to improve early diagnosis and treatment of T2D. Cultural beliefs, personal control, and low health literacy influence diabetes self-management in adults with T2D with limited resources. Mental health and financial challenges of adults with T2D will require multidisciplinary team-based care. Future research on best practices to implement and scale-up evidence-based patient-centered T2D prevention and DSME programs for the poor and underserved is warranted in Mexico and world-wide.

PurposeThe purpose of the current study was to explore family members’ experiences of how to support an adult person with type 1 diabetes (T1D).MethodsA qualitative descriptive study with thematic analysis was conducted in Sweden between 2020 and 2021. Interview transcripts were analyzed from 13 people who are a family member (≥18 years) of an adult with T1D, and inductive coding identified salient themes. Family members were recruited via social media, and their length of time as a family member to an individual with the T1D ranged between 3 and 38 years (median 24).ResultsThe analysis and coding identified 4 salient themes: (1) searching for knowledge in unfamiliar situations, (2) applying new knowledge in everyday life, (3) balancing support to fit need and situation, and (4) over time, the support role matures.ConclusionsFamilies with members with T1D are complex, with relational and behavioral challenges arising as the members live their lives. Routines, habits, and unexpected events become especially challenging for families with a member with T1D. Because most self-care activities for adults are carried out within the family, directly involving family members in educational interventions is important. These interventions should include providing information about the symptoms and treatment for T1D, developing knowledge about how families can be affected, but also providing strategies for how families optimally implement necessary daily changes.

This study aims to explore and evaluate postgraduate student experiences of a perinatal mental health education programme and to explore the value of collaborative learning within an interprofessional group. Evidence highlights the need for accessible mental health care during the perinatal period from educated and skilled healthcare professionals. Until recently, there has been a lack of emphasis on perinatal mental health care provision and a subsequent lack of education and training in the area for healthcare professionals. A qualitative descriptive research study was conducted to evaluate an interprofessional approach to perinatal mental health education. A purposive sample of postgraduate healthcare professionals (n = 10) who completed the first year of the Master of Science in Perinatal Mental Health programme or who had completed relevant standalone modules, at a Higher Education Institute in Ireland, participated in the study. Data collection were conducted via four online small-group discussions and thematic analysis was utilised to analyse the narrative data. Three themes illustrate participants' experiences of the perinatal mental health programme: Learning with other professionals, Enhanced confidence for clinical practice and Challenges of the programme. By undertaking the perinatal mental health programme/modules participants were provided with opportunities to engage in interprofessional education. The programme offered opportunities for developing networking relationships which continued into clinical practice. Participants acknowledged the benefits of the programme in acquiring specialist knowledge and skills regarding the spectrum of perinatal mental health enhancing clinical assessment, communication, and confidence in care provision.

The 3C Study: Coverage cost and care of type 1 diabetes in China—Study design and implementation

Background: Developmental challenges of adolescence, such as puberty and social pressures, exacerbate the complexity of managing type 1 diabetes (T1D) as they transition from pediatric to adult care. However, there is a paucity of codesigned, evidence-based diabetes education and support programs and services to guide adolescents through this transition. Objective: This study aimed to explore the experiences, perspectives, facilitators, and barriers faced by adolescents with T1D in diabetes education and program services and to identify feasible approaches to support them as they transition from pediatric to adult care. Methods: Semistructured interviews were conducted with 13 adolescents aged 13-19 years with T1D. Thematic analysis was used to understand participants' past experiences, facilitators, barriers, and preferences regarding diabetes education programs and services. Results: Participants highly valued the opportunity to meet with peers living with T1D and the emotional support from those interactions. Participants also highlighted the need for age-appropriate content and interactive learning experiences. Suggested gamification features were well-received, with participants emphasizing the importance of interactivity. While there was not a strong preference between virtual or in-person game formats, it was suggested that online options offered flexibility and inclusiveness regardless of physical abilities. Participants were not as enthusiastic for a one-on-one live chat compared to an online community chat, again, for the opportunity for peer support. Conclusion: The study highlights the value that adolescents with T1D place on peer support that arises from opportunities to meet others through in-person events. It was evident that codesigning diabetes education programs and services with adolescents with T1D is key to develop tailored offerings for this population.

Diabetes Technology and the Human Factor.

Although binge-eating disorder (BED) is a common comorbidity of type 2 diabetes, little is known about the treatment experiences for persons with both conditions. Our aim was to explore perceptions of Primary Care Providers' (PCPs') treatment among adult women with both diagnoses. In this qualitative descriptive study, we conducted semi-structured interviews with a sample of 21 women (90% non-Hispanic white; mean age 49 ± 14.8 years, mean body mass index [BMI] 43.8± 8.4; 48% had type 2 diabetes, mean HbA1c 68 mmol/mol, 8.4%) who had previously participated in a secondary care specialized eating disorder treatment programme. Interviews were audio-recorded, transcribed and analysed using thematic analysis and NVivo 12. Participants described PCPs' helpful and unhelpful attitudes and behaviours during type 2 diabetes and BED treatment experiences. Helpful treatment was experienced when PCPs demonstrated a person-centred approach by providing adequate diabetes education, individualized care and non-judgmental attitudes from which participants reported increased understanding of diabetes and BED, improved diabetes self-care and fewer negative self-perceptions. Unhelpful treatment occurred when PCPs did not provide sufficient diabetes education and manifested deficient understanding of BED characterized by simplistic advice or judgmental attitudes, from which participants reported having limited knowledge and understanding of diabetes and BED, low self-efficacy, diminished trust and feelings of guilt, shame and failure. We propose a preliminary pathways treatment model derived from our findings, which utilizes integrated type 2 diabetes and BED education and person-centred collaboration. This preliminary model needs to be tested in quantitative research with a larger sample.

Patients' Perspectives on Personalized Glycemic Targets for Coronary Artery Disease Prevention Based on the Haptoglobin Phenotype: A Qualitative Study.