Abstract
Research suggests that guided self-determination programmes can support self-management of diabetes by empowering self-determined goal setting and competence building. As most research in this area has focused on people with type 1 diabetes, knowledge is lacking on how adults with type 2 diabetes mellitus experience participation in such programmes. This study reports the modelling phase of a complex intervention design that explored the experiences of adults with type 2 diabetes who participated in a nurse-led guided self-determination programme in general practice and examines how the programme affected patients' motivation to self-manage diabetes. The qualitative design with semistructured interviews included 9 adults with type 2 diabetes who participated in the programme. Qualitative content analysis was used to analyse the data. The findings indicate that the participants experienced new life possibilities after participating in the programme, which seemed to have a positive influence on their motivation for self-management. Through reflections about how to live with diabetes, the participants reinterpreted their life with diabetes by gradually developing a closer relationship with the disease, moving towards acceptance. The fact that dialogue with the nurses was seen to be on an equal footing helped support the participants to become more self-determined.
Highlights
We report on the modelling phase of a complex intervention design aimed at exploring the experiences of adults with type 2 diabetes (T2DM) who took part in a nurseled guided self-determination (GSD) programme in general practice
A Reinterpretation of Living with Diabetes. This theme emerged from the participants’ descriptions of how GSD counselling had initiated processes that led to a reinterpretation of living with diabetes, as illustrated by the following two subthemes: (1) inviting diabetes into one’s life and (2) finding new resources and possibilities in the disease
This adds to findings in a previous study suggesting that GSD counselling for adults with type 1 diabetes resulted in greater acceptance of diabetes and a realisation of the need to deal with the disease [28]
Summary
An alarming increase in the prevalence of T2DM is evident worldwide and it is a growing public health problem in Norway [1]. There is no cure and people with T2DM are recommended to engage in multiple selfmanagement behaviours to achieve adequate blood glucose control and prevent long-term complications [2]. Diabetes self-management involves an active and ongoing process including behaviours such as healthy eating, regular physical activity, blood glucose monitoring, and medication in addition to problem solving and coping [2]. For many people with T2DM appropriate self-management is difficult to achieve [3]. Research suggests that people with T2DM find the attainment of treatment goals challenging and many fail to reach optimal treatment outcomes with regard to glycosylated haemoglobin (HbA1C), cholesterol, and blood pressure [4]. Support from health care professionals is required for patients to implement the majority of selfmanagement tasks in daily life [5, 6]
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